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STEP 5: Tapping and Final Positioning of Implant

This step involves tapping of the implant using the seating instrument and a surgical mallet. The mallet should be used only lightly so as to achieve initial stability. The placement head is then removed and the implant driver is placed into the internal hex of the implant, attached to a ratchet. Three full clockwise turns is done to place the implant into its final position.

The cover screw is then placed and tightens with the cover screwdriver. The trapezoidal flap is then reposition forward to an extent that the implant is totally covered. Careful suturing is then done with either resorbable or non-resorbable suture material, either silk or Vircryl are material of choice.

STEP 6: Closure and Postoperative Care

The implants are then left dormant in the bone for about four to six months depending on the quality of bone, for the osseointegration to take place.

In cases of immediate implants, it is imperative that primary stability is achieved. If the implant is not stable in bone and exhibits some mobility, the chance of survival is reduced. It is also worthy to note that postoperative care is as important as the surgical procedure. In many cases, antibiotics and analgesics are prescribed. Immediate loading of the implant with dentures is also not advisable since this will hinder soft tissue healing. After several days, dentures can be used again, however relining of these dentures with soft tissue conditioner is recommended. Temporary prosthesis option may include resin-bonded bridge, which can utilise adjacent teeth as abutment and cemented with a semi temporary cement.

Radiographs should be taken from time one week after surgery and again the day of second stage recovery to examine of the state and condition of both bone and implants and its osseointegration.

Prosthetic Steps

STEP 1 : Exposure of Implant

After three months of healing period, the implant is now ready to be exposed as part of stage 2 of treatment. Local anaesthetic infiltration is given to area of the implant and a crucifix flap is opened. The implant is exposed and cleaned. Overgrowth of bone or soft tissue is cleared around the margins. The cover screw is removed and the inner part of the implant cleaned. A gingival former is introduced and left in for the next two weeks.

STEP 2: Taking Final Impressions

The patient is recalled after several weeks for final impression taking. The gingival former is replaced and an impression coping is introduced and screw tightened into place.

A plastic transfer cap is then placed on top of the transfer coping to enhance accuracy of the impression. Elastomeric impression material such Polysiloxane or Polyether is used for impression taking.

After taking the impression, the impression coping is then removed and gingival former placed back into the implant. The impression coping is then placed into the impression tray for mounting by the technician in the laboratory.

STEP 3: Laboratory Stage

The Impression and abutment (MH 6) is then sent to the laboratory for mounting and the construction of the final crown will now commence. The technician will now mount the MH 6 Abutment on the model and cut the abutment accordingly to the unique specifications of the patient. The porcelain fused to metal crown will then proceed later. Later at chair side, the shade of the crown is checked to the satisfaction of both the patient and clinicians expectation

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