Skip to main content

Step-by-Step Surgical Considerations and Techniques

  • Chapter
  • First Online:

Abstract

The management of the edentulous patient may represent a challenge in implantology for most surgeons. Careful planning using evidence-based methods will not only facilitate the surgical intervention but might also greatly improve the long-term prognosis of implant-supported prostheses. In this chapter, the anatomy of the mandible with a surgical perspective is reviewed in detail. The pre-, intra-, and postoperative elderly patient management including strategies to reduce anxiety, risk, and morbidity is reviewed. Mucogingival considerations, keratinized gingiva augmentation procedures, and steps for optimal implant placement are illustrated with clinical cases. Detailed pre- and postoperative instructions are presented as well as management of common surgical and postsurgical complications.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Niccoli T, Partridge L. Ageing as a risk factor for disease. Curr Biol. 2012;22(17):R741–52.

    Article  PubMed  Google Scholar 

  2. de Grandmont P, Feine JS, Tache R, Boudrias P, Donohue WB, Tanguay R, Lund JP. Within-subject comparisons of implant-supported mandibular prostheses: psychometric evaluation. J Dent Res. 1994;73(5):1096–104.

    Article  PubMed  Google Scholar 

  3. Tang L, Lund JP, Tache R, Clokie CM, Feine JS. A within-subject comparison of mandibular long-bar and hybrid implant-supported prostheses: psychometric evaluation and patient preference. J Dent Res. 1997;76(10):1675–83.

    Article  PubMed  Google Scholar 

  4. Sivaramakrishnan G, Sridharan K. Comparison of implant supported mandibular overdentures and conventional dentures on quality of life: a systematic review and meta-analysis of randomized controlled studies. Aust Dent J. 2016;61(4):482–8.

    Article  PubMed  Google Scholar 

  5. Hains F, Jones J. Treatment planning for the geriatric patient. In: Homl-Pedersen PWA, Ship JA, editors. Textbook of geriatric dentistry. 3rd ed. Chichester: Wiley; 2015. p. 165.

    Google Scholar 

  6. Alqutaibi AY. There is no evidence on the effect of the attachment system on implant survival rate, overdenture maintenance, or patient satisfaction. J Evid Based Dent Pract. 2015;15(4):193–4.

    Article  PubMed  Google Scholar 

  7. Hwang K, Lee WJ, Song YB, Chung IH. Vulnerability of the inferior alveolar nerve and mental nerve during genioplasty: an anatomic study. J Craniofac Surg. 2005;16(1):10–14; discussion 14.

    Article  PubMed  Google Scholar 

  8. Kim ST, Hu KS, Song WC, Kang MK, Park HD, Kim HJ. Location of the mandibular canal and the topography of its neurovascular structures. J Craniofac Surg. 2009;20(3):936–9.

    Article  PubMed  Google Scholar 

  9. Miller CS, Nummikoski PV, Barnett DA, Langlais RP. Cross-sectional tomography. A diagnostic technique for determining the buccolingual relationship of impacted mandibular third molars and the inferior alveolar neurovascular bundle. Oral Surg Oral Med Oral Pathol. 1990;70(6):791–7.

    Article  PubMed  Google Scholar 

  10. Yu SK, Lee MH, Jeon YH, Chung YY, Kim HJ. Anatomical configuration of the inferior alveolar neurovascular bundle: a histomorphometric analysis. Surg Radiol Anat. 2016;38(2):195–201.

    Article  PubMed  Google Scholar 

  11. Renton T, Dawood A, Shah A, Searson L, Yilmaz Z. Post-implant neuropathy of the trigeminal nerve. A case series. Br Dent J. 2012;212(11):E17.

    Article  PubMed  Google Scholar 

  12. Misch CE. Root form surgery in the edentulous mandible: stage I implant insertion. In: Misch CE, editor. Implant dentistry. 2nd ed. St. Louis: The CV Mosby Company; 1999. p. 347–70.

    Google Scholar 

  13. Kim YK, Park JY, Kim SG, Kim JS, Kim JD. Magnification rate of digital panoramic radiographs and its effectiveness for pre-operative assessment of dental implants. Dentomaxillofac Radiol. 2011;40(2):76–83.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Vazquez L, Nizam Al Din Y, Christoph Belser U, Combescure C, Bernard JP. Reliability of the vertical magnification factor on panoramic radiographs: clinical implications for posterior mandibular implants. Clin Oral Implants Res. 2011;22(12):1420–5.

