Implant Surgical Placement
(Standards of Care)
1. Review patient's Medical & Dental History and medication Interaction
A thorough medical and dental history is obtained from the patient's dental record to include required medical and/or dental consultations with Periodontics, Endodontics, Oral Surgery, Oral Medicine, Orthodontics.
Review of medical conditions that could make a patient unsuitable for implant treatment or could complicate surgery
Resident should be able to determinate patient’s medication interactions and need for medical consultation.
2. Diagnostic Articulated Casts
Accurate, clean, bubble-free reproductions of the existing dental anatomy and surrounded soft tissue should be fabricated.
Two sets of diagnostic casts, one set as pre-treatment record and a second set for diagnostic wax-up should be accurately articulated at the proposed vertical dimension of occlusion to reveal available mesial-distal, buccal-lingual, and interocclusal space for implant placement.
3. Diagnostic Waxing and Radiographic/surgical Guide
Guides should indicate the desired location and inclination of implants during placement. Radiographic guides will be fabricated for every patient. For overdenture or hybrid prostheses, dentures will be fabricated to the wax stage to determine proper location of implants, type of abutments for stage 2, and ultimately the type of retention mechanism, i.e.: precision attachments, locator, ERA, etc. A surgical guide will be made based on this information. For partially edentulous prostheses, a complete waxing will be completed to determine contours of the final prosthesis, type of prosthesis to be fabricated, i.e.: cemented vs. screw retained, type of abutment for stage 2, etc.: Final position of implants will be based on these decisions. A surgical guide will be fabricated based on this information using conventional guide methods or Nobel Biocare guided surgery methods as needed. Digital technology is to be used when applicable and advantageous to the patient.
4. Diagnostic imaging
Distortion-free intraoral radiographs should be taken. Appropriate imaging of the mandible and the maxilla, and interpret the findings to inform treatment.
Use of cone beam CT is required and should be read with a help of planning software.
Evaluate surgical anatomy and/or pathological process of the maxilla, the mandible and the surrounding tissues.
Accurately identify location of vital structures: i.e. maxillary sinus, mandibular inferior alveolar canal, mental foramen, incisive canal.
Evaluate quality, quantity and morphology of the bone in possible implant sites.
5. Treatment Plan & Implant selection
Upon presentation of photographs, articulated cast, diagnosis waxing and cone beam CT, a plan based on sound surgical and prosthodontic procedures will be formulated.
Prior to initiating therapy, a comprehensive treatment plan, including caries removal, disease control, periodontics, endodontics, etc. must be formulated. All available treatment options must have been presented to the patient prior to beginning therapy.
Know the principles and process of obtaining patient consent form prior to implant treatment: other treatment options, indications and contraindication, advantages and disadvantages.
At this point selection of surgical sites are made and surgical materials are ordered with 15 working days of anticipation. Please see Dental Implant Prosthetic Order Form and submit form to Mail Box Location-Rm.4453 to Rose Morgan at least 15 working days prior to scheduling the surgical procedure.
6. Surgical Procedure
Perform surgery following effective control of infection and principles of aseptic techniques, proper wear of surgical gowns, mask and sterilized non-latex gloves.
Proper medical management of patient, Blood Pressure must be taken at the beginning of each visit.
Practice appropriate record keeping, treatment plan consent, patient consent on day of treatment, axium notes on day of treatment.
Manage appropriate pharmaceutical agents and know interaction with existing medication/s. Understand prescription of pre-operative and post-operative medications- antibiotics,analgesics, anti-inflammatory, antihistamines/decongestants and anti-microbials, ie. Chlorhexadine gluconate oral rinse.
7. Post-Surgical Period
Understand the healing processes that normally occur following implant surgery- stage 1 vs. stage 2 procedures.
Identify early and late complications and do follow-up treatment as needed: i.e. 1 day after immediate placement, immediate loading, extraction and immediate delivery of prosthesis, 7 days after conventional implant placement.
Cover fixtures or healing abutments should be placed accordingly and if not visible clinically a final radiograph confirming seating of the abutment is needed.
8. Phase 2 – Surgery
Understand need for stage 1 or stage 2 surgical procedures. Transmucosal abutments will be placed at the appropriate time. Understand selection of mucoperiosteal flap, apical reposition flap or tissue punch for stage 2 procedures. Complete seating of the abutments to underlying fixtures must be verified radiographically, if not visible clinically.
9. Home Care Instructions
Instruct patient of surgical care, Coe-pack placement, use of reusable insulated cold pack, chlorhexidine rinse. A demonstration of the proper cleaning and care of the interim prosthesis must be given to the patient at the time of insertion. The patient should be given a follow-up appointment to evaluate and reinforce surgical care.
10. Post-Surgical Care
Following insertion of the implant placement, the patient must be seen in 1 day, 7 days or a 2 -week period depending on the type of surgery performed.
11. Standards of Care
All patients will be evaluated utilizing the appropriate standards of care forms.