A: As a general rule, most postoperative symptoms such as pain and swelling are caused by soft tissue manipulation not by bone manipulation. The process of making an incision through attached gingiva, raising a periosteal flap, leaving the surface of the bone exposed for longer periods of time and the suture placement all involve undue trauma to the soft tissue, and subsequent pain and swelling.
The cookie-cutter technique is indicated when the underlying bone ridge is sufficiently flat and wide (5-7 mm), covered with sufficient attached gingiva to allow at least a 1mm periphery around the edge of the cookie cutter. These conditions are usually found when the implant site is located between existing teeth and/or where the teeth have been recently extracted.
The punch cuts a small diameter hole through the soft tissue, exposing the underlying bone. Using a small curette, lift the circular soft tissue plug from the underlying bone and set the plug aside. Similar to a laparoscopy, all subsequent bone surgery and implant placement is performed through this small opening. Once the implant has been placed, it is not necessary to replace the soft tissue plug over the implant. The soft tissue will epithelialize over the implant within two weeks.
Postoperative symptoms of pain and swelling should be less been found after a simple extraction.
Above left is a photograph of the cut made using the tissue punch; right, the soft tissue plug is removed and the top of the implant showing.
Please do not hesitate to contact me if you have any questions about this subject, or have other questions involving oral surgery or dental implants.
Dr. Harold Bergman, DDS, Dipl.(OS&A), MScD(Path)