Let's Get Clinical: Dental Implants Preparation and Procedure - T-Bone Speaks
Dental Implants preparation and procedure

Let’s Get Clinical: Dental Implants Preparation and Procedure

Dental Implants Preparation and Procedure

All right, I want to take a chance to walk everybody through a setup. Today, I’m going to show you Dental Implants Preparation and procedure here at Raleigh Dental Arts. We’re going to be placing three implants on our patient today, in sites number four, five, and six.

Our patient had some infection on her teeth, requiring us to remove the teeth, do some grafting, do some temporary work, to be able to allow her to have some teeth during that period of time, and her smile. And now we’re at the four, five, six month mark, after the bone has been placed. We’re finally at a point where we’re placing the implants in.


The Preparation

So in this particular case, we’re moving to the BioHorizons guided surgical kit. So we’re using their surgical kit here. And here’s their surgical kit using keys and drills. And they have multiple drill lengths to allow the difference sleeve heights. I also have here, the Versah Universal Densah kit here. And I use that, in the case that I end up having to go freehand, I like their drills. And also, if I want to do some densification of the bone, in other words, I want to have more dense bone, I have that ability to do that.

That other nice thing here also, is on this particular system, with the Sirona Teneo chair, what we have is, we have a high speed, a low speed electric, and a dedicated implant drill. And what we’re able to do is just simply go from within. You can see here, we have our saline bag, dedicated implant drill. And I’ll simply go in here and tell it that we’re in implant mode. And now when I pick this up, it’s automatically in implant mode here.


SICAT’S Accurate Precision

We chose to have our surgical guide made by SICAT, using the Sirona workflow. And the reason we do the SICAT workflow, versus our own printed guide or in-house guide is because it allows us accurate precision. Because they’ll do a double-check of making sure that not only did we plan correctly, but also was the guide fabricated correctly?

Also, since we’re doing a pure guided protocol, which is what I want to do here, our in-house milled guides don’t have that full guided opportunity at this time, so we’ll use the BioHorizons protocol. So with SICAT, you can see here, it tells us what implant we’re using, what length we’re using, what burrs, and what burrows we have to use for the implants site creation, and what settings to use for the implant placement.


The Glimpse of our Implants

We’ll also have a visual here, of the implants and the plan. So I have a visual, ability to see what everything looks like. So our implants here, will match what’s on the surgical plan and report. And also, I intend to use healing abutment, so to allow us to gain tissue thickness and to make our future steps a little bit easier.

The last thing I want to point out to everybody is our blood work here. In this particular case, we’re prepared in case we want to do some grafting or anything like that. We use blood, so we do PRP, PRF to mix with that bone to create “Sticky Bone,” and to create the PRF plugs to enhance the feeling. So all of that is done for me here in advance.


BioHorizon’s Kit makes our life a little bit easier

We have everything ready to go pretty much. In a perfect world, we don’t have to leave the room. One of the things I like about the BioHorizon’s kit, is that we have these key holders that are double-ended. So what we’re able to do actually to make our lives a little bit easier, is I can go ahead and get the 2-0 key put in. I can get the 2-5 key put in. So that way, when I’m doing my work, I can go from here to there, and everything’s ready to go, without worrying. Then it calls for the 3-2 key next. I’m actually going to put the 2-8 key on as well, just in case I decide to undersize my osteotomy a little bit more than normal. I’ll put the 3-2 key on. So now, I have everything ready to go, and there’s not a lot of fumbling around here. And then what I’ll also do is, we have our burrs, 2-0, 2-5, 2-8, 3-2, ready to go, in order. And so, we’re pretty good to go on that.


The Procedure

All right we’re going to begin our case by removing the temporary. As what you’ll see here, a temporary is a full-coverage prep on tooth number three, with two pontic wings on tooth number seven and eight. Now that we have the temporary off, we’ll go ahead and fit the surgical guide. We’ll verify that the surgical guide does fit. Unfortunately, typically, I’ll refer …

Check this, before we start. But in this case, because of the temporaries, I couldn’t. And what we can see here is that we have wonderful passive fit, and a stable surgical guide.

So here, you can see that they have golden colored sleeves inside of here, which correspond to the sleeve keys. If they were green, then we would use the green. If they were blue, we’d use the blue keys. What this does is this takes this hole, let’s say for example, it’s four and a half, five millimeters, and you put that in there, and what that does is it now allows you to take your two millimeter osteotomy drill and you’ll put that through there, to help keep you from having any type of wiggle room and the accuracy. So we’ll just go through, go through, just like so.


The Decision

While this case would be a good candidate for punch, we made a decision to do an incision so that we could preserve some of the keratinized tissue and actually roll that tissue to the buckle. So we’re actually going to be placing healing abutments today. And allowing the tissue to granulate in and creating a greater zone of keratinized tissue and a greater, thicker tissue there. So now, we’re going to use a mouth prop to help hold the surgical guide. Now we’re going to go ahead and begin our osteotomy sequence.

As you can see here, we’re doing it with copious amounts of irrigation, and manufactured recommended speeds. Once we’re done, I will take a rongeur and clean out any tissue tags. I’m going to go ahead and clean our site to make sure everything’s good.

The Finishing Touch

We’re going to use our guided implant mounts to place our implants at 50 RPM, 35 centimetres of torque. And then we’re going to, in this particular case, use visualization to verify that we have the implants at the proper depth to allow emergence profile. So now we have our implants in place. We should be ready to place our healing abutments and then do some suturing. But before we put the healing abutments on, we do a little bone recontouring to make sure everything does fit.

And here we are, all completed. And case completely done. Ready to fit the temporary back in place. But we don’t want the temporary to touch the healing abutment and put any torque or force onto the implants. So we’re going to reduce the pontic site to be completely free and clear of the healing abutments, and do not put any pressure on our implants. So we’re using an acrylic burr to adjust. And now we’ll go ahead and temporary cement this into place now. Clean up our excess. Smooth and contour. Check our bite. And we’re done.

About the Author Tarun Agarwal

Dr. Tarun Agarwal represents the next generation of leadership for the dental profession. As a respected speaker, author and opinion leader, he is changing the way general dentists and their teams practice.

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