CHAPTER 7 Operative tips

Because the field of dental implantology is relatively new, it is necessary to point out a few of the more important considerations involved in using implants, preparing the patient for the intervention, and dealing with possible complications. These considerations range from the highly specific, such as the special instruments needed for a particular operative step typical of only one type of implant, to broad generalizations applicable to all types of implant interventions. Not only must the dentist be familiar with his new tools and their uses, he must also recognize how skills learned in other areas of dentistry may be most effectively applied to particular implant situations.

IMPLANT INSTRUMENTATION

Each type of implant has implements suitable to its insertion. Some of the instruments may be used for most insertions; others have special uses, depending upon the type of implant used and its intended location in the dental arch.

Post type implant armamentarium

To insert R. Chercheve's spiral-post implant and Linkow's vent-plant, drilling, screwing, and various miscellaneous instruments are needed.

Drilling instruments. Drilling instruments include a belt-driven, latch type contra-angle with a water attachment and burs (Fig. 7-1). A No. 6 round bur, a spear-point bur, or a hollow-mill trephine is used for entering the bone. The bone may be approached either directly through the fibromucosal tissue, or the tissue may be first incised and reflected, a preferable method.

Helical burs are used to gradually widen the site. The number of helical burs needed depends on the type of implant and its diameter. The first used with the spiral-shaft implant is wider than the initial round or spear-point bur, and the last is narrower

than the taps. With the self-tapping vent-plant the last used is slightly narrower than the implant itself.

Screwing devices. A ratchet is used to screw both the taps and the implants into the bone (Fig. 7-2). At least two prolongators are needed to engage the narrower shaft of the implant to the head of the ratchet. One prolongator should be much longer than the other.

To finally prepare the site for a spiral-post implant, two taps are needed. The first is slightly narrower than the implant, the second the exact diameter.

Miscellaneous materials. Duplicate implant shafts are needed for facilitating laboratory procedures (Fig. 7-3). Interchangeable prefabricated gold copings should be on hand for placement over the seated implant shafts (Fig. 7-4). These will be picked up in a plaster index for rapid completion of the prosthesis. A very sharp scalpel for incising the soft tissues and a periosteal elevator for reflecting them are needed if the bone is to be exposed.

A paralleling device may be used, if desired, when two or more implants are to be inserted. One type of device is a specially designed unit that attaches to a contra-angle (Fig. 7-5). An extension arm bears a pin bent at a right angle that is held firmly against either the tooth or another implant. This permits drilling a hole parallel to the guide tooth or implant.

Sometimes templates can be fabricated to act as paralleling devices (Fig. 7-6). These are made from an impression of the entire arch and contain either holes or tubes through which the implants are inserted. Although such templates seem to be a good idea, particularly when inserting several implants, the danger of perforating the buccal or lingual plates of bones is increased with such a device. Be-cause the mucoperiosteal tissue may have camouflaged the true shape of the alveolar crest, inserting

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