The proposed three-stage protocol :
The protocol used in our case report consists in deviding implant
placement into 3 distinct surgeries :
- First stage : Drilling sequence with abundant cooling solution,
betadine rinsing of the newly-created socket, hermetic closure of the
wound and prescription of antiobiotic therapy.
- Second stage : Reopening of the site after 3 weeks (proliferation
phase of the socket healing process) and implant placement.
- Third stage : Replacing the cover screw with the healing abutement
after a healing period of 3 months.
The frist surgery is undoubtedly the most risky ; in fact, drilling
through the dysplasic tissue generates heat which increases the risk of
infection and necrosis of the surrounding tissue. Systematic
antiotherapy is highly advised in this stage to prevent such risks. In
case it proved unsufficient, infection must be treated with surgical
curettage of the site, betadine rinsing and the prescription of an
antiseptic mouthwash.
Delaying implant insertion 3 to 4 weeks comes with 2 major advantages ;
First, preventing implant surface contamination in case of infection due
to the drilling sequence. And second, the time lapse between the
drilling sequence and implant placement matches the proliferation phase
of the socket healing process caracterized by the formation of a woven
immature bone surrounded by a provisional fibrous matrix (fig 14)(14).
It has been hypothesized that this newly-created healthy tissue
surroundig the implant would act more like normal bone and would be more
compatible with implant osseointegration than the cementum-like tissue
originally found in COD.
In addition, delaying the placement of the healing abutement is highly
advised. In fact, exposing the implant to the oral cavity’s flora
simultaniously with its insertion increases the risk on infection. A
3-month delay enables the surrounding hard tissue to reach a more mature
state corresponding to the remodeling phase of the socket healing
process (14).