Category: Two Stage

Appointment sequence for dental implant procedure

Appointment
1. Examination and diagnosis.
2. Treatment planning.
3. First surgery, fixture installation.
4. Suture removal one week post surgery.
5. Soft denture reline insertion two weeks post surgery.
6. Relining procedures once a week for first month, then once every two to three weeks. Healing period is three to four months for mandible and four to six month for maxilla.
7. Second surgery, abutment connection.
8. Suture removal one week post-surgery.
9. Prosthesis insertion two weeks post surgery. Oral hygiene final instructions.
10. Regular recall appointments, one, three, six and twelve month time intervals. Remove and clean a free standing fixed partial denture once a year.

Reference
Hobo S, Ichida E, Garcia L T: Osseointegration and Occlusal Rehabilitation, Quintessence Publishing Co., Ltd. 1989

A list of post-surgery instructions should be given to dental implant patients. It is important to describe all post surgery home care instructions for the patients to follow.

It is important to follow the directions during the first 2 weeks after the operation to insure adequate healing.

1. Do not rinse your mouth vigorously during the first 24 hours after the operation.
2. Use ice packs over the surgical area for 20 minutes at a time, during the first 2 days after the operation.
3. If nose bleeding starts, do not blow your nose vigorously.
4. Maintain a liquid diet for the first 5 days after the operation. Do not smoke or consume alcoholic beverages during the first week.
5. Two weeks after the operation, begin a soft diet and restrict smoking and alcoholic consumption.
6. Use an elevates head rest or an extra pillow for the first 2 nights after the operation.
7. If bleeding begins in the surgical area, apply gentle pressure to the area by biting on a roll of gauze for 1 hour. If bleeding does not stop, please contact Dr. _______.
8. Rinse your mouth thoroughly with a salt water rinse or prescribed mouth rinse after every meal.
9. Do not use prosthesis until it has been relined.
10. Follow the directions carefully for any prescribed medications.
11. If you have any questions or any problems related to the healing of your operation, please contact Dr. _______.

Indications for Dental Implant Treatment

1. Edentulous patient.
2. Partially edentulous patient with history of difficulty in wearing removable partial dentures.
3. Patient with missing dentition requiring long span fixed partial denture (bridge) treatment.
4. Patient who refuses using removable type dental prosthesis.

Reference
Hobo S, Ichida E, Garcia L T: Osseointegration and Occlusal Rehabilitation, Quintessence Publishing Co., Ltd. 1989

There are four divisions of available bone based on width, height, length, angulation and crown height in the edentulous site.

1. Division A edentulous ridge offer abundant bone in all dimensions.
2. Division B bone may provide adequate width for narrower, small diameter root form endosteal implants.
3. Division C edentulous ridge exhibits moderate resorption and presents more limiting factors for predictable endosteal implants.
4. Division D edentulous ridge basal bone loss and severe atrophy, resulting in dehiscent mandibular canals or a completely flat maxilla.

Reference
Misch CE: Dental Implant Prosthetics, Mosby Inc 2005

Angulated Abutment is an innovative component designed to adjust access hole position, prosthetic screw angulation and improve cosmetics. Before the development of Angled Abutments, if screws and access holes were positioned jutting through the labial aspect of an anterior tooth, there were basically three options:
1. The double casting technique.
2. Unsightly patch marks which closed the access holes after final insertion.
3. The combination of implant supported posts securing a crown and bridge type prosthesis.

Implant Angulated Abutments

Factors to Consider in Dental Implant Treatment

1. How does the patient feel about surgery?
2. Is the patient prepared to pay the costs involved in implant theraphy?
3. Does the patient have sufficient bone to place dental implants? Bone grafting may be required and this could be a barrier to treatment.
4. If bone grafting is required, is the patient prepared to accept this?
5. Is the patient prepared to accept the burden of maintenance associated with implant retained prosthesis?

Implant Analog for Impression

Implant Abutment

Tools for titanium machining are used for drilling of titanium abutment. The fixture must be well fixed and correct RPM must also be checked before drilling. There must be adequate cooling so that overheating of abutments is prevented.

Titanium Implant Abutment Component

Bone Graft

The success rate of bone grafts in the jaw for dental implants is high. But, there is always a chance that the bone graft will fail. They are not rejected like organ transplants. Failure of bone graft is usually because of infection. There’s also higher risk of bone graft failure in patients who smoke and those with certain medical conditions.

Torque wrench was used to to achieve the desired dental implant bone contact and avoid too much compression on the bone that may lead to necrosis of the implant bed.

Implant was placed mesial to tooth number 22 (FDI Two-Digit Notation).

Implant was placed mesial to tooth number 22 (FDI Two-Digit Notation).

Drilling Procedure

Following dental implant surgical sequences and protocols, drilling should follow the desired RPM with copious irrigation preferably with an NSS refrigerated the night before surgery.

Drilling Procedure

Drilling Procedure