Today it is widely acknowledged that the best method to replace a missing tooth is with a dental implant. But did you know that there are two main techniques for placing implants? Implants can be placed either using a one stage or a two stage surgical technique, and as their names suggests, one is performed in one step (at the time of implant placement) while the other requires a second surgery.
With a one-stage procedure, a healing abutment is placed at the time of surgery. A healing abutment is a connector that attaches to the implant and protrudes through the gum tissues allowing the gums to be shaped in preparation for the implant-supported crown. Following a 3 to 6 month healing period in which the implant fuses to the bone, a crown is then placed on the implant restoring the immediate appearance of a healthy, normal tooth. One-stage implant systems are generally used when the bone quality is good and provides good initial implant stability. They are also used when cosmetics is not a concern, such as the back areas of the mouth.
Under special conditions, a temporary crown can be placed on top of an implant at the time of implant surgery. However, this is a very special circumstance requiring ideal conditions and surgical experience as well as a highly experienced general dentist or prosthodontist. It is generally safer and wiser not to subject an implant to biting forces until it is fully healed and integrated with the supporting bone. (*If immediate temporization of your implant is an option, Dr. Weiner will discuss this with you at your initial consultation appointment)
A two-stage procedure is typically used for replacing teeth where there is no immediate need for a cosmetic solution and when more of a margin of safety is required. With this approach, the implant(s) are placed into the jawbone and the gum tissues cover them. Thus, the implants are not exposed to the oral cavity, but rather stay buried below the gums and left to heal completely out of function. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is used when there is poorer bone quality or quantity of if bone or soft tissue grafting is necessary at the time of implant placement. There may also be other systemic health considerations that favor a two-stage approach to implant surgery.
In summary, it is up to your surgeon to determine whether a one- or two-stage approach is recommended at the time of your implant surgery. However rest assured, research shows that success rates of dental implants are not significantly different between approaches. Please see the charts below for a brief overview of the pros and cons of one- versus two-stage surgery for both partially edentulous patients (patients missing one or several teeth but with remaining natural teeth) and fully edentulous patients (patients with no natural teeth).
For further questions regarding one- versus two-stage implant surgery, please contact Dr Weiner by emailing firstname.lastname@example.org.
- Cordaro L, Torsello F, Roccuzzo. Clinical outcome of submerged versus non-submerged implants placed in fresh extraction sockets. Clin. Oral Impl. Res. 20, 2009; 1307-1313
- Esposito M, Grusovin MG, Chew YS, Coulthard P, Worthington HV. Interventions for replacing missing teeth: 1 VS 2 stage implant placement. The Cochrane Collaboration 2010:1.
- Cecchnato. Submerged or non-submerged healing of endosseous implants to be used in the rehabilitation of partially dentate patients. J Clin Periodontol 2004; 31 299-308
CHART II: ONE- VERSUS TWO-STAGE SURGERY FOR FULLY EDENTULOUS PATIENTS
- Becktor JP, Isaksson S, Billstrom C. A prospective multicenter study using two different surgical approaches in the mandible with turned Branemark implants: conventional loading using fixed prostheses. Clinical Implant Dentistry and Related Research 2007;9(4):179–85
- Esposito M, Grusovin MG, Chew YS, Coulthard P, Worthington HV. Interventions for replacing missing teeth: 1 VS 2 stage implant placement. The Cochrane Collaboration 2010:1
- Heijdenrijk, K., Raghoebar G., Meijer, H., Stengenga, B., Reijden.Feasibility and Influence of the Microgap of Two Implants Placed in a Non-Submerged Procedure: a five-year Follow up Clinical Trial, Journal of Periodontology, 2006; Vol. 77-numb. 6, 1051-1060
- Heydenrijk K, Raghoebar GM, Meijer HJA, van der Reijden WA, van Winkelhoff A-J, Stegenga B. Two-part implants inserted in a one-stage or a two-stage procedure: A prospective comparative study J Clin Periodontol 2002;29:901-909
- Heydernijk, K, Raghoebar, G, Meijer, H, Stegenga B.Clinical and Radiographic Evaluation of 2-Stage IMZ Implants Placed in a Single-Stage Procedure: 2-year Results of a Prospective Comparative Study, The International Journal of Oral and Maxillofacial Implants 2003; 18: 424-432.