Dental restorative materials, procedures, and strategies that are predictably effective for the long-term management of tooth loss have advanced dramatically. Scientifically validated technologies have evolved to give dental patients with cosmetic and functionally superior tooth replacement solutions. Dental implants have been used to replace lost teeth with a high success rate in a revolutionary fashion for over a century, therefore they were regarded as an important contribution to dentistry.
Today dental implant constitutes one of the most reliable choices for replacing lost teeth. They also help in restoring normal articulation, swallowing, facial attractiveness, and aesthetics to patients around the globe. However, the capacity of the implant material to integrate with the surrounding tissues is critical to its success. Also, several other parameters, including implant material, implant loading condition, and bone quality and quantity influence the integration process. Therefore, understanding of fundamentals of placing dental implant is crucial for its long-term function and success.
Key factors to consider in dental implant placement:
Dental implant placement protocol requires consideration of many factors. Some of which can be patient factors, implant material factors and clinical related factors. One should follow these following steps during dental implant placement:
Step-1: Diagnosis and treatment planning:
A proper diagnostic and treatment regimen are critical for the long-term effectiveness of dental implants. Comprehensive medical and dental histories, clinical pictures, study casts, and periapical and panoramic radiographs are basic requirements. Also, with the help of computerized or linear tomography of the intended dental implant placement sites should all be evaluated. Prognosis of the dentition, and in particular the prognosis of the tooth in question, are critical in treatment planning.
The crown-to-root ratio, residual root length, periodontium attachment level, interproximal involvement, and periodontal functional capacity should be looked into. Moreover, considerations should be given to teeth next to the proposed implant location and root fractures with large endodontic posts. Implants are considered as choices of treatment for non-vital teeth and those with roots shorter than 13 mm.
Step -2: Pull out/extract the tooth:
Post basic assessment of patient and local factors next step in dental implant placement is the extraction of the offending teeth. The tooth should be extracted as painlessly as feasible, with the preservation of the buccal plate and surrounding bone. Periotomes help atraumatic removal after tracing around the root with a very fine diamond bur. After the tooth has been carefully removed, the status of the extraction site should be evaluated by probing the socket. Endodontic or periodontal probes are used to search for any bone deformities. Practitioners new to the surgical side of therapy should feel comfortable pushing forward with implant placement as long as the buccal plate and other bone surrounding the socket are intact.
Step-3: Socket management and grafting:
This step is critical for dental implant placement as the prognosis of a dental implant depends on socket management. It’s crucial to graft the socket to protect the bone of the extraction site, which will make implant placement easier. To begin, use a surgical curette to carefully remove any granulation material from the socket. After that, irrigate the area and scrape the walls with an appropriate scaler to start bleeding. The socket is then filled with grafting material, either synthetic or allograft, up to the crest of the bone. A simple X-suture can then be used to close the incision.
Step-4: Provide time for healing of the dental implant placement site:
Following the ridge preservation treatment, the grafting is done. This aids in the preservation of bone volume, which is necessary for a simple, predictable implant placement procedure. It also helps in achieving an aesthetically pleasing, functional result. The extraction site heals and the graft matures over for four months. The graft acts as an extracellular scaffold. During this time, it allows the patient’s natural bone cells to replace the grafting material with live bone. This results in an optimum implant placement location.
Step-5: Follow dental implant placement surgery:
The patient returns for dental implant placement when the socket site has healed. The site should have an intact buccal plate with enough ridge height and width if the previous steps are followed. To ensure appropriate bone volume for implantation, the location can be examined intraorally and radiographically. A periodontal probe assesses the facial-lingual and occlusal bone after the patient has been anesthetized for implant surgery. The diameter of the implant can be estimated based on the edentulous space’s mesial-distal and buccal-lingual dimensions.
Flapless implant insertion is an ideal alternative for many of these situations. It reduces blood supply disturbance and promotes a quick dental implant surgery recovery. To begin the flapless surgery, a tissue punch is utilized to make a hole. For the osteotomy in the proper place, an implant should be 1.5 mm from the adjacent teeth. Also, there should be 1.5–2.0 mm of bone on the face side.
The osteotomy is made using the manufacturer’s recommended surgical drill sequence for the diameter and length of the implant. During the surgery, radiographs should be acquired at regular intervals to ensure appropriate angulation and positioning. The implant is implanted once the surgical procedure is done with the final shaping drill.
The adoption of an implant with a pronounced thread design is desirable. This allows the physician to maintain directional control during placement. It also helps in achieving high primary stability. A tapered implant placement system is a better option, as the tooth-root-like shape is easier to place within the available bone. These characteristics make implant insertion easier. It is very useful for implant surgeons who are just starting.
A handpiece driver is used to thread the implant into the osteotomy site. A torque wrench should be used to complete the final insertion so that the implant’s stability can be assessed. Although implant manufacturer instructions should be followed, 35 Ncm is a common rule of thumb for main stability.
Step-6: Placement of healing abutment:
A healing abutment, rather than a cover screw, can be supplied at the time of dental implant placement. This is done if appropriate primary stability has been attained. This is usually the case when the stages above have been followed. It’s critical to make sure the healing abutment is free of occlusion in centric and all excursions when doing so. This will prevent any forces from being applied to the implant while it is recovering.
Step 7: Final impression taking:
The patient returns three months after the implant is placed for the final impression, and the healing abutment is removed. This will reveal a healthy, attractive soft-tissue collar surrounding the implant site, led by the healing abutment. The implant is subsequently attached to an impression coping. A closed-tray impression can be made with a vinyl polysiloxane material are used for final restoration construction.
Step 8: Crown with screw placement:
The screw-retained crown is inserted into the implant after the healing abutment is removed. The crown’s complete seating should be confirmed radiographically. A torque wrench is then used to tighten the prosthetic screw into place. To hide the screw, Teflon tape is put into the access channel, and the crown opening is covered with composite. With the final delivery of the monolithic zirconia implant crown, an attractive implant restoration can be predicted with an outstanding long-term prognosis.
Single-unit posterior extraction cases are good for gaining confidence, honing surgical and restorative abilities, and achieving predictable implant placement results. With many such patients seeking treatment, the well-trained general dentist has every incentive to offer implant therapy directly to them. Most importantly, the patient gets a superior long-term solution to his or her missing tooth condition. The outcomes are truly life-changing for both the implant patient and the clinician.
For more information on dental implants, contact Kamal MedTech:
Kamal Medtech is one of the leading. Our made-in-India dental implants have been tested on the highest quality parameters. This has led to its trusted use pan India. Under the i-fix brand, our Indian dental implants have excelled in recent years. It has made a significant mark among leading dental professionals in India. It was developed by the IIT Delhi, approved by FDA, certified by ISO 13485, and endorsed by the prestigious Maulana Azad Institute by Dental Sciences, New Delhi. If you wish to know more about dental implant placement steps then please contact us.