Dental Implant is a surgical procedure to replace a missing tooth root and fused with the bone providing a fixed or permanent foundation or support for crown, bridge(s), or dentures. The back of the lower jaw has the highest success rate of dental implantation and osseointegration because it is denser than the posterior (back) section of the upper jaw.
The pre‐operative protocol covers a review of the patient’s medical history and recording of the vital signs such as pulse rate. The patients will pre‐rinse with chlorhexidine solution to reduce the bacterial load. Subsequently, the patient should be anesthetized, typically with maxillary infiltration of both the buccal and palatal, and/or a mandibular block.
Steps in surgical procedure for a simple implant
- Create access
- Perform osteotomy
- Place the implant
- Site closure
Access to the Bone
There are two approaches to creating access, namely flap reflection or a surgical punch (flapless).
- Flap reflection
The flap reflection allows the surgical site to be visible, easy to access, and accurate positioning for implant placement. But the reflected tissue must be sutured back in place after implant insertion.
- Surgical punch
A surgical punch is a simpler process for an experienced dentist to gain access to the cortical bone surface. But, it necessitates accurate location of the cut hole on a first‐time basis. The tissue punch removes keratinized gingiva.
Performing the Osteotomy
Three basic steps are important in performing the osteotomy (surgical cutting or removal of bone) regardless of the mode of access:
- Center the osteotomy
- Establish the length of the osteotomy
- Establish the width of the osteotomy
Osteotomy procedure
- Establish the center of your final restoration
- Purchase point made with a high‐speed surgical bur
- Center B‐L, M‐D
- Establish the length (implant depth)
- Length is established with a locator drill (sharp‐tipped drill)
- Use radiographs to check angles
- The most common implant body length is 10mm.
- Establish the width
- Width is based on the width of bone and on the tooth to be restored
- Anterior 3.2–4.7mm width
- Premolar 3.7–4.7mm width
- Molar 4.7–7mm width
Surgical Procedure
Step 1
- An initial bone incision is made with a locator drill to a depth of 6–8mm.
- After taking a radiograph and carrying out an analysis to check the accurate positioning of the hole using a locating indicator, the locator drill is then used to drill to the full length (depth) required for the implant, typically 10mm.
Step 2
- The initial osteotomy in soft bone is progressively widened using osteotomy drills of increasing diameter.
- Coarser thread and heavier-duty drills are used for dense bone.
- Toto maintains a clean (saliva‐free) work siworksiteevent burning and possible bone necrosis, the osteotomy site is continuously irrigated with sterile saline solution. Ideally, the osteotomy should be isolated from saliva to prevent contamination.
Step 3
- Remove the implant body from its packaging and insert it into the prepared site using the provided carrier.
- After initial placement, torque the implant/ carrier in place with the torque driver.
- Remove the carrier and, after reviewing the positioning and placement, fine-tune positioning: the implant platform should be flush with the bone level or 0.5–1mm below the bone level.
- Note: The torque wrench should be set to 50Ncm. If the implant cannot be inserted to the required depth (10mm and at the bone level or 0.5–1mm below the bone level), back the implant out and use the corresponding dense bone drill to widen the osteotomy. It is important to not over‐torque the implant to place.
Step 4
- Insert the healing abutment or cover screw with driver to 15Ncm and suture the reflected flap tissue in place.
- Note that it is important to maintain the buccal keratinized tissue accomplished at the initial flap design
When suturing the flap, some dentists recommend the use of Cytoplast Polytetrafluoroethylene (PTFE) suture material, since this material is found easy to handle and passes through tissue easily without snagging or tearing.
Time‐Line for a Simple Implant
- Surgery
- Two‐week follow‐up with radiographs and, if necessary, suture removal.
- Impressions. These are taken at six to eight weeks post‐surgery.
- Delivery of the crown at 10–12weeks post‐surgery
Postoperative Protocol
- Eating or other potential trauma to the operative site should be avoided: adjacent teeth may be brushed but not the surgical site for at least 48hours.
- Antibiotic may be prescribed, typically Amoxicillin 500mg, TID, for five to seven days provided the patient is not allergic
- Chlorhexidine rinse BID for 10days.
- Warm salt water rinses after meals.
- Pain medications: recommend or prescribe as determined by the patient medical history. Typically, ibuprofen 600–800mg is sufficient for most healed site implant placement procedures.
- Schedule a two‐week follow‐up appointment
Conclusion
The most basic surgical requirement for implant placement is having adequate bone volume and quality. The rule of 6’s illustrates that a patient should have a minimum of 6mm of bone in all dimensions as well as 6mm of interocclusal space. Consult your dentist if you are suitable to have dental implantation.
