276 Theories and techniques of oral implantology

Fig. 7-47. Soft wax may be used inside the denture as a guide for relieving interferences from the implant posts.

the protruding implant posts, indentations will clearly show inside the wax (Fig. 7-47). Thus all interfering spots can be easily relieved by grinding away more of the denture.

Subperiosteal implant armamentarium

The basic armamentarium includes a scalpel, a periosteal elevator, a contra-angle, a tapered diamond stone, suture needles and .000 silk ligature, hemostats, and a pair of scissors (Fig. 7-48). Heat-less stones are sometimes needed to smooth out kriifeedge ridges.

Tips. Several generalizations may be made about many stages of subperiosteal procedures. Specific de-tails about the various types of suturing will be discussed in a separate section, beginning on p. 287.

Incising soft tissues. The incision line should follow the crest of the ridge as closely as possible so that when the subperiosteal framework is finally set on the bone, the lingual tissue may be pulled labially to join with the labial tissues without interference from the implant posts. This is often a problem when the incision has been made too far labially in the anterior region.

The incision should not extend into the retromolar pad areas, since it can cause postoperative pain and discomfort. The scalpel should be directed buccally as these areas are approached. Also, in order not to cause too much trauma to the soft tissues by overstretching them, vertical accessory incisions are sometimes necessary, usually in the symphysis area. When the mandibular canals are partially or entirely dehiscent, the posterior incision should be made buccal to the canal along the external oblique ridges. Anteriorly, as the incision ap-

Fig. 7-48. The basic armamentarium for a subperiosteal implant insertion.