Implant Second Stage Surgery

Question 1

Single Stage Surgery

Answer 1

Transmucosal opening created at
time of placement
ADVANTAGE: Only one surgical
procedure required
DISADVANTAGE: Less predictable
augmentation

Question 2

Two Stage

Answer 2

Implant submerged under mucosa for duration of healing time
ADVANTAGES
- Primary wound closure
 Osseointegration allowed to occur in a sterile, stress-free environment
-Form and amount of remaining hard and soft tissues can be influenced during second stage procedure

Question 3

Timing of second stage surgery

Answer 3

 Type I/II Bone 3-4 months
 Type III/IV Bone 6-8 months
 GBR at stage I 6-8 months
 Fixtures in sinus 6-8 months

Question 4

Objectives of stage two surgery

Answer 4

 Expose submerged implant without damaging surrounding bone
 Evaluate for integration
 Control thickness of both hard and soft tissue surrounding implant
 Preserve or create keratinized
tissue around implant
 Facilitate oral hygiene and
implant maintenance
 Remove cover screw,
 Ensure proper transepithelial
Abutment seating
 Preserve phonetics and esthetics

Question 5

3 types of second stage surgical techniques

Answer 5

 EXCISIONAL:
 Punch Technique
 INCISIONAL:
 Full Thickness Flap
 COMBINATION

Question 6

DETERMINING FACTORS for 2nd stage TECHNIQUE SELECTION

Answer 6

1. Need to access osseous structures
2. Thickness of overlying soft tissue
3. Amount of keratinized tissue
4. Available healing time
5. Need to control abutment length
6. Patient’s ability to perform oral hygiene
7. Esthetic considerations
8. Thickness of bone surrounding implant

Question 7

Ways to do Punch technique

Answer 7

 Surgical Blade
 Punch
 Rotary
 Laser

Question 8

Steps of punch technique

Answer 8

1. Locate and expose cover screw
2. Remove cover screw
3. Seat Abutment
4. Take Radiograph to assess seating

Question 9

Excisional Punch Technique Advantages

Answer 9

 Quick and easy
 Minimal morbidity
 Less healing time required
 Avoids exposing bone

Question 10

Excisional Punch Technique Disadvantages

Answer 10

 Locating fixture may be difficult
 Possible problems seating abutment
 No control over abutment length
 May sacrifice existing keratinized tissue
 Can’t address hard/soft tissue problems

Question 11

minimum wait time before restorations

Answer 11

likely 4 weeks but depends on case.
2 weeks mentioned in class but then backtracked

Question 12

Incisional Tech: Full Thickness Flap advantages

Answer 12

 Keratinized tissue maintained
 Control of final hard/soft tissue architecture of area
 Abutment height can be altered
 Visualization of abutment seating assures precise fit

Question 13

Incisional Tech: Full Thickness Flap disadvantages

Answer 13

 Increased morbidity
 Longer healing time required
 Bone surrounding implant is exposed May cause F or L bony dehiscence
 Interproximal bone can remain denuded

Question 14

Advantages of keratinized tissue

Answer 14

1. Facilitates making of impression
2. Tissues less likely to collapse over implant
3. Facilitates maintenance procedures
4. May be more resistant to hygiene trauma
5. Provides greater tissue tone around
   abutment
6. Esthetic blending possible in maxillary
7. Epithelial implant junction may be more
   resistant
8. Horizontal connective tissue fiber orientation
   (perpendicular arrangement)

Question 15

Types of soft tissue augmentation

Answer 15

 Apically positioned flaps
 Free soft tissue autografts
 De-epithelialized pedicle grafts
 Free connective tissue grafts

Question 16

When second stage surgery properly performed…

Answer 16

 Complete seating of abutment
 Adequate access for OH / maintenance
 Optimal hard/soft tissue architecture
 Minimal peri-implant tissue thickness
and pocket formation
 Maximum esthetics and phonetics
 A Peri-Implant Environment Where
Functional and Biologic Needs Are Met
AND ULTIMATELY IN A
 MORE PREDICTABLY SUCCESSFUL
IMPLANT