Category Archives: Two Stage

Bone Graft – bone augmentation

A good brand of particulate allograft is Puros Allografts by Zimmer. From its line of allografts for bone augmentation, puros cancellous particulate allograft has become the bone grafting of choice for many dentists.

Cancellous particulate allograft acts as an osteoconductive scaffold for new bone formation. In large volume of applications, studies have shown faster bone regeneration at 6 months than grafts containing sintered bovine bone matrix. While in small volume applications, regeneration of hard bone has been reported as early as 3-5 months.

Cancellous particulate allograft retains osteconductive properties due to preservation of the natural bone matrix collagen and mineral composition, trabecular pattern, and original porosity enabling the ingrowth of vascular and cellular connective tissue.
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Perforation in Dental Implant Installation

Perforated Lingual or Buccal There will be no problem if the fixture threads are imbedded in bone.

Perforated Bone Coronally Do a bone graft procedure if fixture threads are exposed at the coronal. Section small amounts of bone, mix with Resorbable Tissue Replacement, then place the bone graft material over the exposed threads.

Bone Graft Procedure on buccal bone plate. Photo credit: Oris Neobiotech

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Dental Implant Torque

For final tightening of the dental implant, torque ratchet is used. It is also used to measure the exact torque of the dental implant. Over threading is also prevented by using the torque ratchet. Over threading could strip all threads in bone.

Neobiotech torque ratchet is used to measure the exact torque of the dental implant. Photo credit: Oris Neobiotech

Dental Implant Fixture Installation

The dental implant fixture mount is attached to the fixture using the open ended wrench. The inner hexagonal surface should fit properly over the fixture head. Match the inner surface of the handpiece connector to the square top of the fixture mount and apply gentle pressure between the components.

When the apex of the fixture is threaded and no longer visible, begin irrigation. Photo credit: Oris Neobiotech

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Dental Implant Fixture Parallelism

The direction indicators are inserted into the dental implant site to check and maintain parallelism during preparation.

Poor fixture alignment

If the angle with adjacent fixture is less than 35 degrees, there will be not be a major problem prosthetically.

Direction indicators are inserted after each twist drill procedure is completed to verify parallel fixture sites. Photo credit: Oris Neobiotech

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Dental Implant Drilling Procedure

Copious saline irrigation is required in the use of any drilling instruments. A surgical splint is used to determine dental implant fixture insertion site. In the maxilla, a fixture for 11 or 21, is placed 3 mm from the midline suture line.

After pilot drilling is done, the fixture site is enlarged using a 3.0 mm diameter twist drill. The procedure is important for preparing the implant fixture site to proper depth. The indicator mark on the drill should be level with the bony margin.

Use the twist drill to finalize enlargement fo dental implant fixture site. Photo credit: Oris Neobiotech

Implant Supported Complete Denture

Implant Supported Complete Denture is an optimum solution for Completely Edentulous patient. Implant Supported Denture virtually eliminates slipping and movement. Patients will be able to laugh and speak with confidence and eat food with ease.

Dental Implant supported complete denture have the following advantages:

  • It increases comfort and stability.
  • It restores a secure biting ability.
  • Maintains integrity of facial structure.
  • It eliminates need for adhesives.
  • It improves facial appearance.
  • It improves eating.
  • Improves speech and confidence in speaking.

Multiple Dental Implants

Implant Supported Bridge is an optimum solution for multiple missing teeth. Implant supported dental bridge stays secure and strong. It is comfortable, natural and look like natural dentition.

Dental Implant supported bridge have the following advantages:

  • It looks, feels and performs similar to natural teeth.
  • Sound adjacent teeth are not compromised to support a bridge.
  • Preserves sorrounding bone.
  • Dental bridge attached securely to dental implants.
  • It prevents resorption of bone.
  • Recurrent wear around abutment is eliminated.
  • Seld esteem of the patient is improved.

Dental Implants will maintain surrounding bone and soft tissue, as well as replace missing teeth.

Dental Implant Procedure Appointment Sequence

Appointment sequence for dental implant procedure

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.

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

Post-operative Intructions for Dental Implant Patients

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. _______.