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In the early 1980's, Dr. P. I. Brånemark introduced a very specific technique for the placement of dental implants. This technique became the basis for the incorporation of successful endosseous dental implants into every-day dental practice. The hallmark of Dr. Brånemark's technique is:
Some variations on this basic technique have been proposed over the years, but in actuality, successful implant procedures are to this day very much dependent on these principles. As you go down these pages, the basic Brånemark technique will be presented. To see an actual clinical picture, just click on any of the drawings.
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While seemingly a simple task, this procedure is really the most critical step in implant placement. If we have learned nothing else over the past decade and a half, it is that implant positioning is the key step in the use of dental implants for the support of a dental restoration.
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Once the site has been carefully located so that the three dimensional location of the implant is determined, the first hole is made in the bone. A 2mm Twist drill under copious irrigation is moved to the entire depth of the implant site. Drilling speed is about 1200 RPM and great care is taken to not overheat or damage the bone. The twist drills are generally marked to show the required depth for implants corresponding to lengths of 7mm, 10mm, 13mm, 15mm, and 20mm.
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Once the 2mm site has been drilled, guide pins are inserted to check the direction of the implants. At this stage, adjustments may still be made to correct any alignment problems. Implants do not have to be parallel to each other, they merely have to be orientated correctly with regard to the final restoration.
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A safe cutting step-up drill is used to initially enlarge the 2mm diameter site to 3mm. The drill only enters the bone for a few millimeters to establish the direction for the 3mm bur.
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The 3mm drill is moved to the final depth of the site preparation. Keep in mind that the markings on the drill are not absolute measurements, but rather dimension indications for the appropriate length implant to be placed slightly below the crest of bone. A site for a 10mm implant is actually prepared to a depth of approximately 11.5mm in order to accommodate the total length of the implant and place it completely into bone.
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The rational behind countersinking is to provide a definitive seat for the head of the implant while still allowing the implant to be completely seated in bone. This process has come under some controversy in recent years. My thoughts are to eliminate countersinking and infraboney placement of implants wherever possible.
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If the implants have been properly placed both with respect to not damaging the surrounding bone and to considerations of implant alignment consistent with the final restoration, the completion of the restorative process should be fairly simple. Most difficulties encountered in implant restorative dentistry can be traced back to poor implant placement.
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