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Off-Protocol (Dental blog)

I placed a 4mm Straumann dental implant today in a LR5 area.

I placed this implant to re-place an implant I had placed there 5 months ago which had failed to integrate.

I placed this implant next to a 4mm WNI Straumann implant that I placed at the same time 5 months ago, which has integrated beautifully and is ready for reconstruction.

This space was tight to place this implant, close to the inferior dental canal, but it was planned carefully with the CT scan and executed with the care that we always take in placing a posterior lower implant.

My standard lower implant placement protocol is to allow 4mm of clearance to IDC but on this occasion I had less that 2mm on the CT Scan.

This is off-protocol.

I have protocols in my practice for the placement of a posterior lower implant.

I have a protocol for the placement of an upper anterior aesthetic implant.

I have a protocol for a sinus graft.

Past a certain level of experience, it is fine to go off-protocol as long as the reasons are clear and the patient is aware.

Guidelines and protocols are guidelines and protocols, they are not patients.

As long as you are prepared to live and die by your decisions for going off protocol in individual patient cases, it is sometimes the best possible healthcare you can deliver.

The procedure went well. For those of you interested in implant placements and the measurement of stability, the ISQ measurements for the fixture were 75,75,75 and 75.

At the same time I provided an ISQ for a distal WNI and the measurements were 82x4.

What remains to be seen is how long these implants will remain in place, but my patient is entirely clear that we are off protocol and have a limited ability to provide a guarantee for the outcome of the treatment.

This was one of the nicest surgeries that I have done for a long time and it was free and I never got paid because it was a replacement.

That never entered my head throughout the procedure, as all I wanted to do was to provide the best possible outcome.

If you don’t hear about this again on these pages, you will know it was ok. If it is not, I will let you know.

By Colin Campbell on 19/12/19 18:00