53. Implantation in case of insufficient bone volume

Question 1

2-stage “submerged” implant placement

Answer 1

• Initially placing implant and covering it w/ gum tissue=>
• Heal undisturbed for several months
• Areas w/ dense cortical bone and good initial implant support=>implants can heal for 2-4 months
• Areas w/ loose trabecular bone, grafted sites, or lesser implant stability=>require 4-6 months of healing

Question 2

Purpose of the second-stage exposure surgery in a 2-stage implant placement

Answer 2

• Uncover submerged implant and connect healing abutment=>
• Restorative dentist=>prosthodontic aspects of implant therapy=>
• Impressions and fabrication of prosthesis

Question 3

Crestal flap design used in implant surgery

Answer 3

• Incision along crest of ridge=>bisects existing zone of keratinized mucosa
• Facilitates easier closure=>less bleeding and edema, faster healing
• Full-thickness flap raised to expose alveolar ridge of implant surgical sites

Question 4

How implant site prepared during surgery

Answer 4

• Reflecting flaps=>debriding bone of granulation tissue, flattening any knife-edge ridges
• Series of drills=>prepare site and place implant=>
• Small round bur for initial penetration, followed by 2-mm twist drill to establish depth and alignment
• Subsequent drills used to incrementally increase width of osteotomy site to match planned implant diameter=>
• Precise and trauma-free preparation

Question 5

Steps involved in implant placement after site preparation

Answer 5

• Implants inserted using handpiece rotating at slow speeds (e.g., 25 rpm)=>
• Following established osteotomy path
• Placing multiple implants, guide pins used to ensure proper alignment
• Once implants inserted=>cover screws secured, and surgical sites irrigated w/ sterile saline=>
• Clean wound
• Flaps managed to achieve good approximation and primary closure without tension
• Combination of horizontal mattress and interrupted sutures

Question 6

Postoperative care recommended after implant surgery

Answer 6

• Antibiotics=>amoxicillin 500 mg x3/day
• If surgery extensive or patient medically compromised=>Cold packs recommended for first 24-48 hours to manage swelling
• Chlorhexidine gluconate oral rinses=>plaque control
• Adequate pain medication=>ibuprofen 600-800 mg
• Soft diet and avoid tobacco and alcohol use

Question 7

Objectives of second-stage exposure surgery

Answer 7

• To expose submerged implant without damaging surrounding bone
• Control thickness of soft tissue around implant
• Preserve or create attached keratinized tissue around implant
• Facilitate oral hygiene
• Proper abutment seating
• Preserve soft-tissue esthetics

Question 8

1-stage “nonsubmerged” implant placement

Answer 8

• Implant or healing abutment protrudes 2-3 mm from bone crest=>
• Flaps adapted around implant/abutment
• Similar healing period as 2-stage approach but eliminates need for second surgical procedure to uncover implant
• Primary difference=>coronal aspect of implant or abutment remains exposed from initial surgery