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Transcript of Implant Exposure
Implant Exposure Techniques
Dental Implant Surgery can be performed either as :
Techiques chosen for uncovering the implant depends on :
Premature Exposure of the cover screw
One - Stage procedure
Two - Stage
Characteristics of tissues that overlies the implant .
The amount of attached gingiva .
The thickness of overlying mucosa .
The Presence or absence of interdental papilla .
The early exposure of the cover screw results in breakdown of the mucosal seal inflammation & mucosal damage accelerate early peri-implant crestal bone loss.
HOW TO TREAT
Implant exposure techniques for second-stage surgery can be divided into:
Excisional or “destructive”
because excisional techniques reduce the width of the fixed mucosa .
Incisional techniques preserve the soft tissues at the implant site, and they can be classified into two categories:
1-without tissue transference
2-with tissue transference
For fixed mucosa greater than 4 mm
For fixed mucosa between 1mm and 4mm
For patients with too little mucosa.
a free-gingival graft preceding incisional technique
To Determine which technique to employ
the amount of preoperative fixed gingiva can help clinicians :
At times, the excisional method can be preferred
even if the attached gingiva is insufficient, as is the
case with mandibular implants, with which there is no other choice but to perform a connective tissue graft taken from the palate at a later time .
Without tissue transference
Cross - type Incision "+"
if implant site cannot be accurately located a midcrestal incision is performed .
Diagonal Incision "X"
With tissue transferance
The first action is to completely expose the implant the cover screw is then removed the implant body irrigated with chlorhexidine 0.12% a permucosal extension is then inserted into the implant .
Rotated Palatal Flap
The T-shaped incision
After reflecting the flap , A T- shaped incision is made on the buccal aspect of the flap to allow both sides of the flap to slide laterally to fill the spaces between the healing abutments & adjacent teeth .
Pouch Roll technique
A surgical approach to increase the keratinized tissue width in maxillary implant uncovering .
A surgical technique to restore a papilla-like tissue
(unilateral Semilunar Incision )
The attached masticatory mucosa is displaced buccally , thereby increasing the tissue volume at the buccal side of the implant(s).
The repositioned buccal tissue is stabilized by the connected abutments , the excess buccal tissue allow for dissection & rotation of pedicles with the purpose of filling the inter-implant space with papilla like tissue .
The main objectives of the proposed technique are to enhance the marginal gingival thickness for a more stable gingival margin around the dental implant & to augment a mild to moderate soft tissue deficiency on the buccal aspect of a dental implant site .
Criteria for Evaluation of Successful Implants at II stage surgery :
1- Rigid Fixation
2- Absence of crestal bone loss
3- Absence of Pain
4- Adequate Zone of Keratenized Gingiva
5- Sulcus Depth 4 mm
6- Absence of Inflammation
7- Proper Hard and soft tissue Contour