A dental implant navigation system includes handpiece and jaw attachments, a motion tracker sensor, motion tracker software, and cameras. This technology is used to create real-time imagery and calculations of where dental tools are in relation to the patient’s jaw so dental implants can be placed precisely where they should be, with accuracy of about a millimeter or so. An image of the patient’s jaw and tooth structures is created within seconds by a CT and with some systems, can include digital impression data. This technology is likened to GPS and allows periodontists and oral surgeons to fully visualize the patient’s mouth and the instrument in their hand in real-time. Dental implant navigation systems allow periodontists to perform flapless surgeries and reduce the necessity of bone augmentation and custom abutments. Overall, these navigation systems enable dental professionals to provide less invasive, safer, and faster care.
A hard tissue graft is used to restore bone height and stimulate the growth of new bone in patients who have lost teeth. A bone graft should be done following tooth loss or extraction to prevent atrophy in the remaining bone and in the gum tissue surrounding it. Following a hard tissue graft, the patient may also require a gum graft. This process removes tissue from another part of the mouth then grafts it onto the existing tissue in the area requiring attention. There are several different options for this procedure and the one selected will depend on the tissue available within the patient’s mouth. The amount of gum pain that a patient may feel, as well as the nature of their gum tissue graft recovery, will vary from one individual to another. While there are not separate gum insurance options, many dental insurance plans will cover gum graft costs.
The structure of bone is an important consideration for the size, type, and surface of dental implants. Haversian canals are microscopic tubes or tunnels in cortical bone that house nerve fibers and a few capillaries. This allows bone to get oxygen and nutrition without being highly vascular. These canals also communicate with bone cells using special connections, or canaliculi. This connection facilitates the deposit and storage of mineral salts, which essentially gives bones their strength. Haversian canals are formed by lamellae, or concentric layers of bone, and are contained inside osteons. Osteons are cyndrylical structures that transport oxygenated blood to bone, and they are arranged parallel to the surface of the bone, along the long axis. Osteons that have intact Haversian canals comprise about 45% of cortical bone, or a little less than half. Haversian canals and osteons are part of the Haversian system, which allows nutrients to pass between the blood and bone.
The human body possesses the incredible ability to heal itself over time. Cells, which are living units that are the foundation of the body; they renew themselves constantly and work to bring the body back to “normal,” or a state of homeostasis. They operate according to instructions found within the DNA, or the body’s unique “blueprint” for life. This includes a healing mechanism: cells that are damaged may be able to repair themselves, and cells that are destroyed are replaced. Healthy cells surrounding an injury, which is essentially a group of destroyed cells, will begin to replicate quickly. At the same time, platelets are sent to the area to stop any bleeding, and white blood cells start digesting dead cells to make room for new ones. When healing is complete, the process simply stops on its own. The body is constantly in a state of healing itself, generating new cells and replacing dead or destroyed cells.
A healing abutment is a special type of abutment designed to facilitate the healing of bone and soft tissue around a dental implant. It takes approximately 4-6 weeks for the gums to heal after a healing abutment is placed, after which a final abutment can be placed. After much research, it was discovered that the material of an implant and its properties — most notably the topography of its surface — plays a significant role in the healing of the tissue around it. Two zones of oral tissue come into contact with healing abutments: fiber-rich connective tissue, and junctional epithelium. These tissues react to the surface texture and chemical composition of the material, and the ability of tissue cells to adhere to the surface of the implant depends largely on the lack of surface contamination and the hydrophilicity of it. While some dental professionals advocate the reuse of healing abutments after sterilization, new abutments should be used for each patient.
Healing by first (primary) intention, or primary closure, refers to the healing of a wound in which the edges are closely re-approximated. In this type of wound healing, union or restoration of continuity occurs directly with minimal granulation tissue and scar formation. It works best with wounds or incisions where there has been little loss of tissue. Healing by primary intention is often used in a surgical setting where a clean incision is present. The wound is closed by using skin adhesive, staples, Steri-Strips, or sutures. This is the opposite approach to the one taken by secondary closure, or healing by second (secondary) intention, in which a gap is left between the edges of the wound for natural healing to occur. In dental applications, primary closure may be used following an oral surgery, implant, or restoration procedure where there has been little tissue loss to help prevent infection and aid in the healing process.
Healing by second intention, also known as secondary closure, is the healing of a wound in which a gap is left between its edges. Union occurs by granulation tissue formation from the base and the sides. This requires epithelial migration, collagen deposition, contraction, and remodeling during healing. Healing by second or secondary intention differs from healing by first or primary intention in that it does not bring the edges of the wound or incision into contact with each other. Healing by first intention is best used in situations where there is a clean incision with little tissue loss while healing by second intention may take place when there is not enough tissue to bring the edges of the wound together for suturing or stapling. Secondary closure is considered the most important type of bone healing in procedures that include maxillo-facial surgeries. It occurs through cell proliferation which eventually becomes lamellar bone.
The healing period, also known as the healing phase, is the time allocated for healing following one surgery and before the next surgery that will be performed at the same site. Dental implant preparations often require more than one procedure to achieve the final product. For example, some patients require bone augmentation procedures before an implant can be placed. The time between the bone augmentation and the implant placement is the healing period or healing phase. This phase may be necessary before subsequent procedures for several reasons including to allow for decrease in swelling and inflammation in affected tissues, to provide time for incisions to heal and for bone osseointegration, and to provide an opportunity for any complications to be addressed and resolved. The healing period allows the procedure site to be in the best possible condition for the success of implant and prosthesis placements or for other subsequent surgeries.
Heat necrosis is cell death caused by effectively prolonged exposure of bone to elevated temperature such as during an osteotomy preparation. An osteotomy is a procedure that cuts, shortens, lengthens, or otherwise reshapes a bone. In dentistry, osteotomies are required in some patients because of a condition where the bones of the face do not meet with the bite position of their teeth. In order to correct this, an osteotomy is done on the lower jaw to bring it into a correct position for proper bite alignment. Heat necrosis can occur during this type of procedure due to the friction involved in bone cutting. To avoid this type of cell death, an osteotomy may be performed using a piezoelectric device. Such devices allow for precise cutting of bone without substantial damage to the surrounding soft tissues. Piezoelectric surgical devices utilize ultrasound technology rather than traditional cutting methods to reduce cell death due to heat necrosis.
A hematoma is a localized mass of extravasated blood, usually clotted, that is relatively or completely confined within an organ or tissue. Hematomas differ from smaller bruises in that the latter occur as a result of damage or injury to small blood vessels while the former comes from damage to larger blood vessels. A hematoma can occur in dentistry following a surgery, treatment, or other oral procedure where the tissues of the mouth are manipulated in such a way that blood vessel damage can occur. Though hematomas are generally not dangerous and can be a common side effect of some dental procedures, the practitioner will often examine it to ensure it will heal without additional aid. Some patients experience a hematoma following an injection used to numb or block the sensation in the tissues around a dental procedure site. Most hematomas will resolve on their own.