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  Implant # 20

The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. Photos courtesy Jared T Buck - ROOTS

From: Fred Barnett
Sent: Saturday, February 28, 2009 3:32 AM
Subject: [roots] 2nd stage surgery

from 2nd year super star.....Fred

2nd Stage surgery from implant #20 today:

59 y.o. female, implant placed 13 weeks prior.  Tried to keep 
incision to a minimum, but I was unable to locate the head of 
the implant because it was buried in bone! I extended the flap 
and then using hand instruments from a perio sugery setup,
gently removed the new bone.   Exposed the cover screw, removed 
it and placed a healing abutment.   After tissue maturation, 
I will bring the patient back to torque in the abutment.   
Working through the scope allowed for great visualization of the
field as I pealed back the excess bone, and the rubber not only 
kept the lip and tongue out of my way, but it prevented my patient 
from swallowing implant parts.

Lessons learned:
1. whenever possible place healing abutment at the time of surgery
2. I should have removed the traumatized buccal tissue with a scalpel 
   or punch biopsy    prior to suturing.  Although, in four weeks
   I am confident it will look pretty good.

- Jared T. Buck, D.D.S.

implant tooth #20

implant tooth #20

implant tooth #20

implant tooth #20

implant tooth #20

implant tooth #20 Nice case and great documentation. I don't remeber if you posted the surgery before, but if you used any type of surgical guide you save that and can the use that to locate your 4 mm biopsy punch hole and then dig down from there is you have to. Sometimes, as Jared metioned, placing the healing cap at the time of sx is best- if you can. If you can't or don't use a surgical guide use some fast setting bite registration material (or whatever your speed preference is) to create a quick and easy implnat locator for your uncovery. Basically, you take the long mandrel you use to remove the internal screw from the implant and gently finger snug into the screw (if its an immediate mostly) and then use the bite reg material to capture the adjacent teeth w the mandrel sticking out of the implant and voila you have a stent that will help you locate your tissue punch for the uncovery. Works well, may not be suitable for all occasions. It's a snap to dig out the bone under the scope and keep it flapless. Arturo Amazing bone growth. Dear Arturo, How or what kind of material do you use being non-sterile in your opereation field? I do like the tip! - Drs. J.W.J. Spaargaren I like a fast set (30-60 sec) bite registration material, this is persoanl preference, for me the fatster the better- I have a limited tolerance for time :-). Yes, the material is non sterile, but it does not go into the ext site or ostetomy if you control it and its only there for a minute or so. At the uncivery or exposure appt place it and use a long isnt to go down the hole until it touches the tissue, push to make a mark and then pull the guide out and center a biopsy punch over the mark and take out the tissue core - Arturo

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