3.5 Implantology

The basis of dentistry is the prevention of oral disease. Wear and tear, and trauma can cause tooth loss regardless of prevention practices. These healthy patients are perfect candidates for tooth replacement by dental implants.

A dental implant is an implantable medical device that replaces single teeth, multiple teeth or entire arches.

Once it’s determined that the patient is a good candidate for dental implants and the treatment plan has been elected, the next aspect of implantology to consider is system. System is usually determined by the referring dentist or lab that a dentist is using to fabricate the prosthetic portion of the implant (crown, bridge, or denture).

KEEP IT STERILE: There is a high risk of bone infection (osteomyelitis), and specifically peri-implantitis when placing dental implants because the surgery involves drilling into bone. Osteomyelitis and peri-implantitis can be disastrous to successful dental implants because it is difficult to rid the bone of infection, and maintaining asepsis and sterile surgical procedures are the best method of prevention.

Categories:

  • First Stage: a flap is elevated and the implant is placed using a specialized console, handpiece, and a system specific surgical kit containing osteotomy drills, and attachments. A cover screw or healing abutment is placed and the flap is sutured.
  • First Stage with Provisional Appliance/Denture Conversion: the implant is placed and instead of a cover screw or healing abutment, the implant is loaded with a provisional crown or denture.
  • Second Stage: If a cover screw was placed at implant placement (first stage), approximately 4 months later, a flap is elevated, the implant is tested for osseointegration, and loaded with a healing abutment. The tissue is allowed to heal for approximately 2 weeks before an impression or scan for the final abutment (e.g. crown) is obtained.

Implants are lengthy invasive procedures that can introduce bacteria into bone

The First Stage of implant placement requires the Sterile Technique and is performed with or without Sedation.

Armamentarium FIRST STAGE:

• REMOVE FORCEPS and  ELEVATORS from  Surgical Tray

PROCEDURE SPECIFIC CHECKLIST:
Italics = OPEN ONLY AS DIRECTED

• #12 scalpel blade
• 
#15 scalpel blade
• Barriers (sterile): light handles, unit handle, hose covers
• Bite Block: edentulous
• Bone Mill
• Bone Trap with suction tips
• Cautery
• Chlorhexidine & Bowl: for provisional appliance
• 
Discoid/Cleoid carver
• 
Face Prep Sponge
• Gauze: sterile 2×2’s & 4×4’s
• Graft Bin: allograft, bone scraper, membranes
• Handpiece and Hose
Implant Console
Implant Handpiece
Implant Surgical Kit
Implants
Implant Healing Abutments/Cover Screws
• Kidney Basin
• Magnetic Drape
• 
Patient Drape: sterile (large)
• Personal Protection Equipment: Sterile Gowns, Sterile Gloves, Bonnets, Masks
• Retractors: Right Angle
• 
Saline: sterile
• S
terile back counter drape, implant cart drape
• Sinus Instruments: maxilla (include osteotomes and mallet)
• Suction Tubing

• 
Sutures: 3.0 or 4.0 chromic gut (surgeon’s preference)
• Towel Clamps
• Sutures: silk
• Sutures: vicryl
• Tissue Glue

Prosthetic Appliance (ADD):
• Impression Copings
• Impression Puddy (standard set) & Tray
• Light Body Impression Material: Tips, Gun & Tray
• Replicas

Denture Conversion (ADD)
• Curing Light
• Implant Multi-Unit Abutments (MUA’s)
• Impression Putty (standard set) & Tray
• Marking Pen: sterile
• Prosthetic Kit: for MUA’s
• Tacklebox: copings, chimneys, temporary abutments, comfort caps
• Triad
• Teflon Tape and Fermit

The Second Stage of implant placement requires the Aseptic Technique.

Armamentarium SECOND STAGE

• REMOVE FORCEPS and TOOTH ELEVATORS from BASIC OMS TRAY WITH SUCTION
• Implant system specific prostho/processing kit
• Healing or locator abutments

Preoperative Considerations:
• Follow written Pre Op Instructions (sedation).
 Check if a denture will be converted following surgery: ensure that denturist or dentist has coordinated fabrication.

Intraoperative Considerations:
 Grafting often occurs during surgery: ensure that grafting materials are in the operatory.
Excessive bleeding during surgery may require the use of cauterization. Ensure that the cautery unit is at hand.
Effective assisting is required: do not desiccate surgical site with suction, and be mindful of the mental foramen and the inferior alveolar nerve.

Postoperative Considerations:
• Follow written  Post Op Implant Instructions.
 T
here is a risk of peri-implantitis which is a latent inflammation of the periodontium (it’s not caused by the surgery itself, rather it is caused by other risk factors such as poor oral hygiene, and smoking: POST-OP CONSIDERATIONS!!
 Care of provisional: healing abutment, temporary crown or denture.
 No chewing on provisional until integration is confirmed.

REMEMBER: All implant components must be recorded for warranty purposes. This can be done online AND a backup copy is recommended. Each item comes with a discrete Lot and Reference number on stickers that must be placed in the patient’s chart and a practice wide filing system (sorted by date).

NOTE: No implant system is endorsed or promoted in this publication

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