Surgical Precautions

Clinical Considerations
True bone contours can only be evaluated after tissue flaps have been reflected at the time of surgery. Even if bone dimensions are painstakingly measured prior to surgery, the doctor and patient must accept the possibility that inadequate bone anatomy might be discovered during surgery and preclude implant placement.

During the presurgical planning phase, it is important to determine the vertical dimension - the actual space available between the alveolar crest and the opposing dentition - to confirm that the available space will accommodate the proposed abutment and the final crown restoration. The height required by the abutment may vary with the type of abutment; therefore, the surgeon and restorative dentist should carefully evaluate the abutment size. The final prosthesis should be designed prior to the placement of the implant.

Study models should be used preoperatively to evaluate the residual ridge and to determine the position and angulation of all implants. These models allow the clinician to evaluate the opposing dentition and its effect on the implant position. A surgical guide stent, which is critical for determining the precise position and angulation of the implant, can be constructed on the study model.

To prevent damage to the bone tissue and to prevent compromising osseointegration, abundant and continuous irrigation with a cool, sterile, irrigating solution is mandatory during all drilling procedures. The application of excessive pressure during preparation of the bone site must be avoided.

To prevent damage to the bone tissue and to prevent compromising osseointegration, abundant and continuous irrigation with a cool, sterile, irrigating solution is mandatory during all drilling procedures. The application of excessive pressure during preparation of the bone site must be avoided.

Bone surgery utilizes a high-torque electric drilling unit that can be operated in forward and reverse modes at speeds ranging from 0 to 1500rpm, depending on the surgical requirements. Sharp instruments of the highest quality should be utilized during implant site preparation to reduce possible overheating and trauma to the bone. Minimizing trauma enhances the potential for successful osseointegration.

The time elapsed between surgical placement of the implant and final abutment placement is referred to as the healing period. Healing periods can vary or be modified, depending on the quality of the bone at the implantation site, bony response to the implant surface and other implanted materials and the surgeon’s assessment of the patient’s bone density at the time of the surgical procedure. Extreme care must be taken to avoid excessive force being applied to the implant during the healing period.