    Article  PubMed  Google Scholar 

  15. Polland KE, Munro S, Reford G, Lockhart A, Logan G, Brocklebank L, McDonald SW. The mandibular canal of the edentulous jaw. Clin Anat. 2001;14(6):445–52.

    Article  PubMed  Google Scholar 

  16. Rosa MB, Sotto-Maior BS, Machado Vde C, Francischone CE. Retrospective study of the anterior loop of the inferior alveolar nerve and the incisive canal using cone beam computed tomography. Int J Oral Maxillofac Implants. 2013;28(2):388–92.

    Article  PubMed  Google Scholar 

  17. Uchida Y, Noguchi N, Goto M, Yamashita Y, Hanihara T, Takamori H, Sato I, Kawai T, Yosue T. Measurement of anterior loop length for the mandibular canal and diameter of the mandibular incisive canal to avoid nerve damage when installing endosseous implants in the interforaminal region: a second attempt introducing cone beam computed tomography. J Oral Maxillofac Surg. 2009;67(4):744–50.

    Article  PubMed  Google Scholar 

  18. Kqiku L, Sivic E, Weiglein A, Stadtler P. Position of the mental foramen: an anatomical study. Wien Med Wochenschr. 2011;161(9–10):272–3.

    Article  PubMed  Google Scholar 

  19. Ngeow WC, Yuzawati Y. The location of the mental foramen in a selected Malay population. J Oral Sci. 2003;45(3):171–5.

    Article  PubMed  Google Scholar 

  20. Wang TM, Shih C, Liu JC, Kuo KJ. A clinical and anatomical study of the location of the mental foramen in adult Chinese mandibles. Acta Anat (Basel). 1986;126(1):29–33.

    Article  Google Scholar 

  21. Massey ND, Galil KA, Wilson TD. Determining position of the inferior alveolar nerve via anatomical dissection and micro-computed tomography in preparation for dental implants. J Can Dent Assoc. 2013;79:d39.

    PubMed  Google Scholar 

  22. Rashid N, Yusuf H. Intermittent mental paraesthesia in an edentulous mandible. Br Dent J. 1997;182(5):189–90.

    Article  PubMed  Google Scholar 

  23. Kuzmanovic DV, Payne AG, Kieser JA, Dias GJ. Anterior loop of the mental nerve: a morphological and radiographic study. Clin Oral Implants Res. 2003;14(4):464–71.

    Article  PubMed  Google Scholar 

  24. Apostolakis D, Brown JE. The anterior loop of the inferior alveolar nerve: prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging. Clin Oral Implants Res. 2012;23(9):1022–30.

    Article  PubMed  Google Scholar 

  25. Gomez-Roman G, Lautner NV, Goldammer C, McCoy M. Anterior loop of the mandibular canal-a source of possible complications. Implant Dent. 2015;24(5):578–85.

    Article  PubMed  Google Scholar 

  26. Juan del VL, Grageda E, Crespo SG. Anterior loop of the inferior alveolar nerve: averages and prevalence based on CT scans. J Prosthet Dent. 2016;115(2):156–60.

    Article  PubMed  Google Scholar 

  27. Lu CI, Won J, Al-Ardah A, Santana R, Rice D, Lozada J. Assessment of the anterior loop of the mental nerve using cone beam computerized tomography scan. J Oral Implantol. 2015;41(6):632–9.

    Article  PubMed  Google Scholar 

  28. Ritter L, Neugebauer J, Mischkowski RA, Dreiseidler T, Rothamel D, Richter U, Zinser MJ, Zoller JE. Evaluation of the course of the inferior alveolar nerve in the mental foramen by cone beam computed tomography. Int J Oral Maxillofac Implants. 2012;27(5):1014–21.

    PubMed  Google Scholar 

  29. von Arx T, Friedli M, Sendi P, Lozanoff S, Bornstein MM. Location and dimensions of the mental foramen: a radiographic analysis by using cone-beam computed tomography. J Endod. 2013;39(12):1522–8.

    Article  Google Scholar 

  30. Bavitz JB, Harn SD, Hansen CA, Lang M. An anatomical study of mental neurovascular bundle-implant relationships. Int J Oral Maxillofac Implants. 1993;8(5):563–7.

    PubMed  Google Scholar 

  31. Benninger B, Miller D, Maharathi A, Carter W. Dental implant placement investigation: is the anterior loop of the mental nerve clinically relevant? J Oral Maxillofac Surg. 2011;69(1):182–5.

