Implant Placement #19

As we move forward implant placement will no longer be alternative treatment, but will in fact become standard of care (if not already). The general dentist will be the front line for patients seeking this level of care. The general dentist who embraces implants and goes onto implement the SURGICAL aspect will benefit greatly.

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Most generalists are typically hesitant to enter into surgical placement of dental implants. While there is no such thing as ‘easy’ implant placement, there are certain cases that are ideal for placement by the hesitant general dentist. Replacement of upper and lower premolars are such sites. They typically present with ideal bone quality and generally free from the vital structures, such as maxillary sinus and inferior alveolar nerve, that are the cause of hesitation for general dentists. By starting with these ‘easier’ cases the dentist can then slowly move into the next level of implant treatment to replace lower molars.

This case study demonstrates the replacement of a lower molar with a dental implant. This particular case was done without the use of flap. However, please note that the use of a flap is critical for ensuring success and cases without flaps should tried once a level of competence is achieved.

Pre-Operative photo shows edentulous site #19. There is plenty distance between #18 and #20 and the only hurdle is the slight boney defect on buccal of implant site.

Pilot drill is used to make initial osteotomy. The pilot allows for evaluation of angulation for ideal restoration in future.

Here a nobel ‘dummy’ abutment was placed in the pilot osteotomy to evaluate the location of abutment to ensure ideal placement.

The full osteotomy is commenced with initial drill to final implant depth.

The second osteotomy drill was then used to further expand osteotomy

Final osteotomy drill was taken to appropriate depth to complete the osteotomy.

The implant being carried to osteotomy site. Implant Direct Screwplant 4.7mm X 8mm

Implant being ‘tapped’ into place. Implant gains initial stability by self-threading into slightly undersized osteotomy.

Implant abutment being removed from implant to allow for placement of cover screw healing abutment.

Single stage surgery being completed by placement of healing collar.

Final implant placement with healing abutment in place.

Final implant placement with healing abutment from occlusal view. Note placement in mesio-distal and bucco-lingual directions.

Implant placement will become a large part of dentistry – whether for replacement of single teeth, multiple teeth, fixed edentulous restorations, or as aid in implant reinforced removable prosthetics. The key is for the general dentist to become capable and confident in the restoration of such cases. Even more important will become the ability to surgically place the implants. It starts with ‘simple’ cases and then can progress to more complex cases.