TRANSCRIPT:

All right, so first thing I do is open up this implant like this. I'll have somebody else open it up, my assistant, and then they drop it on the tray like that, so that the contents are sterile and they're not contaminating anything.

Next, this is the implant contained in this little vial kind of thing. What I do is I grab my manual driver, and so this manual driver, I can actually use it to pick up the implant like that and just insert my manual driver on top of there and then it clicks. See? If there is a little bit of, let's say if the teeth are in the way, right?

So for maybe like anterior teeth or something, I can add an extender. This little extender, I can put it on this driver, it snaps onto there, and you can use that to pick it up as well.

Okay, there is also a bigger extender. And that's over here. There's a big one. I put that on there and you can pick up the implant like so. All right. Now you can use this to place to place your implant, I like to not use any extenders. I like to just use. I like to just use this thing. So let’s put that on there. And let's go ahead and place this guy on the model.

All right, I'm going to take the implant that's on my manual driver and I'm going to insert it right into the osteotomy site that we made. And if you prepped it all the way to the proper depth and especially if you tapped it, it’s just going to pop right in there. And I take the manual driver and I put one, I put like my index finger on the top of it and then I use my other hand to go ahead and spin it and seat it all the way down. Sometimes you might get some bone engagement. So some really strong primary stability, and it's just going in at a really high torque.

What I do for those cases if I feel like the torque is too high, then I'll turn my manual driver upside down, so that's I’ll essentially run it in reverse, and I'll go ahead and back it out a little bit. And then re-insert it, in this case, I'm going to show you right now. I'm going to be backing it out more, but usually, what I'm doing is all I'll reverse it, like three turns, and then go in and see how it feels again. And if it's still feeling pretty tight, what I'll do is just back it out 2 turns and then insert it 3 turns and then back it out, 2 turns and then insert it 3 turns and it's kind of like a feel, right? I mean if the torque is still too high, you should make sure that you went to the proper drill size, and if you didn't take your implant out and go to the proper drill size and then put your implant back in.

So you can see, I was having trouble with my manual driver was bumping up against the neighboring teeth. And so, I'm going to use this extender. You got to make sure the extender is on properly though, I had it at an off angle there, you got to make sure it snaps on properly. So right there it's snapped in and now you can go ahead and sink that implant the full distance. And if you went to the proper depth and use your the proper width implant drill, you should be able to go all the way down. You don't want to see any more of the metal of the implant. So all I'm seeing now is that green.

And you can go ahead and examine that implant placement, so look at it from an occlusal aspect. Just make sure you're 100% comfortable with it. Now. You've already prepped it out but but just make sure you're comfortable with it. That's looking like a really well-placed implant.

And so now what I do is you, you put your little driver in and take that implant transfer out. You want to be really careful. You don't want that to happen. You don’t want the implant transfer to fall and for the patient to swallow it. I like to place my implants to where they're about a millimeter below bone level. so you can come see what that looks like right there and And I place a cover screw on patients who I feel like are higher risk for implant failure. If I feel like they're going to play with that implant site, if they may be a little bit non-compliant if they have any wound healing problems or anything like that. I might put a cover screw on. But what's, what's way More convenient is to use a healing abutment.

So if you feel confident your patient is not going to put their finger on it and move it around and spin it around with their tongue and mess it up, and then go ahead, put a cover screw sorry. Not a cover screw but a healing abutment because it makes it way easier for your impressions later. And you know it eliminates implant uncovery.

Lesson Summary

- The process of implant placement begins with opening the implant package and ensuring that the contents remain sterile. - A manual driver is used to pick up the implant, which is then inserted into the osteotomy site. - If there are obstacles like neighboring teeth, extenders can be used to facilitate implant placement. - The implant is seated by spinning the manual driver while applying pressure. - In cases of high torque, the manual driver can be reversed and backed out before reinsertion. - Implant placement should be evaluated from an occlusal aspect to ensure proper positioning. - After placement, the implant transfer is carefully removed to prevent any accidental swallowing. - Implants are typically placed about a millimeter below the bone level for optimal results. - Depending on the patient's risk factors, a cover screw or a healing abutment may be used to protect the implant. - A healing abutment is more convenient for future impressions and eliminates the need for implant uncovery.