    Article  PubMed  Google Scholar 

  32. Uchida Y, Yamashita Y, Goto M, Hanihara T. Measurement of anterior loop length for the mandibular canal and diameter of the mandibular incisive canal to avoid nerve damage when installing endosseous implants in the interforaminal region. J Oral Maxillofac Surg. 2007;65(9):1772–9.

    Article  PubMed  Google Scholar 

  33. Mardinger O, Chaushu G, Arensburg B, Taicher S, Kaffe I. Anatomic and radiologic course of the mandibular incisive canal. Surg Radiol Anat. 2000;22(3–4):157–61.

    Article  PubMed  Google Scholar 

  34. Kalpidis CD, Setayesh RM. Hemorrhaging associated with endosseous implant placement in the anterior mandible: a review of the literature. J Periodontol. 2004;75(5):631–45.

    Article  PubMed  Google Scholar 

  35. McDonnell D, Reza Nouri M, Todd ME. The mandibular lingual foramen: a consistent arterial foramen in the middle of the mandible. J Anat. 1994;184(Pt 2):363–9.

    PubMed  PubMed Central  Google Scholar 

  36. Felisati G, Saibene AM, Di Pasquale D, Borloni R. How the simplest dental implant procedure can trigger an extremely serious complication. BMJ Case Rep. 2012;2012:bcr2012007373.

    PubMed  PubMed Central  Google Scholar 

  37. Jo JH, Kim SG, Oh JS. Hemorrhage related to implant placement in the anterior mandible. Implant Dent. 2011;20(3):e33–7.

    Article  PubMed  Google Scholar 

  38. Laboda G. Life-threatening hemorrhage after placement of an endosseous implant: report of case. J Am Dent Assoc. 1990;121(5):599–600.

    Article  PubMed  Google Scholar 

  39. Yildirim YD, Guncu GN, Galindo-Moreno P, Velasco-Torres M, Juodzbalys G, Kubilius M, Gervickas A, Al-Hezaimi K, Al-Sadhan R, Yilmaz HG, et al. Evaluation of mandibular lingual foramina related to dental implant treatment with computerized tomography: a multicenter clinical study. Implant Dent. 2014;23(1):57–63.

    Article  PubMed  Google Scholar 

  40. Greenstein G, Cavallaro J, Tarnow D. Practical application of anatomy for the dental implant surgeon. J Periodontol. 2008;79(10):1833–46.

    Article  PubMed  Google Scholar 

  41. Mraiwa N, Jacobs R, Moerman P, Lambrichts I, van Steenberghe D, Quirynen M. Presence and course of the incisive canal in the human mandibular interforaminal region: two-dimensional imaging versus anatomical observations. Surg Radiol Anat. 2003;25(5–6):416–23.

    Article  PubMed  Google Scholar 

  42. Romanos GE, Papadimitriou DE, Royer K, Stefanova-Stephens N, Salwan R, Malmstrom H, Caton JG. The presence of the mandibular incisive canal: a panoramic radiographic examination. Implant Dent. 2012;21(3):202–6.

    Article  PubMed  Google Scholar 

  43. Sahman H, Sekerci AE, Sisman Y, Payveren M. Assessment of the visibility and characteristics of the mandibular incisive canal: cone beam computed tomography versus panoramic radiography. Int J Oral Maxillofac Implants. 2014;29(1):71–8.

    Article  PubMed  Google Scholar 

  44. Raitz R, Shimura E, Chilvarquer I, Fenyo-Pereira M. Assessment of the mandibular incisive canal by panoramic radiograph and cone-beam computed tomography. Int J Dent. 2014;2014:187085.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lee CY, Yanagihara LC, Suzuki JB. Brisk, pulsatile bleeding from the anterior mandibular incisive canal during implant surgery: a case report and use of an active hemostatic matrix to terminate acute bleeding. Implant Dent. 2012;21(5):368–73.

    Article  PubMed  Google Scholar 

  46. Romanos GE, Greenstein G. The incisive canal. Considerations during implant placement: case report and literature review. Int J Oral Maxillofac Implants. 2009;24(4):740–5.

    PubMed  Google Scholar 

  47. Chan HL, Benavides E, Yeh CY, Fu JH, Rudek IE, Wang HL. Risk assessment of lingual plate perforation in posterior mandibular region: a virtual implant placement study using cone-beam computed tomography. J Periodontol. 2011;82(1):129–35.

    Article  PubMed  Google Scholar 

  48. Chan HL, Brooks SL, Fu JH, Yeh CY, Rudek I, Wang HL. Cross-sectional analysis of the mandibular lingual concavity using cone beam computed tomography. Clin Oral Implants Res. 2011;22(2):201–6.

