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Int J Periodontics Restorative Dent 29 (2009), No. 2 1. Apr. 2009
Tapered implants have become routine for immediate implant placement after tooth extraction. It seemed extremely advantageous to use tapered implants in type 4 bone, where primary stability is difficult to achieve. The authors established a surgical implant placement protocol to be followed in areas where type 4 bone and a wide bone ridge (>= 8 mm) are present. First, preparation of the implant alveolus is done exclusively with cylindric osteotomes, rather than with conic osteotomes or drills. The final cylindric osteotome is the same diameter as the final twist drill that is typically used in conventional preparation of the implant alveolus (a technique that can be adapted for use with other tapered implants). Because of the self-tapping property of the tapered implant used and its anatomic design, this surgical technique was developed to optimize the bone compaction effect in the coronal third of the implant, improving bone density and providing better primary stability values (>= 70 ISQ, via the Osstell Mentor device). With the strong bond that is created between the implant surface and the surrounding bone using this technique, immediate loading can be predictable, even in the type 4 bone that is commonly found in the maxillary tuberosity.