Join Dr. Daniel Briskie from the Colorado Surgical Institute as he delves into the intricacies of dental implant procedures. This video covers essential surgical techniques for optimal incision placement and the strategic use of healing abutments versus cover screws. Gain insights into proper suturing methods, the importance of choosing the correct abutment size, and best practices for post-procedure care to ensure successful implant outcomes and minimize complications. Whether you're new to dental implants or looking to refine your techniques, this tutorial offers valuable guidance for enhancing your surgical skills.
Key Surgical Techniques and Considerations
1. Incision Placement:
• Common Mistake: Incorrect placement of the incision line.
• Optimal Technique: Incision should be slightly lingual (1-2 millimeters more than midcrestal) to ensure adequate buccal tissue coverage over the implant, which is crucial for preventing peri-implantitis.
2. Implant Coverage:
• Coverage Proportion: Approximately three-fourths to 80% of the implant should be covered by buccal tissue if incised correctly.
• Importance: Adequate coverage helps in suturing and reduces the risk of tissue opening, thereby minimizing the risk of bacterial infection and subsequent bone loss.
Suturing Technique:
• Skill Level: Acknowledgment that proficiency in suturing varies and improves over time.
• Technique Tips: Ensuring the bulk of keratinized tissue covers the top of the implant to avoid direct exposure of the implant through potential suturing gaps.
Healing Abutment vs. Cover Screw
1. Healing Abutment:
• Advantages: Suitable for scenarios with stable implants (25 newton centimeters or greater); allows for a single surgery approach, letting the tissue heal around the abutment.
• Suturing: Simpler, with generally two interrupted sutures sufficient for closure.
2. Cover Screw:
• Usage Consideration: More lingualized incisions recommended; ideal for initial cases or for dentists gaining experience with implant placement.
• Risk Management: Helps manage the soft tissue better, reducing the risk of bacterial ingress under less ideal suturing conditions.
Selecting the Correct Healing Abutment Size
• Tool: Usage of a tissue height measurer to determine the appropriate height of the healing abutment.
• Common Error: Choosing an abutment that is too short, increasing the risk of soft tissue overgrowth and infection.
• Recommendation: Opt for slightly taller abutments to ensure proper tissue adaptation and sealing.
Closing Technique and Advice
• Suturing Detail: Emphasis on the precise placement and laying down of sutures.
• Final Steps: Surgical site irrigation with a suitable agent (Closis, not Paradex due to its anti-fibrinolytic effect), and application of antibiotic gel (metronidazole) to minimize infection risks.
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