Before a building is constructed, the land is surveyed and graded according to plan for success of the site. Likewise, a dentist must survey the site for dental implant placement, whether it is for a single tooth replacement or for the restoration of the entire arch.
There are certain parameters that need to be followed by implant surgeons to ensure success. Almost every surgical principle for the successful placement of dental implants relates to having adequate bone around a dental implant and adequate keratinized tissue. With the presence of adequate bone around a dental implant and adequate soft tissue, the likelihood of long-term success increases.
Having adequate bone and soft tissue is directly related to proper treatment planning prior to implant placement. The engineers of implant treatment planning access the site, using CBCT scans and soft-tissue measurements. Before a building is constructed, the land is surveyed and graded according to plan for success of the site. Likewise, a dentist must survey the site for dental implant placement, whether it is for a single tooth replacement or for the restoration of an entire arch.
If teeth are going to be removed, then the presenting architecture must be looked at with respect to the need for bone grafting, either prior to implant placement or during placement. If teeth are not going to be removed, then a CBCT is also used to determine the presenting anatomy.
Having adequate bone around a dental implant also requires that there is adequate spacing between dental implants and/or teeth. This is especially the case around adjacent dental implants; there must be at least 3.0 mm of bone between implants. This requires adequate planning, either by using guides or performing it nonguided. In addition, the soft-tissue architecture around an implant site needs to be assessed and treated accordingly to ensure the presence of adequate keratinized tissue. If there is inadequate soft tissue, grafts can be done either prior to or during implant placement.
Performing the correct placement guidelines and surgical steps can avoid prosthetic complications in later years. The best way to avoid receding gums on the facials of dental implants is to make sure adequate bone and soft tissue are there. Another prosthetic complication that can be seen from poor planning is not having enough prosthetic height for a prosthetic option. Through adequate alveoloplasty to set up the correct amount of prosthetic space, prosthetic height problems can be avoided.
Dental implant complications can be prevented through adequate planning and adhering to the principles of vascularity and soft tissue. Building a good foundation will allow for a better, longer-lasting final result.
In this issue, Dr. Randolph R. Resnik, one of our distinguished Implants Today Advisory Board members, has an excellent article addressing the prosthetic complication of screw loosening. Also in this section, Dr. Steven Rasner presents the second in a 2-part series on exodontia techniques. It is a fitting example of how the early steps in implant treatment are extremely important.
If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.
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