    Article  PubMed  Google Scholar 

  49. Bavitz JB, Harn SD, Homze EJ. Arterial supply to the floor of the mouth and lingual gingiva. Oral Surg Oral Med Oral Pathol. 1994;77(3):232–5.

    Article  PubMed  Google Scholar 

  50. Uchida Y, Goto M, Danjo A, Yamashita Y, Shibata K, Kuraoka A. Anatomical relationship between the sublingual fossa and the lateral lingual foramen. Int J Oral Maxillofac Surg. 2015;44(9):1146–51.

    Article  PubMed  Google Scholar 

  51. Nickenig HJ, Wichmann M, Eitner S, Zoller JE, Kreppel M. Lingual concavities in the mandible: a morphological study using cross-sectional analysis determined by CBCT. J Craniomaxillofac Surg. 2015;43(2):254–9.

    Article  PubMed  Google Scholar 

  52. Pietrokovski J, Chapman RJ. The form of the mandibular anterior lingual alveolar process in partially edentulous patients. J Prosthet Dent. 1981;45(4):371–5.

    Article  PubMed  Google Scholar 

  53. Kalpidis CD, Konstantinidis AB. Critical hemorrhage in the floor of the mouth during implant placement in the first mandibular premolar position: a case report. Implant Dent. 2005;14(2):117–24.

    Article  PubMed  Google Scholar 

  54. Mason ME, Triplett RG, Alfonso WF. Life-threatening hemorrhage from placement of a dental implant. J Oral Maxillofac Surg. 1990;48(2):201–4.

    Article  PubMed  Google Scholar 

  55. Mordenfeld A, Andersson L, Bergstrom B. Hemorrhage in the floor of the mouth during implant placement in the edentulous mandible: a case report. Int J Oral Maxillofac Implants. 1997;12(4):558–61.

    PubMed  Google Scholar 

  56. Netter FH. Section 1: head and neck. Oral region: tongue. In: Hansen JT, editor. Atlas of human anatomy. Teterboro: ICON Learning Systems LLC; 2003. p. 55.

    Google Scholar 

  57. Netter FH. Section 1: head and neck. Oral region: muscles involved in mastication. In: Hansen JT, editor. Atlas of human anatomy. Teterboro: ICON Learning Systems LLC; 2003. p. 50.

    Google Scholar 

  58. Noia CF, Rodriguez-Chessa JG, Ortega-Lopes R, Cabral-Andrade V, Barbeiro RH, Mazzonetto R. Prospective study of soft tissue contour changes following chin bone graft harvesting. Int J Oral Maxillofac Surg. 2012;41(2):176–9.

    Article  PubMed  Google Scholar 

  59. Jung SY, Shin SY, Lee KH, Eun YG, Lee YC, Kim SW. Analysis of mandibular structure using 3d facial computed tomography. Otolaryngol Head Neck Surg. 2014;151(5):760–4.

    Article  PubMed  Google Scholar 

  60. Murlimanju BV, Prakash KG, Samiullah D, Prabhu LV, Pai MM, Vadgaonkar R, Rai R. Accessory neurovascular foramina on the lingual surface of mandible: incidence, topography, and clinical implications. Indian J Dent Res. 2012;23(3):433.

    Article  PubMed  Google Scholar 

  61. Kolsuz ME, Orhan K, Bilecenoglu B, Sakul BU, Ozturk A. Evaluation of genial tubercle anatomy using cone beam computed tomography. J Oral Sci. 2015;57(2):151–6.

    Article  PubMed  Google Scholar 

  62. Misch CE. The division c mandible: mandibular complete and unilateral subperiosteal implants. In: Misch CE, editor. Implant dentistry. 2nd ed. St. Louis: The CV Mosby Company; 1999. p. 434–5.

    Google Scholar 

  63. Tan WC, Krishnaswamy G, Ong MM, Lang NP. Patient-reported outcome measures after routine periodontal and implant surgical procedures. J Clin Periodontol. 2014;41(6):618–24.

    Article  PubMed  Google Scholar 

  64. Swenor BK, Ramulu PY, Willis JR, Friedman D, Lin FR. The prevalence of concurrent hearing and vision impairment in the United States. JAMA Intern Med. 2013;173(4):312–3.

    Article  PubMed  Google Scholar 

  65. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63–75.e2.

    Article  PubMed  Google Scholar 

  66. Scheltens P, Blennow K, Breteler MM, de Strooper B, Frisoni GB, Salloway S, Van der Flier WM. Alzheimer’s disease. Lancet. 2016;388(10043):505–17.

