Surgical Stage

Preparation

Training and Competence

Dentists performing dental implant treatments must have received thorough postgraduate training specific to implantology. They need to demonstrate proficiency and competence in handling the varying complexities of each case they undertake. Additionally, it is crucial that they hold appropriate indemnity insurance that covers the full scope of dental implant procedures and the associated risks.

Surgical Complexity:

Dental implant surgery can range from relatively straightforward procedures to highly complex treatments. Some patients may be candidates for immediate loading, where implants and restorations are placed on the same day. Conversely, other cases may require a more staged approach, allowing the implant site to heal before final restorations are completed. In certain situations, additional surgical interventions, such as bone grafts or soft tissue grafts, may be necessary to adequately prepare the implant site.

Patient Preparation:

Effective communication is essential in the planning stages. The treatment plan must be clearly explained to the patient, ensuring they fully understand the process and can provide informed consent. The clinician should work with the patient to prepare them both mentally and physically for the procedure. This preparation includes confirming the patient's medical fitness for surgery and ensuring that their oral environment is optimal, with no plaque, infections, or inflammation present.

Preoperative Care:

Timely administration of preoperative medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and antimicrobials, is vital to ensure their effectiveness during the procedure. Maintaining a sterile surgical environment through rigorous aseptic techniques, proper disinfection, sterilization, and appropriate surgical gowning and zoning is critical to minimise the risk of post-surgical infections. Prophylactic antibiotics, such as 2 grams of amoxicillin administered orally one hour before surgery, have been shown to significantly reduce implant failure rates under standard conditions (Esposito et al., 2010; Keenan & Veitz‐Keenan, 2015).

 

Local anatomical structures

Anatomical Visualisation:

A comprehensive understanding of the local anatomical structures is essential during implant placement. For example, implants should be positioned no closer than 1.5-2 mm from the mental foramen, which should be clearly visible during the osteotomy. Other critical structures include the incisive canal and the concavities of the buccal and lingual bone, all of which must be accurately identified to ensure correct implant placement.

 

Radiographic and Clinical Confirmation:

Radiographic imaging can help identify anatomical variations or pathologies that may impact the procedure. However, these findings must be confirmed clinically by raising a sufficiently large surgical flap to thoroughly inspect the area. This approach also helps to prevent inadvertent damage to adjacent roots during the osteotomy.