Dr. Z asks:
This is a broad question, but I have been doing two-stage implant surgery and I have been hearing about one-stage also being successful and I would now like to try some one-stage implant surgeries. When can I choose one-stage implant surgery? What are the indications and contraindications for doing one-stage implant surgery? Thanks.
When Can I Choose One-Stage Implant Surgery?
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One stage implant surgeries are as successful as two stage surgeries. They are more convienient for the patient as no second surgery is necessary to expose the implant. u can even take a soft tissue level impression at the time of implant placement, so that u can have the prosthesis fabricated while the implant is healing.As u can see u can finish the whole procedure in just two visits.This reduces the treatment time by half.(as opposed to the two stage surgery:implant placement/uncovering and healing abutment/impressions/prosthesis placement). i use the zimmer swiss pluss implant for 5 years now, and it really gives excellent results.
To place one stage implants, u have to make sure that enough gingival thickness is present above the crest of the alveolar ridge (at least 2mm). Such that when the implant is placed, the cover screw(in that case will act as a healing abutment) would be flushed with the gingival margin.
i mainly use one stage implants on posterior teeth.i beilieve that they require more inter-arch space than with the standard two stage implants, as these implants tend to have a longer polished neck. 8-9mm would be adequate.
if these simple criteria are followed i do not see a contraindication to the use of this protocol for implants placement.
my patient need an implant restoration on upper right premolar but distance bee twin two arches is around4-5 mm.how can i achieve more space to make this restoration
As long as you can get 35ncm or so of stability, there should be no reason not to single stage. However if the patient has unresolved periodontal issues elsewhere, you may want to 2 stage the implant as the pathogens may cause perimplantitis.
Single stage surgery can be done anywhere a two stage surgery can be done as long as adequate primary stability is achieved. If the implant does not have adequate primary fixation then it is more prudent to leave it submerged and expose it later. Tissue forming healing abutments or even temporary crowns that have minimal engagement can be utilized with the very significant benefits of saving morbidity and time. If you can manage the soft tissue in performing second stages you will have no issue with the single stage technique. In my practice the single stage has been the preferred method for over five years.
i Have got exellent results with all designs of sinlge stage implants .i.e.- zimmer, osstem and tatum.
i am using it for more than six years.my majority implant
practice cover the single stage implants.
i found it really trouble free and predictable as good as two stage implants.
Usually i don’t prefer to ppace it in the ANTERIOR region because of esthetic concern.
if the inter arch distance is less than 5-6 mm it should be used with caution or avoid it.
I have found excellant success with one-stage implants if I can torque just to 20 ncm. I agree with the success being as good as a two stage.
For me, I had my implant immediately after having a bad tooth removed as this is the idea situation which improves the chance of the implant setting really well and avoiding complications.
there are some important points regardes single stage implant:-
1-Bone quality D1,D2 is the best
2-occlusion.it must be freed of occlusion for osseointegration
3-position,perfect postioning as u can,t change the angulation later on.
4- abutment preparation well be done in the muouth
5-perfect impression .as no transfer technique can be used
Some people wrote about single peace impalnts, while the question was of one-stage surgical protocol.
Whenever the torque is 25+ncm i place a healing abutment, unless there was a grafting done simultaniously. In this case i choose staged(more cautious) approach.
One stage surgery usually gives more mucosa.