In one-stage grafting procedures, there is a simultaneous implant placement where primary stability is achieved followed immediately by grafting procedures to fill the remaining defect and/or to support the soft tissue. Following the placement of an implant, some patients may still not have enough of the soft tissues needed to create a pleasing post-surgical aesthetic. In order to correct this, a soft tissue—or even a hard tissue—graft may be done immediately following implant placement both for the support of the implant and for a more normal appearance. Soft tissue grafting may be done by utilizing the pouch technique to add contour and bulk to the tissues surrounding the implant. A good source for graft material can be found in the subepithelial connective tissue. Harvesting tissue from this location has several benefits including a lower chance of necrosis and a higher volume of soft tissue harvesting.
A one-stage implant, also known as a nonsubmergible or single-stage implant, is an endosseous dental implant designed to be placed following a one-stage surgery protocol. The implant is designed with a transmucosal coronal portion. Usually the transmucosal portion and the implant are one piece with no microgap. A one-stage implant is often used when the patient has very good bone quality and density ensuring that the implant will be stable upon placement. A one-stage implant places a healing abutment into the bone at the time of a one-stage surgery. The tissues around the abutment are given time to heal for up to six months before the prosthesis is attached. One-stage implants may also be used in areas of the mouth where cosmetic appearance is not a significant issue. For patients who do not have good bone quality or who have insufficient bone, a two-stage implant procedure may be utilized.
A one-stage surgery is a surgical protocol consisting of placing an endosseous root-form dental implant in bone and leaving it in contact with the oral environment during the healing process. This approach eliminates the need for a second surgical procedure. A one-stage surgery is generally used in a situation where the patient has good bone quality and depth and where the cosmetic appearance is not an immediate concern. The one-stage surgery is usually utilized in conjunction with the one-stage implant in which a healing abutment is placed and left exposed at the time of the surgery. In contrast, the two-stage surgical approach is best used for patients who have insufficient or poor-quality bone. In this type of procedure, the implant is placed, and the gum tissue closed over the top to allow for healing. Following proper healing, the gum tissue is opened again, and the abutment and prosthesis placed.
A bone graft in dental implantology is often needed to support weakened or deteriorated bone prior to placing a dental implant. This procedure involves grafting a section of donor bone — either from another part of the patient’s mouth or from an external donor. There are many different materials used for bone grafts and many types of grafts that can be done based on the patient’s needs and desired clinical outcome. An onlay bone graft is a widely used type of graft that involves laying the donor bone directly on top of the recipient bone’s surface. A membrane is typically applied, either resorbable or nonresorbable, to protect the graft from bacteria and soft tissue cells that can impede bone regeneration. During the 4-6 month healing period after an onlay bone graft, the patient’s natural bone will begin to fuse with the bone graft, also called osseointegration. Then, the patient will be ready for an implant.
An open-ended wrench is a type of dental wrench that has a U-shaped end. The neck of the wrench is tilted forward at roughly a 45-degree angle to allow more access to the oral cavity, particularly the back teeth, and also to make the surgeon’s job a little easier. However, some straight-necked open-ended wrenches are available and which to use depends on the type of dental work needing to be done and the surgeon’s preference. Its unique design allows the implant surgeon to hold the mount in place while attaching it to implants with screw-type ends. In most cases, it’s used with external hex connection dental implants. Some open-ended wrenches have a handle on the bottom, while others are designed to have an open-end wrench on either side of the tool and to be held in the middle of the tool. An open-ended wrench is an essential part of the dental implantologist’s toolbox, along with torque wrenches, spring wrenches, ratchet wrenches, and more.