Read the Canine - Dont Hit him

“Most upper 1st premolar implant mistakes don’t come from lack of skill — they come from not reading the canine.”

Good morning, ChatGPT. Good morning, world. Good morning, Lisbon.

Today we’re finally hitting 25°C. Real spring. I just finished an amazing climbing session — one more step toward conquering my 6C+ . Today I fell on a move I had never reached before. It was a nice feeling because a lot of people was watching and i´m baby steps to close the 6 deal and move to the 7A tackle ! Stay tuned for next week … I will do this one !!!

And that, by itself, is progress.

Because in climbing — and in implant dentistry — it’s not about reaching the top. It’s about going further than yesterday.

From Beirut to Lisbon… to real-life dentistry

I was supposed to be in Beirut with Elena for a nice IEXcel launch by Straumann. A childhood dream — to see Fenicia, the port, the history.

But geopolitical reality had other plans. The Middle East is at war, and no plane goes in or what a mess......

And suddenly, I was in Lisbon.Sunday. Family lunch. Burger in hand. Kids in the restaurant !! No clinical plans.

Until…Margarida calls me.

“We have a patient. She wants implants. Now.”

No guide. No navigation. Just experience.

So it's 2 in the afternoon, I´m in a call with Mayra from Straumann in the car and suddenly shift course to the clinic for implant placement !!!

10 mn after I’m there to start the case a look at the medical history , to the CBCT agreement light and off we go !!

This is the real message of this case:

👉 What do you do when you don’t have a surgical guide?👉 When you don’t have dynamic navigation?👉 When all you have is… your expertise ?

The so-called analog mode, in other words, lets go with the anatomical landmarks to do the implants in the correct prosthodontic position!

The problem - 2 Premolars to replace with 14 in a healed ridge and 15 in an immediate implant placement, both with immediate loading with non-occlusal contacts and 2 lower molars . Lets go !!!

The classic premolar mistake

I have seen may mistakes from students and myself and for sure One of the most common errors I’ve seen — especially when I was teaching — is this:

➡️ Placing a premolar implant and hitting the canine root apex.

Why?

• The canine root is distally angulated

• The crown is more upright

• The operator follows the crown…

  
  

  ➡️ and the implant apex goes straight into the canine - a classy Phil as in the hangover movie …

  
  

A classic — and avoidable — mistake.

Read the canine (the key nuance)

Absorb what the anatomy is reeling you speak with

In this case, everything comes down to one principle:

👉 Read the canine.

Not the crown.Not the space.Not your intuition.

👉 The canine.

More specifically:

👉 Follow the distal slope of the canine cusp

That becomes your invisible surgical guide.

Clinical execution

Implant 14 (healed ridge)

• Reference: distal slope of the canine

• Preparation up to 2.8

• Implant: 3.5 x 12 PLX

• Direction pin to confirm axis

  
  

Implant 15 (post-extraction) — the real challenge

Here’s where finesse matters.

We need to achieve three things simultaneously:

1. Anchor in the palatal bone

2. Maintain parallelism with 24

3. Avoid the canine root

   
   

Strategy:

• Initial drill entry:

  
  

  👉 45° toward the buccal

• Then:

  
  

  👉 Redirect toward the palatal bone (for anchorage)

  
  

  👉 Slight adjustment toward mesial (for parallelism)

  
  

💡 This 3D movement is everything.

If you miss it:

• you lose stability

• or you lose alignment

• or you hit the canine

  
  

Outcome

• Implant 24: 3.5 x 12 PLX

• Implant 25: 4.0 x 8 PLX

• Excellent primary stability

  
  

Restoration

• SRA 2.5 abutments

• Direct relining of provisional crowns

• Immediate loading without occlusion

• Jumping gap filled with xenograft

• Sutured with provisionals in place

Result:👉 Two implants👉 One delayed + one immediate👉 Parallel👉 Biologically stable👉 Prosthetically functional

Take-home message

When you don’t have technology…

👉 You must become the technology.

Read anatomy. Trust your mental map. Execute with intention.

And finally…

Friday ended the right way:

👉 A big açaí👉 Zero guilt👉 And the feeling that we did things right