Operative phase - Implantology
The following describes the procedure for placing a two-phase implant. Work must be carried out under sterile conditions. The treatment takes place under local anesthesia.
- Folding up the mucoperiost. A few incisions are made in the mucosa, after which the mucosa and the underlying perioste are shifted. The jaw bone is now visible.
- Possible corrections of the jaw bone. The location of the implants is determined and sharp bone edges or bumps are corrected.
- Preparation. It is preferable to use a drilling template or drilling template whenever possible. First, a so-called "pilot drill" indicates the location and direction. The preparation with the first drill is then designed. No heat may be generated when drilling into bone, as this will cause the bone to die (necrosis). The drill is therefore cooled. Cooling takes place with a sterile physiological saline solution. After preparation with the first drill, the length and direction can be checked by placing a length meter in the preparation and thereby assessing the direction and depth both clinically and radiographically. Adjustments in direction and depth are still possible at that stage. In addition to length and depth, any parallelism must be checked (see image below).
a The drilling template is placed in the mouth. b The jaw is prepared.
- Inserting the implant. If direction and length are correct, the implant bed is further prepared to the correct diameter with successive drills. After preparation, thread can be applied in advance with the aid of a screw tap. Finally, the implant is placed sterile in the bone. The implant is fitted with an internal cover screw.
- Bone augmentation. In some cases, additional build-up of (artificial) bone is necessary. The (artificial) bone is applied and positioned in the correct shape. A soluble (resorbable) membrane is applied over the artificial bone.
- Close the mucosa. The mucoperiost is folded back and stitched very precisely. During the healing of the mucous membrane, no perforations to the implant should occur. In some cases, the implant and the possible bone structure take up more space than the mucoperiost allows. By cleaving the periost (bone fleece), the lap becomes more flexible, so that the wound can still be closed without tension.
- Healing. A period of rest now follows, during which the implant must grow completely unloaded into the bone.
- Releasing. Depending on the bone quality, the stability of the implant during placement and the presence or absence of bone augmentation, the implant is looked up again after a period of three to five months by a small incision or a special punching knife. The cover screw is removed and replaced with a healing abutment. The gingiva heals around it and the top of the implant now remains visible in the mouth and projects slightly above the gums (see image below).
Steps during the operative phase: a before the operation. b The mucoperiost is folded up and the bone is prepared. c The implants are fitted. d The mucoperiost has been replaced and attached.