2. Composed by Dr. Gary F. Turnier Implant placement Dr.Gary F. Turnier

3. Local anesthesia:4 carp. Articaine HCL 4% with epinephrine 1:100,000 Informed consent given Surgical procedure performed by Dr. Gary F.Turnier Premedication with 1gm Azithromycin 1 hour before tx Ibuprofin 600mg 1 tab 1 hour before tx Dr. Gary F. Turnier

4. Maxillary soft tissue considerations: Since interdental papillae –saving incision was not needed, sulcular incision performed midcrestal mesial of #15-distal of #13

6. 9.94 MM M-D

7. Drilling sequence A-LENDERMAN’SDRILL 9MM B.2.3MM PILOT DRILL 10MM C.2.8MM OSTEOTOMY DRILL 10MM D.3.4MM OSTEOTOMY DRILL 10M-FINAL DRILL FOR PLA CING A 4.7X11.5MM IMPLANT

8. ZIMMER GUIDE PIN Dr. Gary F. Turnier

9. Used Nobel Biocare osteotomes Bone spreading techniques 3.4mm osteotomy drill was used to a depth of 10mm then Dr. Kale proceeded to use the osteomes to a depth of 11mm. Using the engine to place the implant, we achieved a torque of 55ncm and at this point we had to use the Gemlock Retaining Square ratchet to hand torque. As a result of the bone spreading with the Nobel Biocare Osteotomes. The hand torque ratchet was extremely difficult due to the tightness between implant and bone contact. It felt like D1 bone. We might of achieved a torque of >70ncm as a result of using the osteotomes. However, it was so tight that in hindsight, we could of gone to the 3.7mm osteotomy drill and proceeded with implant placement without sacrificing buccal bone. Dr. Gary F. Turnier

10. Nobel Biocare Osteotomes measured with perio probe to confirm depth of 11mm Dr. Gary F. Turnier

12. 4.5mm diameter platform diameter Dr. Gary F. Turnier

13. ZimmerTapered screw vent implants have 1.0mm machined milled platform and 1.5mm textured surface 4.5mmDiameter platform 4.7mm Diameter tapered screw vent body 1.0mm 1.5mm 2.5mm length from first thread to the coronal aspect Dr. Gary F. Turnier

14. sinus 2.5mm 9.0mm implant tapered screw- vent MTX surface THCW5/5 healing collar for internal hex 4.5mm diameter platform Dr. Gary F. Turnier

17. THE END.