The Planing Phase.
This is the most important phase of the whole procedure. In this stage we assess the presence of any risk factors (plaque control, smoking, periodontal disease, systemic disease), the feasibility of the proposed treatment options, the position of the teeth, the amount of bone and the types of soft tissues at the site. We will assess the surgical site using cone beam radiographs and this will allows us to plan the angulation, length and size of the implants that can be supported. We also assess if there are any nerves or blood vessels near the site. We will also take study models which are used to further confirm the positioning of the replacement teeth and implant position.
Once all of these factors are assessed, in most cases we will construct a surgical guide to help us to place the implant as close as possible to the ideal position. The better the positioning the better and easier it is for the restoring dentist to place the crown components of the implant. Accuracy is important.
The Surgical Phase.
This can occur at several time frames after extraction of a tooth: 1) immediately upon extraction; 2) after an adequate healing phase (usually between 8 and 12 weeks minimum); or 3) years later.
The procedure to place an implant takes 30 to 60 minutes for one implant and not much more time for multiple implants. The amount of planing done prior to surgery is usually reflected in a reduced surgery time even with multiple implants. The number of appointments and time required, vary from case to case. The procedure is usually performed under local anaesthetic. We usually use a surgical guide to facilitate as close to ideal placement of the implant as possible.
We will give post-surgery instructions as to how you need to look after the surgery site to reduce the possibilities of post-surgical complications.
The Healing Phase
This can occur in several phases: 1) If the implant crowns are placed immediately as in the “all on four™” or “restore of four™” procedures the healing phase is part of the process and reduction in loading and usage is required during this phase even though the components are present; or 2) After the usually accepted healing phase of 8-12 weeks (minimum).
The healing phase post-surgery is dependent upon a number of variables and these include whether you have a systemic disease, smoke or have a history of periodontal disease. This phase is all about allowing the bone to grow to and integrate with the titanium. Like with a broken bone it takes a minimum of 6 weeks but can take longer in some individuals. Whilst it may have grown to integrate with the implant the maximum strength of the bond with the bone takes another 2-4 weeks. Whilst some clinicians place the crowns on the implants at 8 weeks we feel that we offer a reduced risk of displacement by waiting a few extra weeks. At the end of the healing phase the periodontist places an abutment (support post) or a healing cap onto the implant. This allows gum tissue to mature and provides access to the implant prior to placement of the crowns.
The Restoring Phase.
This usually is performed by the restoring dentist (either your dentist of a specialist). We work with them in both the planning stage and later to try to provide you with the best outcome. This may be done on the same day for the “all on four™” or “restore of four™” procedures but a normal healing phase of 8-12 weeks (minimum) is the more accepted approach as it gives a better outcome certainty.
The Maintenance Phase.
This is the most important of all the phases of treatment. Once the crowns have been placed on the implants we like to review your case to ensure that you know how to clean the crown components correctly. After ensuring that you know how to look after the implants we then will arrange for maintenance appointments. The frequency of these will depend upon the susceptibility to potential factors that may increase biological complications. These appointment need to be with both the periodontist to try to prevent biological complications and with the restorative dentist to prevent or avoid complications with the crown components.
© Penam Investments Pty Ltd 2014
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