Dental implants are defined as an artificial titanium fixture which is placed surgically into the jaw bone to support a crown, fixed or removable denture through a phenomenon called osseointegration.
Before implant surgery
The dental operator should be sure that the patient has good oral hygiene, free from uncontrolled diabetes and does not take any steroid therapy.
The dental operator should explain the risks to the patient and the patient should sign the consent.
Dental Implant surgery
It can be one of the two following methods:
One stageEndosseous Implant Surgerywhere the coronal parts stays exposed through gingiva throughout the healing period.
Two stage Endosseous Implant Surgerywhere the top of the implant is totally submerged beneath the gingiva.
Two stage Endosseous Implant Surgery
First stage surgical technique
1- Flap design &Incision
Two types of incisions can be used:
- crestal design:The incision is formed on the crest of the ridge, bisecting the present zone of keratinized mucosa.
- Remote incision:It is done once bone augmentation is planned to reduce the incident of bone graft exposure.
The crestal incision is most popular in most instances because it leads to less bleeding, trauma, edema, ecchymosis in addition to easier flap management and faster healing of the flab.
2- Flap elevation
A full-thickness flap is raised buccally to the level of the mucogingival junction to expose the alveolar ridge of the implant sites. Elevated flaps could also be sutured to the buccal mucosa or the opposing teeth to stay the surgical site open throughout surgery.
3- Implant placement
once the implant site is ready, a surgical guide is placed intraorally, a spherical bur or spiral drill is used to mark the implant site. The site is checked for their appropriate labiolingual/buccolingual and then it is marked to a depth of 1 to 2mm, breaking through the cortical bone.
Limitations to implant placement in Maxilla and Mandible:
Buccal Plate: 0.5mm
Lingual Plate: 1.0 mm
Maxillary Sinus: 1.0 mm
Nasal Cavity: 1.0mm
Avoid Incisive canal
Inter implant distance: 1-1.5mm
Inferior alveolar canal: 2.0mm
Mental nerve 5mm from foramen
Inferior border: 1 mm
Adjacent to natural tooth 0.5mm
A small spiral drill, sometimes 2mm in diameter & marked to point acceptable depth, is employed next to determine the depth & align the axis of the implant recipient site, Spiral drill is used at a speed of 800 to 1000 rpm with copious irrigation to prevent heating of the bone.
When multiple implants are used to support one prosthesis, either paralleling or direction indicating pin should be used to align subsequent implants correctly in their places.
After the 2mm spiral drill, a pilot drill with 2mm cross section at the lower part & wider cross section at the upper part is used to enlarge the osteotomy site to allow easy insertion of the following drill then the wider cross section spiral drill is used to drill to the depth reached with the 2mm spiral drill.
The dental operator should drill to approximately 0.5mm deeper than needed; this allows the desired depth to be reached with the final drill without touching the bottom then the implant is placed with tapping procedure.
4- Flap closure
Once the implant is screwed in and the cover screw is placed a combination of inverted mattress and interrupted sutures is done.
Flap should be closed without tension; a 4.0 chromic gut suture is used that does not require removal during postoperative visit.
5- Postoperative care
Usually simple Implant surgery does not require the use of antibiotic however patients can be premedicated with antibiotics (EX: amoxicillin, 1g twice a day) starting from 1 hour before the surgery and continuing for 1 week postoperatively especially if the surgery is extensive, if it requires bone augmentation or the patient is medically compromised.
Chlorhexidine gluconate mouthwash can be prescribed to facilitate plaque control, especially in the days after surgery when oral hygiene is somewhat poor.
Adequate pain medication should be prescribed (EX: ibuprofen, 600 to 800 mg)
Patient ought to have a liquid or liquid diet for the primary few days & then gradually eat traditional diet.
patient ought to additionally refrain from tobacco & alcohol use for one to two weeks postoperatively. oral hygiene directions ought to lean.
Second stage surgical technique
- To show the submerged implant while not damaging the surrounding bone
- To control the thickness of the soft tissues, close the implants
- To preserve and produce keratinized tissues round the implant
- To facilitate oral hygiene
- To ensure correct abutment seating
Partial thickness flap- Gingivectomy technique
- Flap design & incision:the initial incision is formed around 2mm coronal to the facial mucogingival junction, with vertical incisions each mesially & distally.
- Flap elevation:displacement a partial thickness flap is then raised in such a way that a relatively firm periosteum remains. the flap, containing a band of keratinized tissue, is then placed facial to the rising head of the implant fixture to the periosteum with 5.0 gut suture.
- Gingivectomy:Once the flap is positioned facially, the surplus tissue chaplet to the duvet screw is excised, employing a gingivectomy
The cover screw is then removed, the head of the implant is completely cleansed of any debris & the healing abutments are placed on the fixture.
- Postoperative care:prompt the patient permanently oral hygiene round the implant. an antiseptic rinse is used for a minimum of initial two weeks whereas the tissues are healing.
One stage Endo-osseous Implant surgery
In this technique, the implant or healing abutment protrudes about 2-3mm from the bone crest and therefore the flaps are adapted round the implant.
Dental implant surgical technique
- Flap design & incision: a crestal incision bisecting the present keratinized tissue& a vertical incision on one or both ends are placed then full thickness flaps are elevated labially or buccally.
- Placement of implants:same as in two-stage implant surgical approach the only difference is that the implant is placed in such the simplest way that the top of the implant protrudes regarding two to 3mm from the bone crest.
- Flap closure:the keratinized edges of the flap are tied with independent sutures round the implant.
- Post-operative careis the same that for the two-stage surgical approach.
We should mention that each region has minimal integration time of implant placement so osseointegration process can occur and it is classified as the following:
- Anterior mandible:3 months
- Posterior mandible:4 months
- Anterior maxilla:6 months
- Posterior maxilla:6 months
- Into bone graft:6 to 9 months
Schedule a visit at our Victorville dental office: Liberty Village Dental Care.