3.5 Implantology

Unit 3 - OMS Procedures

The basis of dentistry is the prevention of oral disease. Wear and tear, and trauma can cause tooth loss regardless of prevention practices. These healthy patients are perfect candidates for tooth replacement by dental implants.

A dental implant is an implantable medical device that replaces single teeth, multiple teeth or entire arches.

Once it’s determined that the patient is a good candidate for dental implants and the treatment plan has been elected, the next aspect of implantology to consider is system. System is usually determined by the referring dentist or lab that a dentist is using to fabricate the prosthetic portion of the implant (crown, bridge, or denture).

KEEP IT STERILE: There is a high risk of bone infection (osteomyelitis) when placing dental implants because the surgery involves drilling into bone. Osteomyelitis can be disastrous to a successful dental implant because it is difficult to rid the bone of infection, and maintaining asepsis and sterile surgical procedures are the best method of prevention.

Categories:

  • First Stage
  • First Stage with Provisional Appliance/Denture Conversion
  • Second Stage
  • ISQ Test

Implants are lengthy invasive procedures that can introduce bacteria into bone

The First Stage of implant placement requires the Sterile Technique and is usually performed under IV sedation.

Armamentarium FIRST STAGE:

Front Counter
Back Counter and Unit Pre-Op
Back Counter Pre-Op
Back Counter Complete
Unit Complete
Mayo Stand Complete

• REMOVE FORCEPS and TOOTH ELEVATORS from OMS TRAY
• Suction and Irrigation Tray

PROCEDURE SPECIFIC CHECKLIST:
Italics = OPEN ONLY AS DIRECTED

• #12 scalpel blade
• 
#15 scalpel blade
• Barriers (sterile): light handles, unit handle, hose covers
• Bite Block: edentulous
• Bone Mill
• Bone Trap with suction tips
• Cautery
• Chlorhexidine & Bowl: for provisional appliance
• 
Discoid/Cleoid carver
• 
Face Prep Sponge
• Gauze: sterile 2×2’s & 4×4’s
• Graft Bin: allograft, bone scraper, membranes
• Handpiece and Hose
• Implant Handpiece
• Implant Surgical Kit
• Implants
• Implant Healing Abutments/Cover Screws
• Kidney Basin
• Magnetic Drape
• 
Patient Drape: sterile (large)
• Personal Protection Equipment: Sterile Gowns, Sterile Gloves, Bonnets, Masks
• Retractors: Right Angle
• 
Saline: sterile
• 
Set-Up Pack: sterile back counter drape, mayo stand drape
• Sinus Instruments: maxilla (include osteotomes and mallet)
• 
Suction Tubing
• 
Sutures: 3.0 or 4.0 chromic gut (surgeon’s preference)
• Sutures: silk
• Sutures: vicryl
• Tissue Glue

Prosthetic Appliance (ADD):
• Impression Copings
• Impression Puddy (standard set) & Tray
• Light Body Impression Material: Tips, Gun & Tray
• Replicas

Denture Conversion (ADD)
• Curing Light
• Implant Multi-Unit Abutments (MUA’s)
• Impression Putty (standard set) & Tray
• Marking Pen: sterile
• Prosthetic Kit: for MUA’s
• Tacklebox: copings, chimneys, temporary abutments, comfort caps
• Triad
• Teflon Tape and Fermit

Armamentarium SECOND STAGE:

2nd Stage Tray
ISQ Tester
2nd Stage Complete

• REMOVE FORCEPS and TOOTH ELEVATORS from OMS TRAY
• Suction and Irrigation Tray
• Healing Abutments

Preoperative Considerations:
• Follow written Pre Op Instructions.
 Check if a denture will be converted following surgery: ensure that denturist or dentist has coordinated fabrication.

Intraoperative Considerations:
 Grafting often occurs during surgery: ensure that grafting materials are in the operatory.
Excessive bleeding during surgery may require the use of cauterization. Ensure that the cautery unit is at hand.
Effective assisting is required: do not desiccate surgical site with suction, and be mindful of the mental foramen and the inferior alveolar nerve.

Postoperative Considerations:
• Follow written  Post Op Instructions.
 T
here is a risk of peri-implantitis which is a latent inflammation of the periodontium (it’s not caused by the surgery itself, rather it is caused by other risk factors such as poor oral hygiene, and smoking: POST-OP CONSIDERATIONS!!
 Care of provisional: healing abutment, temporary crown or denture
 No chewing on provisional until integration is confirmed

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