    Article  PubMed  Google Scholar 

  67. Small BJ, Hertzog C, Hultsch DF, Dixon RA, Victoria Longitudinal S. Stability and change in adult personality over 6 years: findings from the victoria longitudinal study. J Gerontol B Psychol Sci Soc Sci. 2003;58(3):P166–76.

    Article  PubMed  Google Scholar 

  68. Chalmers JM. Behavior management and communication strategies for dental professionals when caring for patients with dementia. Spec Care Dentist. 2000;20(4):147–54.

    Article  PubMed  Google Scholar 

  69. Bell RA, Arcury TA, Anderson AM, Chen H, Savoca MR, Gilbert GH, Quandt SA. Dental anxiety and oral health outcomes among rural older adults. J Public Health Dent. 2012;72(1):53–9.

    Article  PubMed  Google Scholar 

  70. Locker D, Liddell A, Burman D. Dental fear and anxiety in an older adult population. Community Dent Oral Epidemiol. 1991;19(2):120–4.

    Article  PubMed  Google Scholar 

  71. De Jongh A, Adair P, Meijerink-Anderson M. Clinical management of dental anxiety: what works for whom? Int Dent J. 2005;55(2):73–80.

    Article  PubMed  Google Scholar 

  72. Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J. 2013;58(4):390–407; quiz 531.

    Article  PubMed  Google Scholar 

  73. Alvis BD, Hughes CG. Physiology considerations in geriatric patients. Anesthesiol Clin. 2015;33(3):447–56.

    Article  PubMed  PubMed Central  Google Scholar 

  74. American Society of Anesthesiologists. 2014. ASA physical status classification system. https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. Accessed 1 July 2016.

  75. Malamed S. The geriatric patient. In: Malamed S, editor. Sedation: a guide to patient management. 5th ed. St. Louis: Mosby; 2009. p. 517–8.

    Google Scholar 

  76. Turner M, Greenwood M. Oral and maxillofacial surgery for the geriatric patient. In: Homl-Pedersen P, Walls A, Ship JA, editors. Textbook of geriatric dentistry. 3rd ed. Chichester: Wiley; 2015. p. 256–64.

    Google Scholar 

  77. Rashid F, Awad MA, Thomason JM, Piovano A, Spielberg GP, Scilingo E, Mojon P, Muller F, Spielberg M, Heydecke G, et al. The effectiveness of 2-implant overdentures—a pragmatic international multicentre study. J Oral Rehabil. 2011;38(3):176–84.

    Article  PubMed  Google Scholar 

  78. Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implant retained overdentures—a review of the literature supporting the McGill and York consensus statements. J Dent. 2012;40(1):22–34.

    Article  PubMed  Google Scholar 

  79. Moraschini V, Velloso G, Luz D, Barboza EP. Implant survival rates, marginal bone level changes, and complications in full-mouth rehabilitation with flapless computer-guided surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2015;44(7):892–901.

    Article  PubMed  Google Scholar 

  80. D’Haese J, Van De Velde T, Elaut L, De Bruyn H. A prospective study on the accuracy of mucosally supported stereolithographic surgical guides in fully edentulous maxillae. Clin Implant Dent Relat Res. 2012;14(2):293–303.

    Article  PubMed  Google Scholar 

  81. Di Giacomo GA, da Silva JV, da Silva AM, Paschoal GH, Cury PR, Szarf G. Accuracy and complications of computer-designed selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. J Periodontol. 2012;83(4):410–9.

    Article  PubMed  Google Scholar 

  82. Arisan V, Karabuda CZ, Ozdemir T. Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res. 2010;21(9):980–8.

    PubMed  Google Scholar 

  83. Engquist B, Astrand P, Anzen B, Dahlgren S, Engquist E, Feldmann H, Karlsson U, Nord PG, Sahlholm S, Svardstrom P. Simplified methods of implant treatment in the edentulous lower jaw. A controlled prospective study. Part i: one-stage versus two-stage surgery. Clin Implant Dent Relat Res. 2002;4(2):93–103.

    Article  PubMed  Google Scholar 

  84. Lang NP, Loe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43(10):623–7.

    Article  PubMed  Google Scholar 

  85. Dorfman HS, Kennedy JE, Bird WC. Longitudinal evaluation of free autogenous gingival grafts. J Clin Periodontol. 1980;7(4):316–24.

