What Are the Steps to Two-stage Dental Implant Surgery?

The one stage surgery means that the day that the implant is placed a healing abutment is placed and sits above the gums.  With two stage surgery, the day of the surgery is performed the implant is completely covered.  Three to six months later another surgery is done two expose the implant and place the healing abutment.  The type of surgery chosen is determined by the amount and quality of bone that you have at the time of surgery.  One stage surgery is great  when there is good initial stabilization of the implant and minimal risk of infection.   

Back 20+ years, all implant surgeries were two stage. The old protocol suggest that an implant should be buried under the gums for 4 to 6 months and then the gums would be opened up to expose the implant and allow the crown to be attached. Over time, many of the implants were exposed on their own over the 4 to 6 months of healing. As such, the dental community realized that since there is no deleterious effects of leaving the implants exposed right at the time of surgery, most science and experience led to surgeons now simply doing a ONE stage procedure where implants are left exposed instead of having to go back and expose the implant in a simple second procedure. The only time a TWO stage process might be necessary today is IF you are having an implant placed with extensive bone and gum grafting to correct some defect around the implant. Covering the implant with the gums will allow for complete bone and soft tissue healing and a more predictable long term result. 

A One stage Dental implant means that the implant and healing abutment are placed at the same time. A two stage dental implant involves placing a cover screw on the implant and closing the gums tissue over it during the healing process. There are pros and cons to both procedures as with anything. The pros to a one stage is that there is no second surgical procedure to uncover it at a later date. This also allows for tissue modeling around the implant to occur earlier.  A one stage procedure requires that the bone the implant was placed in have good enough initial quality and that the implant have primary stability, otherwise the prognosis of integration goes down. The one stage is a very predictable procedure in the right hands.  The surgeon must have enough experience to determine if this is whats best for you.  Seek out the advice of a Board Certified Oral and Maxillofacial Surgeon for this.  They will be the most qualified to determine if the surrounding soft and hard tissue makes a single stage procedure right for you

Sental implants historically been designed to be done as a two stages procedure, to let the bone grow around them allowing an adequate healing time. Studies have shown that a one stage procedure is a predictable procedure and even a whole family of dental were conceived as a one stage dental implants which revealed to be reducing the bone loss around the neck of the implants. the surgeon have to consider the bone quality while placing them if it is adequate for one versus the other but also the aesthetic component. when you burry the implant in an aesthetic area sometimes it gives an opportunity to augment the soft tissue at a letr time to maximize the aesthetic results. A qualified periodontist will evaluate all the factors necessary not only from bone quality stand of view but also the need for any aethetic criteria to be considered.

 

Edgard El CHaar, DDS, MS

Traditionally dental implants have been placed using a two staged approach.  The first step in this approach is to surgically place the implant in health jaw bone.  The implant is covered and allowed to heal undisturbed for a period of 3-6 months.  After the healing period the implant is exposed through the gum and a healing screw is place at which point the implant is exposed into the oral cavity.  This approach allows unhindered healing of the dental implant and thus is the preferred way to place implants is bone quality is less than ideal or when implant stability is questionable.

In a single stage approach the implant is placed in bone and allowed to be exposed into the oral cavity the same day as surgery.  The implant is exposed to some forces while it is in the initial healing phase.  This approach has been shown not to reduce the success rate of the implant so as long as the initial stability and the bone quality around the implant is good.
 

In cases where patient benefits more from two step implant surgery (rather than one), we place implant and cover it with a gum first. We wait for complete integration, depending on area waiting time can be from 3 to 6 moth. And then we have second procedure which is called implant uncovering, where surgeon would put a healing abutment of the implant, so that the soft tissue around it could completely heal. If implant is in aesthetic area your restorative doctor might put a provisional crown to create a good contour and condition the tissues. And that would be it with a two step implant surgery. Next - implant restoration.Good luck!

Two stages would mean that at the time of placement, the gingiva (gum) is allowed to grow over.  After the adequate healing period, that small area of gingiva is then exposed, and a "healing" cover is placed, which will at that point stick through your gum, like a small thumb nail.  A one stage procedure, would mean that at the time the implant is placed,  the "healing" cover would be placed, thus a little metal piece would be noticeable through the gum.

Sincerely, 

Anca Bazile, DDS, MSD, Periodontist, New York City

Normally, the success of an implant is determined by the implant integrating (or fusing) with the bone.  The odds for success increase if the implant is not disturbed while the new bone is forming, so traditional methods are where an implant is placed and the gums are allowed to grow over the implant, covering it all up.  After a period of time, the dentist exposes the implant and places the crown in a series of steps.  This is called a two stage process.

A single stage process is where the implant has a temporary crown placed at the time the implant is placed, and after the integration a permanent crown is placed.  The odds for success goes down statistically by about 2%, so this is still a very successful approach.

There is NO method that means the implant and final restoration is placed at the same time.