The implant procedures
There are different
techniques that can be used for the surgical placement of dental implant. It depends on the particular
conditions of the case, doctor’s preferences, and dental implant system used. First let's take a look on a
classical 2 step implant surgery, which is the most common technique used for dental implant placement.
step implant surgery Edentulous
area to be restored by implants
Stage 1 - Surgical placement of implant
1. When you come for the surgery, you will be given a surgical
consent form, describing the procedure and possible complications. It is a good time to address any questions
and concerns. After you sign the consent form, you will be anesthetized and surgery will soon begin.
2. Doctor will
make a cut in you gum along the crest of the bone and push it to the sides to access the bone.
X-ray showing surgically placed dental implants
3. Using different
sizes of special drills, doctor will drill inside the bone to make a path for an implant.
Doctor will start with thin drills, gradually moving to thicker ones. The diameter of last drill will be slight smaller
than the diameter of the selected implant. Surgical drills have a canal inside its body to allow constant
water irrigation, which is necessary to cool down the bone, preventing it from overheating.
Implant is screwed inside the bone. Necessary x-rays can be taken during the procedure
surgical cover screw is inserted into the top if the implant to prevent bone and tissue to grow inside the implant.
6. Gum is placed back and sutures are used.
Doctor will give you all necessary
prescriptions and instructions. In 7-10 days, you come back for suture removal and follow up. There will
be several other follow-up visits to monitor the healing process until such time that the implant
is ready to be restored with a prosthetic. Stage 2 –Uncovering
the implant Left dental implant with healing collar
What happens after dental implant is osseointegrated?
After the doctor has concluded that implant integration
is complete, the dental implant has to be uncovered:
Implants with restoration abutments (posts)
- Local anesthesia is administered.
- A small incision is done in the gum, allowing doctor to unscrew the surgical cover screw.
- Healing cover placed instead of the surgical screw, projects above the gum preventing
it from closing over the implant. Sutures are placed to hold the gum back in place.
- One week later doctor will remove stitches, and after few more days of healing
implant is ready for restoration.
Immediate Placement Of implant ( Implant Placement into fresh extracted site )
When the tooth has to be extracted, and the implant is a choice of treatment for substitution of
removed tooth, immediate placement of implant into extracted site could be done. There are a lot of advantages to this technique.
In aslassical 2 stage technique described above, after the extraction is done, we would wait for about 6 month
for the bone to build up, and then proceed with the implant surgery. The immediate placement of implants eliminates
this 6 month waitng period, no second surgery required, healing process of implant (osseointegration) runs
as natural process (your body buids up the new bone in the extracted site where the implant placed). There are some limitations
though, when this procedure can be done (severe infection, cortical bone lose). Your doctor will advise you if the immediate
placement of implant is the right procedure for you.
The next implant case presentation describes surgical placement of two implants, one of them
is classical two stage technique, another is the extraction and immediate placement of implant.Patient arrived
at the surgery at her scheduled time. It was verified that she was taking prior prescribed medications. All her questiones
were answered once more, she was anesthetized, and the bridge was cut between crown # 20 and pontic 19. Back part of the bridge was removed.
Implants case presentation
showes decay under the crown # 18
53 years old female presented in the office for the exam. Intaraoral and X-ray examination revealed severe
decay under the crown supporting the bridge. The decay was so extensive, that the could not be saved. Since the other teeth
uder the bridge did not require any urgent treatment, it was decided to cut the bridge, leaving antertior crowns intact (##
20, 21), extract back tooth #18, and place two implants # 18, as an immediate placement implant, and # 19, where the
tooth has been missing for a while. 4.7 mm diameter and 13 mm length internal hex Zimmer implants were planned to be
placed. Patient was explained the nature of the surgery and possible complications. All her questions were answered. To
prevent possible secondary infection, patient was placed on antibiotic regimen 4 days before the scheduled surgery, also she
was prescribed and instructed to use PeridexR as mouth rince solution.
Intraoral picture of existing bridge
Bridge was cut
Demolished # 18 ( after bridge removal)
Incision was made along the crest of the bone between demolished # 18 and tooth #20. Periosteal
flap reflected using periosteal elevators. The remaining roots of the # 18 carefully extracted with luxators to preserve integrity
of the bone.
Periosteal Flap opened
Tooth # 18 is removed
Osteotomy was performed in the area of planned
implant sites. Drills of increasing sizes were used. The widest drill 4.4 mm was used to make a 13 mm path for the implant.
Each tooth implants is placed in corresponding sites. Hand ratchet is used to screw the implant (with implant
driver) into the place. Control X-ray is taken.
Implant with implant driver placed in the bone
Same picture from a different angle
X-ray showing implants in place
Implant drivers removed and position of each tooth implant was verified.
cover screw placed into the tooth implant
Gum placed in its place
and silk sutures placed to hold the gum. Patient is given instructions and due back in the office in one week for removal
One week later sutures were removed and patient
is scheduled in two weeks for the follow up visit.
One Step Implant Placement Procedure
Depending on the particular situation 1 step
surgical implant placement technique may be used. Instead of making a line incision and opening the flap doctor
will use the special round knife("tissue puncher") to cut off a round piece of the gum in
the area of projected implant(punch technique). Ostoetomy performed thru this opening, and the implant screwed
directly in. Instead of puting the surgical cover, doctor will place righty away the implant healing color,
having it exposed above the gum line and preventing the gum from closure. Implant remain exposed
and there is no need for the second surgical stage -openning of the implant. This technique is used more and more.
Besides the fact that there is no need for second surgery, the postsurgical discomfort and pain much less than in a 2 stage
Immediate Load implants
Immediate load implants are the implants which are being restored the same visit as their surgical
placement. More and more implant manufactures advertize some of their implants as an immediate load. Immediate loading is
posssible in the areas of the mouth and in patients with "strong" bone. If possible to use immediate load implants
has some advantages. I will dedicate the separate page for immediate load implants soon