One or Two-Stage Implant Placement?

Dr. F asks:

I have treatment planned a full arch maxillary reconstruction with 8 dental implants and a mandibular full arch with five implants placed between the mental foramina. Does anyone have any suggestions and tips on good flap design. Should I bury the implants and do a two-stage procedure or should I place transmucosal healing caps for a single stage procedure?

9 thoughts on “One or Two-Stage Implant Placement?

  1. Leo Bozzi says:

    I completely agree with Dr.B: I feel that it is the appropriate way to solve the case and avoid a LOT of problems, for the patient and for you.
    Then, you should enroll in a complete implant course, they’re surely available in your zone, and choose one that allow you to eventually treat your patient at the course upon the guide of a supervisor.

  2. anonnymous says:

    For mercies sake! Safe yourself and your patient.This is a complex case that require quite a lot of experience and associated knowledge and careful examination and diagnosis and history taking and understanding of patient’s expectations and precise treatment planning. Designing your flap may be the least of your problems. But if you have done all of the above, then proceed provided its not your first case.
    With respect.

  3. Carlos Medina says:

    Hello;

    3 corner, full-thickness. However, if you have not placed at least some implants, this case might carry a reasonable chance of complication(s). You could have the patient get a 3d CTscan and send the info to Nobel, they will send you a precise splint guide with the dimensions of all the implants that can be used in the upper at least. Also, a 2-stage approach carries a bit less risk.

    I disagree with the “if you have to ask, refer please”. Doesnt apply to everyone, but I have learned a lot by doing and I am yet to have a bad complication, after 650 implant placements+restorations. Case selections have been…..Whatever has walked through the door.

  4. Dr New says:

    I would use a one stage process.

    Could even try it flapless in the upper do some ridge mapping. Get a good idea of what the bone widths are before you start and go for it.
    Place short healing collars and get the denture clear of the implants

    Get the implants in the correct 3D dimensions with a stent from the lab.

  5. Fadi says:

    Please ,if you have not decided about the flap design or a 2 or one stage placement, attend a lot of coarses that they are willing to give a lot of info placing and restoring implants and up to date technology that will make your life easier … good luck

  6. JG says:

    It is hard to write a response to this question that is not condescending, but I will give it a try. Imagine that instead of being a general dentist, you are a general surgeon. Instead of placing dental implants, you are placing breast implants. Now ask the question on a blog for your patient: “what kind of incision should I use and what kind of implant should I place?” If you think of it this way, you begin to get a sense of how absurd it is to use this blog or any casual educational format to make these decisions. Sure you will get the implant in, but what about complications, risk, etc. Who do you think is going to bail you out if it goes bad? Do you really think it is as easy as paint by the numbers, even if you have a CAD/CAM guide? Do you know how to read a CT scan well enough to plan the implant positions or are you going to delegate that function to someone whose name you don’t know and who you will never meet?

    If you want to do the procedures, (surgical and restorative) invest the time, effort and energy it takes to develop some expertise in the field. Remeber, you are working on a person, not an animal or a model.

    This is not about limiting surgery to surgeons. It is about limiting procedures to qualified individuals. Get the training qualifications!

  7. berto says:

    I assum that you have alredy planning the future patient prostesis after that i think you should make the incision in the top of the crest, put the implants head 1mm deeper into the bone and suture, then reline the old patients dentures with coe-soft.

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