Implant # 20
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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.
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.
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.
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
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