STANDARD IMPLANT SURGICAL PROCEDURE

Chapter 71

Standard implant surgical procedures

• General principle of implant surgery• Patient preparation • Implant site preparation• One-stage VS Two-stage implant placement • Surgery

• Two-stage “Submerged” implant placement• One-stage “Non-submerged” implant

placement

General principle of implant surgery

• Patient preparation• Health status• Complexity of the case• Local anesthesia/ Conscious sedation• Treatment plan• Informed

consent

Basic principles of implant therapy

• To achieve osseointegration• Biocompatible material : Titanium• Sterilization• Atraumatic surgical technique • Avoid over heating during implant site

preparation

Basic principles of implant therapy

• To achieve osseointegration• Good initial stability• Heal without loading for 2-4, 4-6 months• Bone Density• Bone maturation• Implant stability

• Reduce bacterial loads : CHX mouthwash • Gentle • Atraumatic surgical procedures• Follow clinical guidelines

Implant site preparation

• Good plaque control and appropriate occlusal forces shows little change of bone height in 15 years • 1st year : 1.0 -1.5 mm of bone reduction• Annual crestal bone loss : 0.1 mm or less

Implant site preparation

Adell R, Lekholm U. Int J Oral Surg 1981

• Bone-to-implant contact : • Dense compact VS Loose trabecular• Compact bone: more bone-to-

implant contact• Dense cortical bone: decreased blood

supply• Loose trabecular: loss of support/

integration• Posterior maxilla Lower success

rates

Implant site preparation

• Best result :

• Bone-to-implant contact at the time of placement• Adequate blood supply and bone remodeling• Proper coolant

Implant site preparation

One-stage VS two-stage implant placement surgery• One-stage (nonsubmerged) VS Two-stage

(submerged)

• One-stage surgical approach• Simplify : No need of second-stage expose surgery

• Two-stage surgical approach• Complex situations : Simultaneous bone

augmentation• Mucogingival tissue can be augmented at the

second-stage expose surgery

One-stage VS two-stage implant placement surgery

Standard implant surgical procedures

• General principle of implant surgery• Patient preparation • Implant site preparation• One-stage VS Two-stage implant placement • Surgery

• Two-stage “Submerged” implant placement• One-stage “Non-submerged” implant

placement

• Dense cortical bone with good initial stability : heal without loading 2-4 months

• Loose trabecular, Grafted sites or lesser initial stability : heal without loading 4-6 months or more

Two-stage “Submerged” implant placement

Two-stage “Submerged” implant placement

Two-stage “Submerged” implant placement• Flap design, Incisions and elevation

Two-stage “Submerged” implant placement• Implant site preparation

Two-stage “Submerged” implant placement

Two-stage “Submerged” implant placement

Two-stage “Submerged” implant placement

Two-stage “Submerged” implant placement

• Postoperative care• Healthy patients ≠ antibiotic therapy• Extensive surgery : Premed Amoxicillin 500 mg 1

hour before surgery and continue 3Xday (tid) for 1 week

• Ice pack 20 minutes (on&off) during first 24-48 hrs• Chlorhexidine mouthwash• Soft diet

Two-stage “Submerged” implant placement

• Second-stage expose surgery• Expose the submerged implant• Control the thickness of soft tissue• Preserve or create attached keratinized tissue• Facilitate oral hygiene• Proper abutment seating• Preserve soft tissue esthetics

Two-stage “Submerged” implant placement

• Simple circular “punch” or crestal incision

Two-stage “Submerged” implant placement : Second-stage expose surgery

• Partial thickness repositioned flap

Two-stage “Submerged” implant placement : Second-stage expose surgery

• Partial thickness repositioned flap

Two-stage “Submerged” implant placement : Second-stage expose surgery

• Partial thickness repositioned flap

Two-stage “Submerged” implant placement : Second-stage expose surgery

• Postoperative care• Maintain good oral hygiene• Chlorhexidine mouthwash• Impression for the final prosthesis can begin in 2-6

weeks • Healing and maturation of soft tissue

Two-stage “Submerged” implant placement : Second-stage expose surgery

Standard implant surgical procedures

• General principle of implant surgery• Patient preparation • Implant site preparation• One-stage VS Two-stage implant placement • Surgery

• Two-stage “Submerged” implant placement• One-stage “Non-submerged” implant

placement

One-stage “Nonsubmerged” implant placement• Second implant exposure surgery is not

needed• Implant are left unload• 2-4 months in dense cortical bone and good

stability• 4-6 months or more in loose trabecular

• Healing abutment protrudes 2-3 mm from the bone crest

• Crestal incision • Full-thickness flaps

One-stage “Nonsubmerged” implant placement

• Coronal aspect of implant is placed 2-3 mm above the bone crest

One-stage “Nonsubmerged” implant placement

• Postoperative care• Avoid chewing in the area of implants• In first 4-8 weeks, avoid using dentures if direct

chewing force can be transmitted to the implant• Removable prothesis : adequate relieve & soft

tissue liner

One-stage “Nonsubmerged” implant placement

Conclusions

• It is essential to understand and follow basic guidelines to achieve osseointegration

• Fundamental protocol must be followed in all implant systems