    Article  PubMed  Google Scholar 

  86. Kennedy JE, Bird WC, Palcanis KG, Dorfman HS. A longitudinal evaluation of varying widths of attached gingiva. J Clin Periodontol. 1985;12(8):667–75.

    Article  PubMed  Google Scholar 

  87. Wennstrom JL. Lack of association between width of attached gingiva and development of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol. 1987;14(3):181–4.

    Article  PubMed  Google Scholar 

  88. Atsuta I, Yamaza T, Yoshinari M, Mino S, Goto T, Kido MA, Terada Y, Tanaka T. Changes in the distribution of laminin-5 during peri-implant epithelium formation after immediate titanium implantation in rats. Biomaterials. 2005;26(14):1751–60.

    Article  PubMed  Google Scholar 

  89. Buser D, Weber HP, Donath K, Fiorellini JP, Paquette DW, Williams RC. Soft tissue reactions to non-submerged unloaded titanium implants in beagle dogs. J Periodontol. 1992;63(3):225–35.

    Article  PubMed  Google Scholar 

  90. Gerber JA, Tan WC, Balmer TE, Salvi GE, Lang NP. Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around oral implants. Clin Oral Implants Res. 2009;20(1):75–8.

    Article  PubMed  Google Scholar 

  91. Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B, Thomsen P. The soft tissue barrier at implants and teeth. Clin Oral Implants Res. 1991;2(2):81–90.

    Article  PubMed  Google Scholar 

  92. Atsuta I, Ayukawa Y, Kondo R, Oshiro W, Matsuura Y, Furuhashi A, Tsukiyama Y, Koyano K. Soft tissue sealing around dental implants based on histological interpretation. J Prosthodont Res. 2016;60(1):3–11.

    Article  PubMed  Google Scholar 

  93. Carcuac O, Abrahamsson I, Albouy JP, Linder E, Larsson L, Berglundh T. Experimental periodontitis and peri-implantitis in dogs. Clin Oral Implants Res. 2013;24(4):363–71.

    Article  PubMed  Google Scholar 

  94. Brito C, Tenenbaum HC, Wong BK, Schmitt C, Nogueira-Filho G. Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater. 2014;102(3):643–50.

    Article  PubMed  Google Scholar 

  95. Gobbato L, Avila-Ortiz G, Sohrabi K, Wang CW, Karimbux N. The effect of keratinized mucosa width on peri-implant health: a systematic review. Int J Oral Maxillofac Implants. 2013;28(6):1536–45.

    Article  PubMed  Google Scholar 

  96. Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol. 2013;84(12):1755–67.

    Article  PubMed  Google Scholar 

  97. Adibrad M, Shahabuei M, Sahabi M. Significance of the width of keratinized mucosa on the health status of the supporting tissue around implants supporting overdentures. J Oral Implantol. 2009;35(5):232–7.

    Article  PubMed  Google Scholar 

  98. Kaptein ML, De Lange GL, Blijdorp PA. Peri-implant tissue health in reconstructed atrophic maxillae—report of 88 patients and 470 implants. J Oral Rehabil. 1999;26(6):464–74.

    Article  PubMed  Google Scholar 

  99. Elkhaweldi A, Rincon Soler C, Cayarga R, Suzuki T, Kaufman Z. Various techniques to increase keratinized tissue for implant supported overdentures: retrospective case series. Int J Dent. 2015;2015:104903.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Bjorn H. Free transplantation of gingiva propria. Sven Tandlak Tidskr. 1963;22:684–9.

    Google Scholar 

  101. Karring T, Cumming BR, Oliver RC, Loe H. The origin of granulation tissue and its impact on postoperative results of mucogingival surgery. J Periodontol. 1975;46(10):577–85.

    Article  PubMed  Google Scholar 

  102. Karring T, Lang NP, Loe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodontal Res. 1975;10(1):1–11.

    Article  PubMed  Google Scholar 

  103. Karring T, Ostergaard E, Loe H. Conservation of tissue specificity after heterotopic transplantation of gingiva and alveolar mucosa. J Periodontal Res. 1971;6(4):282–93.

    Article  PubMed  Google Scholar 

  104. Weinlaender M. Bone growth around dental implants. Dent Clin North Am. 1991;35(3):585–601.

    PubMed  Google Scholar 

  105. Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent. 1983;50(1):101–7.

    Article  PubMed  Google Scholar 

  106. Eriksson RA, Albrektsson T, Magnusson B. Assessment of bone viability after heat trauma. A histological, histochemical and vital microscopic study in the rabbit. Scand J Plast Reconstr Surg. 1984;18(3):261–8.

