Alumni that have taken the Engel Curriculum are ahead of other colleagues that place implants in my opinion. The step by step cookbook that Dr. Engel has drilled into you will keep you on a safe pathway to success.
1. Plan you cases within your comfort zone. Dont deviate until you feel confident you can do so. Do 25-30 cases of posterior teeth before you tackle an anterior case.
2. Review the patients medical history and make sure the patient is healthy enough that his or her medical condition will not compromise the outcome.
3. Make sure you have a minimum of 7 mm width of bone early on.
4. Make sure you have 2mm buffer when placing on the mandible for the IAN. if you do not have a CT scan then either get one or if you do not need one make sure you know your anatomy.
5. In the posterior maxilla make sure early on do cases that have minimum length of bone of 7 mm crest to sinus.
6. Use two handed technique to keep you safe especially drilling through cortical plate because you need that second hand to catch the drill if it drops into the softer cancellous tissue.
7. When drilling make sure your drills are sharp and not dull. Make you you use a pumping motion to keep the area well irrigated. This will prevent burning the bone.
8. Even if your implant has great torque and by the book it says place a healing cap, give an overall look at patients hygiene. I have had patient non compliant in eating on the healing cap. If I would have buried the implant and put it to sleep I may not have lost it.
9. Punch vs. Flap It is much easier to punch then to flap but according to studies at the Misch Institute show that even though it shows less bone loss around the implant collar with punching, flapping overall has a higher success rate than punching. Their are more failures with punching.
With all these little pearls lets look at a case.
The patient came to me with #30 fractured and I removed it and grafted it with techniques taught in M2
Even though it says you can go back in after 4 months with a mineralized I usually wait another month before proceeding with my placement. I find going in at three months for demin allograft and 4 months for mineralized allograft just to soon. I like to flap, I like to see the full picture related to my CT scan. I drill in 4 to 6 mm to check my orientation before I go to depth.
I finish my osteotomy with two hands and take a final positioning pin Xray before placement.
Placement of Straumann 4.8 x 10 mm implant. 35ncm was achieved. Patient is very hygienic so healing cap was placed. Sutures used were Cytoplast non resorbable.