Implant Placement Preparation

Implant placement involves deep area such as bone.  It also involves a lot of bleeding , so we need to be strictly clean.

In sterilization room

  1. PA device for Endo so that we can take PA with reamer or drill in place
  2. Sterilized kidney plate and long forceps to pick up iodine and 75% alcohol cotton
  3. Three trays with plastic wrap; one big towel (double for patient’s bib), two small ones (single to cover trays); if we use osteotomes for upper teeth, prepare extra big towel to wrap head with towel forceps so that we hold the nose with gloved fingers while tapping
  4. Implant cassette (Bicon, Tatum Screw (cylindrical), D, or Tapered): one or two
  5. Handpieces: two slow-speed: E16R and 400:1 (for Bicon implant only); 45° surgical (not open), surgical bur block in pouch
  6. Surgical cassette or instruments: syringe, retractor, scalpel, periosteal elevator, small-tip surgical curet, needle holder, scissors, hemostat; pointed driver for D implant (plastic box)
  7. Implant cassette: Bicon large: most comprehensive, but make sure to have mallet, threaded straight or off-set handle, implant/abutment seating tip, plug scissors and dappen dish; small cassette may not have the instruments just mentioned
  8. Osteotome kits (total 4): straight (anterior), or offset (posterior); regular or tapered
  9. Sterilized 2x2, cotton rolls and ordinary q-tip; small or large bowel, monojets x 2
  10. Consent, implant post-op instruction, 2x2 gauze pack (4-5 pieces) for patient

In treatment room

  1. Blades: #15: 1-2: #12: 1; chromic gut or PGA suture (18 or 27 inches)
  2. Extra surgical suction tips (large and small; sterilized x 4 pouches, 2 in each room), normal saline (do not overuse salt when we make normal saline; rather use a little less)
  3. Prepare Chlorhexidine and paper cup (do not throw away when it is done, some patients may want to rinse after procedure)
  4. Take out bottle with large cottons soaked in iodine and 75% alcohol in kidney plate, use long forceps (in pouch) to grasp cotton to clean skin outside mouth
  5. Use sterile large towel as bib, and place small ones on two trays
  6. Another tray with plastic wrap for PA device
  7. Ask doctor whether there is surgical guide for the case.  Go to lab, find patient’s box in implant cabinet (most inner section), and cold sterilize the guide (usually suction down)

 Procedure sequence

  1. Say hi to patient (Mr. Wang, Mrs. Jones, or Peter), confirm procedure, consent
  2. Let patient rinse with Chlorhexidine 5-10 cc for one minute before surgery
  3. Open patient’s file: Dentrix and Clinical View (special layout); layout may exist
  4. Take PA if we have not taken one recently; ask doctor for permission.  We do need another tray with plastic wrap for X-ray device, because there will be blood, whereas in the second and third appointments of implant, we do not need a tray with plastic wrap, because there is no much blood involved
  5. Local anesthesia with Lidocaine 1-2 carpules, Septocaine 1; always load #30 gauge needle for implant placement, no matter upper or lower jaw, we start with it, but prepare #27 gauge needle (not open) for the lower jaw.  Why?
  6. If needed, load pilot drill in E16R slow-speed handpiece, 2.5mm latch reamer in 400:1. If doctor has adjusted knob controlling high-speed handpiece water volume, please clean the knob after procedure
  7. Prepare house scissors by implant box (Bicon)
  8. After finishing drilling or osteotomy, pass small tip curet to doctor to check whether there is perforation in osteotomy (5-walls)
  9. Read Bicon Surgical Manual p 21-28 or watch video
  10. Check Bicon Surgical Manual p 10-17 for arrangement of cassette
  11. Check Tatum binder for arrangement of instruments
  12. Return to Assistant Page

Xin Wei, DDS, PhD, MS 1st edition 07/19/2011, last revision 07/19/2011