    Article  PubMed  Google Scholar 

  107. Benington IC, Biagioni PA, Briggs J, Sheridan S, Lamey PJ. Thermal changes observed at implant sites during internal and external irrigation. Clin Oral Implants Res. 2002;13(3):293–7.

    Article  PubMed  Google Scholar 

  108. Ercoli C, Funkenbusch PD, Lee HJ, Moss ME, Graser GN. The influence of drill wear on cutting efficiency and heat production during osteotomy preparation for dental implants: a study of drill durability. Int J Oral Maxillofac Implants. 2004;19(3):335–49.

    PubMed  Google Scholar 

  109. Koo KT, Kim MH, Kim HY, Wikesjo UM, Yang JH, Yeo IS. Effects of implant drill wear, irrigation, and drill materials on heat generation in osteotomy sites. J Oral Implantol. 2015;41(2):e19–23.

    Article  PubMed  Google Scholar 

  110. Mohlhenrich SC, Modabber A, Steiner T, Mitchell DA, Holzle F. Heat generation and drill wear during dental implant site preparation: systematic review. Br J Oral Maxillofac Surg. 2015;53(8):679–89.

    Article  PubMed  Google Scholar 

  111. Binon PP. Implants and components: entering the new millennium. Int J Oral Maxillofac Implants. 2000;15(1):76–94.

    PubMed  Google Scholar 

  112. Esposito M, Ardebili Y, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database Syst Rev. 2014;7:CD003815.

    Google Scholar 

  113. Chrcanovic BR, Albrektsson T, Wennerberg A. Platform switch and dental implants: a meta-analysis. J Dent. 2015;43(6):629–46.

    Article  PubMed  Google Scholar 

  114. Pons-Vicente O, Lopez-Jimenez L, Sanchez-Garces MA, Sala-Perez S, Gay-Escoda C. A comparative study between two different suture materials in oral implantology. Clin Oral Implants Res. 2011;22(3):282–8.

    Article  PubMed  Google Scholar 

  115. Leknes KN, Roynstrand IT, Selvig KA. Human gingival tissue reactions to silk and expanded polytetrafluoroethylene sutures. J Periodontol. 2005;76(1):34–42.

    Article  PubMed  Google Scholar 

  116. Gartti-Jardim EC, de Souza AP, Carvalho AC, Pereira CC, Okamoto R, Magro Filho O. Comparative study of the healing process when using Vicryl(r), Vicryl Rapid(r), Vicryl Plus(r), and Monocryl(r) sutures in the rat dermal tissue. Oral Maxillofac Surg. 2013;17(4):293–8.

    Article  PubMed  Google Scholar 

  117. Vasanthan A, Satheesh K, Hoopes W, Lucaci P, Williams K, Rapley J. Comparing suture strengths for clinical applications: a novel in vitro study. J Periodontol. 2009;80(4):618–24.

    Article  PubMed  Google Scholar 

  118. Cardemil C, Ristevski Z, Alsen B, Dahlin C. Influence of different operatory setups on implant survival rate: a retrospective clinical study. Clin Implant Dent Relat Res. 2009;11(4):288–91.

    Article  PubMed  Google Scholar 

  119. Scharf DR, Tarnow DP. Success rates of osseointegration for implants placed under sterile versus clean conditions. J Periodontol. 1993;64(10):954–6.

    Article  PubMed  Google Scholar 

  120. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100(3):757–73, table of contents.

    Article  PubMed  Google Scholar 

  121. Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev. 2013;(7):CD004152.

    Google Scholar 

  122. Veksler AE, Kayrouz GA, Newman MG. Reduction of salivary bacteria by pre-procedural rinses with chlorhexidine 0.12%. J Periodontol. 1991;62(11):649–51.

    Article  PubMed  Google Scholar 

  123. Buckley JA, Ciancio SG, McMullen JA. Efficacy of epinephrine concentration in local anesthesia during periodontal surgery. J Periodontol. 1984;55(11):653–7.

    Article  PubMed  Google Scholar 

  124. Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol. 2006;77(12):1933–43.

    Article  PubMed  Google Scholar 

  125. Lekholm U, Zarb GA. Patient selection and preparation. In: Branemark PI, Zarb GA, Albrektsson T, editors. Tissue integrated prostheses: osseointegration in clinical dentistry. Chicago: Quintessence Publishing Company; 1985. p. 199–209.

    Google Scholar 

  126. Bashutski JD, D’Silva NJ, Wang HL. Implant compression necrosis: current understanding and case report. J Periodontol. 2009;80(4):700–4.

