Abstract
The second surgical phase in the Branemark tissue integrated implant system involves uncovering the fixtures and connection of the abutments. According to the Biotes instructional manual (Bofors Nobelpharma, Weston, MA), the fixtures can be individually uncovered, obviating the need for a full alveolar crestal incision. The manual recommends minimally incising the covering mucoperiosteum with a scalpel followed by use of the punch blade instrument, provided in the manufacturer’s kit, to excise the tissue overlying the cover screws on the implants. The author has experienced significant difficulty using the punch blade instrument. Recognizing the advantages in making a circular mucoperiosteal window to expose each implant fixture, two other instruments have been successfully used for this purpose. A hand-held 4 mm disposable Baker Biopsy Punch (Baker/ Cummins, Miami, FL) can be used (Fig. I). After palpating the approximate location of the implant fixture, the punch is preferably placed over the remnant of attached gingiva and twirled to cut a clean circle of tissue. The incised tissue is then lifted off, revealing each cover screw. Similarly, a 4 mm Orentreich scalp punch (Robbins Instrument
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