Modern dental implants have been used successfully for over 30 years. They are the strongest devices available to support replacement teeth – and even better, they allow these new teeth to feel, look and function naturally.

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When performed by a trained and experienced dental implant dentist, dental implant surgery is one of the safest and most predictable procedures in dentistry.

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IMPLANT SURGERY AND EXTRACTIONS

It is very common to replace a missing or broken down tooth with a dental implant. Sometimes the tooth is extracted, a bone grafting procedure is done and after a few months of healing an implant is placed. In other instances, the implant can be placed on the same day the tooth is extracted. Newer grafting procedures such as Leukocyte and Platelet Rich fibrin ( L-PRF) allow for the placement of the implant at the same time as tooth extraction.

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IMMEDIATE IMPLANTS

When the tooth to be extracted is not infected, a dental implant may be placed at the same time as tooth extraction. This procedure is usually done at the same time as a bone grafting procedure. In our practice, the most common grafting procedure is L-PRF.

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For anterior (front) teeth, it is common for the dentist to place a temporary tooth at the same time as the implant is placed, this procedure is called Immediate loading. Immediate loading allows the patient to leave the dental appointment with a temporary tooth. Immediate loading is seldom used in  unilateral posterior areas.

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DELAYED IMPLANTS

When the tooth to be extracted is actively infected, the infection may need to heal before the implant is placed. In these instances, the tooth will be extracted and a bone graft is done. After a period of healing of approximately two months, the implant is then placed.

 

BONE AND SOFT TISSUE GRAFTING

Bone grafting is a surgical procedure that uses transplanted bone or bone forming tissue to repair and rebuild diseased or damaged bones. A bone graft is a choice for repairing bones almost anywhere in your body. In dentistry there are several types of bone grafting procedures such as:

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• Grafting with bovine or cadaver bone

• Synthetic bone replacements such as Beta tricalcium phosphates

• Leukocyte and platelet Rich fibrin (L-PRF)

• In our practice we use L-PRF and/or Synthetic bone replacements.

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LEUKOCYTE AND PLATELET RICH FIBRIN

With this technique, blood is drawn on the day of the dental appointment prior to the extraction of grafting procedure. Using a centrifuge, the blood cells are separated and a plug is created. The L-PRF plug(s) are then placed inside the tooth socket and/or surrounding the implant. This plug contains leukocytes and platelets that can secrete substances that are known to accelerate healing and reduce post-operative pain. Basically, helping to heal the patient with his own cells.

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Platelet-rich fibrin (PRF) or leukocyte- and platelet-rich fibrin (L-PRF) is a technique where autologous platelets and leukocytes are present in a complex fibrin matrix to accelerate the healing of soft and hard tissue and is used as a tissue-engineering scaffold. To obtain PRF, required quantity of blood is drawn quickly into test tubes without an anticoagulant and centrifuged immediately. Blood is centrifuged using a tabletop centrifuge for at least 8 min at 2800 revolution per minute. The resultant product consists of the following three layers; topmost layer consisting of platelet poor plasma, PRF clot in the middle, and red blood cells (RBC) at the bottom. PRF is available as a fibrin clot. PRF clot can be removed from the test tube using a sterile tweezer-like instrument. After lifting, the RBC layer attached to the PRF clot can be carefully removed using a sterilized scissor. Platelet activation in response to tissue damage occurs during the process of making PRF release several biologically active proteins including; platelet alpha granules, platelet‑derived growth factor (PGDF), transforming growth factors‑β (TGF‑β), vascular endothelial growth factor (VEGF), and epidermal growth factor. Actually, the platelets and leukocyte cytokines play important parts in role of this biomaterial, but the fibrin matrix supporting them is the most helpful in constituting the determining elements responsible for real therapeutic potential of PRF. Cytokines are immediately used and destroyed in a healing wound. The harmony between cytokines and their supporting fibrin matrix has much more importance than any other platelet derivatives.

           

BETA TRICALCIUM PHOSPHATE (TCP)

In cases where blood drawing is not possible or practical, we will use bone grafting material made with synthetic materials such as hydroxyapatite or TCP.

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Tricalcium phosphate (sometimes abbreviated TCP) is a calcium salt of phosphoric acid with the chemical formula Ca3(PO4)2. It is also known as tribasic calcium phosphate and bone phosphate of lime (BPL). It is a white solid of low solubility. Most commercial samples of "tricalcium phosphate" are in fact hydroxyapatite.

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It exists as three crystalline polymorphs α, α', and β. The α and α' states are stable at high temperatures. Tricalcium phosphate is produced commercially by treating hydroxyapatite with phosphoric acid and slaked lime.

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