    Article  PubMed  Google Scholar 

  127. Khayat PG, Arnal HM, Tourbah BI, Sennerby L. Clinical outcome of dental implants placed with high insertion torques (up to 176 Ncm). Clin Implant Dent Relat Res. 2013;15(2):227–33.

    Article  PubMed  Google Scholar 

  128. Jung RE, Herzog M, Wolleb K, Ramel CF, Thoma DS, Hammerle CH. A randomized controlled clinical trial comparing small buccal dehiscence defects around dental implants treated with guided bone regeneration or left for spontaneous healing. Clin Oral Implants Res. 2017;28(3):348–54.

    Article  PubMed  Google Scholar 

  129. Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011;84(5):527–36.

    PubMed  Google Scholar 

  130. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110(4):1170–9.

    PubMed  Google Scholar 

  131. Durand R, Tran SD, Mui B, Voyer R. Managing postoperative pain following periodontal surgery. J Can Dent Assoc. 2013;79:d66.

    PubMed  Google Scholar 

  132. Powell CA, Mealey BL, Deas DE, McDonnell HT, Moritz AJ. Post-surgical infections: prevalence associated with various periodontal surgical procedures. J Periodontol. 2005;76(3):329–33.

    Article  PubMed  Google Scholar 

  133. Greenstein G. Therapeutic efficacy of cold therapy after intraoral surgical procedures: a literature review. J Periodontol. 2007;78(5):790–800.

    Article  PubMed  Google Scholar 

  134. Bain CA. Smoking and implant failure—benefits of a smoking cessation protocol. Int J Oral Maxillofac Implants. 1996;11(6):756–9.

    PubMed  Google Scholar 

  135. Isaacson TJ. Sublingual hematoma formation during immediate placement of mandibular endosseous implants. J Am Dent Assoc. 2004;135(2):168–72.

    Article  PubMed  Google Scholar 

  136. Madrid C, Sanz M. What influence do anticoagulants have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009;20(Suppl 4):96–106.

    Article  PubMed  Google Scholar 

  137. Kraut RA, Chahal O. Management of patients with trigeminal nerve injuries after mandibular implant placement. J Am Dent Assoc. 2002;133(10):1351–4.

    Article  PubMed  Google Scholar 

  138. Schwartz-Arad D, Kidron N, Dolev E. A long-term study of implants supporting overdentures as a model for implant success. J Periodontol. 2005;76(9):1431–5.

    Article  PubMed  Google Scholar 

  139. Tolman DE, Keller EE. Management of mandibular fractures in patients with endosseous implants. Int J Oral Maxillofac Implants. 1991;6(4):427–36.

    PubMed  Google Scholar 

  140. Laskin DM. Nonsurgical management of bilateral mandibular fractures associated with dental implants: report of a case. Int J Oral Maxillofac Implants. 2003;18(5):739–44.

    PubMed  Google Scholar 

  141. Park SH, Wang HL. Implant reversible complications: classification and treatments. Implant Dent. 2005;14(3):211–20.

    Article  PubMed  Google Scholar 

  142. Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J, Figuero E, Giovannoli JL, Goldstein M, Lambert F, et al. Primary prevention of peri-implantitis: managing peri-implant mucositis. J Clin Periodontol. 2015;42(Suppl 16):S152–7.

    Article  PubMed  Google Scholar 

  143. Monje A, Aranda L, Diaz KT, Alarcon MA, Bagramian RA, Wang HL, Catena A. Impact of maintenance therapy for the prevention of peri-implant diseases: a systematic review and meta-analysis. J Dent Res. 2016;95(4):372–9.

    Article  PubMed  Google Scholar 

  144. Mahato N, Wu X, Wang L. Management of peri-implantitis: a systematic review, 2010-2015. Springerplus. 2016;5:105.

    Article  PubMed  PubMed Central  Google Scholar 

  145. Chan HL, Lin GH, Suarez F, MacEachern M, Wang HL. Surgical management of peri-implantitis: a systematic review and meta-analysis of treatment outcomes. J Periodontol. 2014;85(8):1027–41.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert Durand D.M.D., M.Sc., F.R.C.D.(C). .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Durand, R., Voyer, R. (2018). Step-by-Step Surgical Considerations and Techniques. In: Emami, E., Feine, J. (eds) Mandibular Implant Prostheses. Springer, Cham. https://doi.org/10.1007/978-3-319-71181-2_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71181-2_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71179-9

  • Online ISBN: 978-3-319-71181-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics