Implant Bed Preparation and Placement
Implant bed preparation protocols are specific to each implant system but generally involve the use of sharp drills, adequate irrigation, and careful adherence to the drill sequence to avoid bone necrosis. Atraumatic surgical techniques should be employed, with osteotomy drill speeds kept below 800 rpm and ample cooling with saline to minimise tissue damage.
Implant Placement:
Before implant placement, the area is numbed with local anaesthesia. Implants are then placed according to the pre-planned locations, often with the aid of a surgical guide, especially in more complex cases. Depending on the situation, a restoration may be placed immediately, or a healing abutment may be used to protect the implant and promote healing.
Assessment of implant stability
Primary Stability:
Achieving primary stability is crucial for the success of the implant. In cases with weaker bone, using parallel-walled implants or those with actively engaging threads can enhance stability. However, care must be taken not to over-tighten the implant, as this can increase the risk of fracture during insertion.
Measuring Stability:
Implant stability can be measured using torque measurements, either through a digital implant motor or a manual torque wrench. Additionally, the Implant Stability Quotient (ISQ) is a method of assessing stability by measuring the vibration of the implant, with a scale ranging from 1 to 100. An ISQ range of 55 to 85 is generally considered acceptable.
Wound closure
In a one-stage procedure, the implant and healing abutment are placed during the same surgery, leaving the healing abutment exposed during the healing period. In a two-stage procedure, the implant is submerged under the soft tissue and requires primary wound closure to protect it from bacterial contamination. This approach necessitates a second surgery to expose the implant and place the healing abutment after.
We would like to acknowledge Dr. Manraj Kalsi for his insights and contributions to this page