In the present case, a single tooth gap with good clinical and radiological conditions is supposed to be treated with an implant. Although the punch technique is not contraindicated in this case, Professor Hürzeler does not recommend it due to the risk of perforations, especially if the surgeon is a beginner. He rather prepares mucoperiosteal flaps to expose the underlying bone. In this case, for the incision he uses a scalpel number 12.
With its curved blade, this scalpel facilitates a clean primary incision that extends from the mesial to the distal tooth on either side of the gap. He is able to avoid vertical incisions. Using a papilla elevator, Professor Hürzeler lifts a mucoperiosteal flap in the buccal and lingual area in order to gain access to the underlying bone and be able to directly assess the bone quality with respect to the planned implantation. In this case the situation is ideal for the insertion of an implant.
Then, the hole for the implant is prepared using different drills aiming at the middle of the exposed bone. Special attention has to be given to the angulation of the drilling in order to avoid perforations and any contact with adjacent roots. A hole with a depth of 11.5 mm is created and verified with a ball-shaped probe. The probe is also used to check for perforations. In this case an epicrestal/slightly supracrestal implant position is aspired, and the implant socket prepared accordingly.
No soft tissue should be incorporated and has to be removed from the socket entrance before the implant is inserted. Blood, however, is required and should not be rinsed off. Since no complication is expected to disturb the healing process, in this case an open healing situation is preferred. A 4 mm healing abutment is placed on top of the inserted implant. Then the soft tissue flaps are fixed around the abutment with interrupted sutures. Deep stitching helps to erect the soft tissue so that is adapts closely to the abutment.