Minimally Invasive Surgical Placements of Nonsubmerged Dental Implants: A Case Series Report, Evaluation of the Surgical Technique and Complications
Minimally invasive surgical implant placement has numerous advantages over conventional open flap technique. A series of cases is described here explaining the use of the tissue punch with discussion of the complications and management.
Patient 1, a 25-year-old Eurasian man missing a left mandibular first molar. (a, b) Note good ridge dimensions and keratinized tissue volume. (c–f) Six-millimeter tissue punch used to remove crestal tissue and access for site preparation and implant placement. (g) Postoperative radiograph shows incomplete seating of the healing abutment due to soft-tissue interference. (h) The healing abutment was reseated after removal of the intervening soft tissue. (i) Three days postplacement. Note excellent soft-tissue response and minimal swelling. (j) Three months postplacement. (k) Final crown delivery with good soft-tissue contours.
Patient 2, a 40-year-old Myamese woman missing a left maxillary second bicuspid. (a, b) The ridge exhibited good dimensions and keratinized tissue volume. (c–f) Five-millimeter tissue punch used to remove crestal tissue for preparation and implant placement. (g) Immediate postoperative radiograph shows complete seating of the healing abutment. (h) The soft-tissue response was excellent with minimal swelling at 1 week postsurgery and remained stable at 6 months (i). (j) Final crown with good soft-tissue contours and esthetics.
(a, b) Patient 3, a 41-year-old Caucasian woman missing a left mandibular first molar with good ridge dimensions and keratinized tissue volume. (c–f) A 6-mm tissue punch was used to remove crestal tissue, for site preparation, and for implant placement. However, the postoperative radiograph (g) reveals incomplete seating of the healing abutment due to bony interference at the mesial aspect of the implant transmucosal polished collar. (h) The healing abutment was reseated after the interfering bone spontaneously resorbed at 12 days after surgical follow-up. This was confirmed with another radiograph immediately after the healing abutment was reseated (i). (j) The final crown was restored 3 months after implant placement with good functional and soft-tissue outcome.
Patient 4, a 33-year-old Chinese woman missing a left mandibular first molar. (a, b) The ridge dimensions and keratinized tissue volume were ideal. (c–f) A 6-mm tissue punch was used to access the site for implant placement, and an immediate postoperative radiograph (g) shows good bone-implant interface and verified complete seating of the healing abutment. (h) Soft-tissue response was good, and minimal swelling was noted at 1 week postsurgery. (i) At 3 months postplacement, the soft-tissue architecture remained excellent, and the final crown (j) delivered with good outcomes.
Patient 5, a 38-year-old Chinese woman missing a right maxillary second bicuspid. (a, b) As in the case of patient 2, the ridge was ideal for a 5-mm-diameter tissue punch access followed by surgical implant placement (c–f). The primary stability of the implant was somewhat compromised, but a decision was made to proceed with the single-stage protocol. (g) Immediate postoperative radiograph shows complete seating of the healing abutment as well as satisfactory bone-implant contact. (h) At 1 week after surgical review, ideal soft-tissue response was noted. There was also no postoperative morbidity. (i) The implant osseointegrated after 6 months of healing, and the soft-tissue contours remained stable. (j) Final crown delivered with excellent esthetic and functional outcome.
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