Most implant systems have five basic steps to place each implant: [29]
- Soft tissue reversal: An incision is made on top of the bone, and the edges of the tissue are pushed back to expose the bone for implant placement. However, there is an alternative technique, where a small portion of tissue (the diameter of the implant) is removed to place the implant instead of lifting the edges of the tissue.
- High Speed Drilling: After inverting the soft tissue, and using a surgical guide or stent as necessary, pilot holes are placed using a precision tool that operates at a regulated speed and has a self-cooling function to prevent burning or necrosis of bone.
- Low speed drilling: The initial pilot hole is enlarged using progressively wider drill tools (usually between three and seven consecutive drilling steps, depending on the implant’s width, length, and operating system specified by the manufacturer). Care is taken not to damage the bone cells through the high temperature, so the tool is attached to a cooling solution or water spray.
- Placement of the implant: The implant screw is placed and can be of the type that rotates and is self-contained in the bone. It is then held in place using a control wrench that produces rotation with a precise torque so that the surrounding bone is not affected (as this can cause osteonecrosis, which may result in the implant failing to fully fuse or bond with the jawbone).
- Tissue adaptation: The gum is positioned and conditioned around the entire implant to provide a band of healthy tissue around the abutment that is attached to the implant. In contrast, the implant can be ‘buried’, where the top of the implant is closed with a screw like a cap and the tissue is closed to cover it completely. In this case, a second procedure is required to detect the implant at a subsequent visit to the doctor.
