incisions

Surgical incisions

Traditionally, an incision is made over the crest of the site where the implant is to be placed. This is referred to as a 'flap'. Some systems allow for 'flapless' surgery where a piece of mucosa is punched-out from over the implant site. Proponents of 'flapless' surgery believe that it decreases recovery time while its detractors believe it increases complication rates because the edge of bone cannot be visualized.^[17][18]Because of these visualization problems flapless surgery is often carried out using a surgical guide constructed following computerized 3D planning of a pre-operative CT scan.

[edit]Healing time

The amount of time required for an implant to become osseointegrated is a hotly debated topic.^[19] Consequently the amount of time that practitioners allow the implant to heal before placing a restoration on it varies widely. In general, practitioners allow 2–6 months for healing but preliminary studies show that early loading of implant may not increase early or long term complications.^[20] If the implant is loaded too soon, it is possible that the implant may move which results in failure. The subsequent time to heal, possibly graft and eventually place a new implant may take up to eighteen months. For this reason many are reluctant to push the envelope for healing.

[edit]One-stage, two-stage surgery

When an implant is placed either a 'healing abutment', which comes through the mucosa, is placed or a 'cover screw' which is flush with the surface of the dental implant is placed. When a cover screw is placed the mucosa covers the implant while it integrates then a second surgery is completed to place the healing abutment.

Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for esthetic reasons. Some implants are one piece so that no healing abutment is required.

In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labeled "Immediate Loading". In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the implant while it integrates with the bone.

[edit]Surgical timing

There are different approaches to place dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction implant placement.
2. Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
3. Late implantation (3 months or more after tooth extraction).

According to the timing of loading of dental implants, the procedure of loading could be classified into:

1. Immediate loading procedure.
2. Early loading (1 week to 12 weeks).
3. Delayed loading (over 3 months)

[edit]Immediate placement

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants.

Most data suggests that when placed into single rooted tooth sites with healthy bone and mucosa around them, the success rates are comparable to that of delayed procedures with no additional complications.^[21]

[edit]Use of CT scanning

When computed tomography, also called cone beam computed tomography or CBCT (3D X-ray imaging) is used preoperatively to accurately pinpoint vital structures including the inferior alveolar canal, the mental foramen, and the maxillary sinus, the chances of complications might be reduced as is chairtime and number of visits.^[22] Cone beam CT scanning, when compared to traditional medical CT scanning, utilizes less than 2% of the radiation, provides more accuracy in the area of interest, and is safer for the patient.^[23] CBCT allows the surgeon to create a surgical guide, which allows the surgeon to accurately angle the implant into the ideal space.^[24]

^{source: wikipedia}

Types

Some of the more common are:

• Endodontic (surgery involving the pulp or root of the tooth)
  • Root canal
    • Pulpotomy The opening of the pulp chamber of the tooth to allow an infection to drain; Usually a precursor to a root canal
    • Pulpectomy - The removal of the pulp from the pulp chamber to temporarily relieve pain; Usually a precursor to a root canal.
  • Apicoectomy - A root-end resection. Occasionally a root canal alone will not be enough to relieve pain and the end of the tooth, called the apex, will be removed by entering through the gingiva and surgically extracting the diseased material.

• Prosthodontics (dental prosthetics)
  • Crowns (caps) — artificial coverings of the tooth made from a variety of biocompatible materials, including CMC/PMC (ceramic/porcelain metal composite), gold or a tin/aluminum mixture. The underlying tooth must be reshaped to accommodate these fixed restorations
  • Veneers — artificial coverings similar to above, except that they only cover the forward (labial or buccal) surface of the tooth. Usually for aesthetic purposes only.
  • Bridges — a fixed prothesis in which two or more crowns are connected together, which replace a missing tooth or teeth through a bridge. Typically used after an extraction.
  • Implants — a procedure in which a titanium implant is surgically placed in the bone (mandible or maxilla), allowed to heal, and 4-6 months later an artificial tooth is connected to the implant by cement or retained by a screw.
  • Dentures (false teeth) — a partial or complete set of dentition which either attach to neighboring teeth by use of metal or plastic grasps or to the gingival or palatial surface by use of adhesive.
  • Implant-supported prosthesis — a combination of dentures and implants, bases are placed into the bone, allowed to heal, and metal appliances are fixed to the gingival surface, following which dentures are placed atop and fixed into place.

• Orthodontic treatment
• Implants and implant-supported prosthesis — also an orthodontic treatment as it involves bones
• Apiectomy — also an orthodontic treatment as part of the underlying bone structure must be removed.
• Extraction — a procedure in which a diseased, redundant, or problematic tooth is removed, either by pulling or cutting out. This procedure can be done under local or general anesthesia and is very common — many people have their wisdom teeth removed before they become problematic.
• Fiberotomy — a procedure to sever the fibers around a tooth, preventing it from relapsing.
  
  source: wikipedia