Insertion Sequence

When bladevents are to be the only artificial abutments, one surgical session is usually sufficient for their insertion. All sites are exposed. As each groove is made, its bladevent is tried in, but not finally seated. Trial insertion helps ensure that the implant fits its socket and gives an opportunity to compare the angle of the bladevent's post with that of other abutments. Final seating is usually delayed until all bladevents are ready, with their posts bent parallel to other abutments and perpendicular to the occlusal plane. This step-by-step method of insertion provides a checks-and-balance system during seating, and permits easier access to the arch by not forcing the operator to work around protruding implants.

When any form of subperiosteal implant is involved, at least two surgical sessions are needed — one to get a direct bone impression for designing the implant, and another to insert the finished product.

The insertion sequence is more complicated when endosteal and subperiosteal implants are used in the same arch. The sequence depends mainly on the relationship of the implants to one another. For example, when a toroplant or pterygoid extension subperiosteal implant incorporates anterior bladevents, the bladevents must be seated first so that they may be included in the direct bone impression used to design and fabricate the subperiosteal implant. How-ever, suppose a unilateral subperiosteal implant is to be used in combination with bladevents elsewhere in the arch. The subperiosteal implant is fabricated first and after the finished implant has been tried in the site and found acceptable, the bladevents are inserted. Thus all implants are inserted at the same session, leaving all in the jaw a minimum amount of time before the final prosthesis is cemented.

It is vitally important to protect any type of implant from occlusal trauma. In many partially edentulous situations, the implant's abutment post falls short of occlusion. In a totally edentulous arch, it is essential to avoid an implant's prematurely contacting an opposing tooth. A temporary splint or the old denture hollowed out and relined is usually appropriate.

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