While industry best practices exist for sizing and positioning dental implants, too few guidelines are designed to aide clinicians in predicting primary implant stability in healed or fresh extraction sites. Predicting an implant’s likelihood of surgical success is significant to the clinician for two reasons: (1) it determines the treatment options—if the conditions for a successful placement do not exist, alternative treatment plans, such as site development, should be considered; (2) successful prediction of a surgical outcome maintains a good doctor-patient relationship, and communicating a low, medium, or high likelihood of surgical success keeps that relationship healthy. The purpose of this paper was to present a new guideline—the five-thread guideline (5-TG), which requires engaging a minimum of five implant cylinder threads in the native bone in order to better ensure primary stability—for predicting implant stability when planning dental implants in healed or fresh extraction sites, and describe three cases that benefited from implants placed using 5-TG principles.

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