Dental implant surgery is a procedure that replaces missing teeth. A titanium post is surgically inserted into the jawbone where it replicates a natural tooth root. The post is left to fuse with the jawbone over a period of several months until it is strong enough to support an artificial tooth (crown) or teeth (bridge, denture). Once the dentist is sure that the post is securely integrated with the jawbone, a new custom-made tooth (restoration) is attached to the post. This completes your smile and restores your ability to talk and eat normally.
Implant surgery may be worth considering if you:
- Have one or more missing teeth
- Have adequate bone to support an implant (or are prepared to have a bone graft)
- Are in reasonable oral and general health
- Are fed up with loose dentures or are facing tooth loss and do not want dentures
- Are willing to wait several months for the procedure to be completed
- Want a long-lasting solution to tooth loss
In This Guide:
- Assessment and Preparation
- One-Stage Surgery
- Post-Surgery Recovery
- Follow-up & Aftercare
- What to Read Next
Assessment and Preparation
It is very important to be properly and thoroughly assessed by your dentist prior to surgery to determine if you have any contraindications (risk factors). Once you’re approved, various diagnostic tests must be carried out in order for the procedure to be properly planned and executed.
The surgeon will need to know your medical history, including any medications you are taking as they could affect your surgery or the healing process. They will also examine your mouth to make sure you don’t have any dental health problems that must be treated before your implants are placed.
If you decide to proceed after discussing the results of the initial assessment, they will take x-rays and a CT scan of your mouth. They may also wish to take “before” photos and/or impressions of your existing teeth.
Planning the Surgery
These diagnostic tests will help your dentist plan the surgery as they determine the location of your sinus cavities, nerves and blood vessels, as well as the mass and density of your jawbone. If you don’t have sufficient bone density, a bone graft may be required. Bone grafts can sometimes be done during the dental implant surgery, but large grafts (more than 1 implant or a lot of bone tissue involved) must be done in a separate procedure beforehand.
A surgical guide (see right) is then custom made using the impressions that were taken. It is used during surgery to guide the dentist’s drill and pinpoint the exact location for the implant. The accuracy of this process is absolutely vital as it must be placed in good quality bone and avoid sensitive and vulnerable areas in your mouth.
All kinds of surgery involve some amount of risk, and placing dental implants is no exception. That said, problems with dental implant surgery are rare and tend to be minor and easily treatable. Risks include:
- Infection due to bacteria being present during surgery
- Damage to nearby structures including blood vessels and teeth
- Nerve damage which can cause numbness, pain or a tingling sensation in the jaw or chin area
- Sinus problems if an implant is placed too near or protrudes into the sinus cavity
Here are detailed descriptions of the issues that an implant can potentially cause.
Most dental implants can be placed by a surgeon or dentist with the use of a local anesthetic. If you are nervous or getting several implants, then you can ask to be sedated by nitrous oxide (laughing gas), or oral/intravenous sedation. Your surgeon should discuss all of these options with you.
There are several methods of placing dental implants. The best method to use depends on your situation, the type of implant used and type of restoration (crown, bridge or denture). The most commonly used is the three-step procedure.
The Three-Step Process
In the first stage, the implant post is surgically inserted into your jawbone so it is flush with the bone. To do this, a small incision is made in the gums to expose the bone. If a surgical guide is being used, it is positioned in the mouth. Your dentist will then drill into your jawbone, gradually widening the hole until it is the correct size for the dental implant. This stage is critical as the jawbone must be treated very carefully to avoid damaging the surrounding bone (bone burn) as well as nearby nerves and sinus cavities. The implant is then screwed into place.
Next, the gum tissue is folded over the implant and stitched back into position. This ensures the area is protected from any external forces, allowing it to heal and integrate with the implant – a process known as osseointegration. New bone cells grow on and around the post, fusing it into your jawbone. Once this process is complete, the second stage of surgery can begin.
In the second stage, they will make an excision in the gum tissue to expose the top of the post. After confirming that it has fully integrated with your jawbone, they will attach the abutment, which is used to connect and support the final restoration. The abutment can be stock-manufactured or custom-molded by a laboratory.
In the final stage, the gum tissue is given time to heal around the abutment while the final restoration is being fabricated. Once ready, the prosthetic tooth can be screwed or cemented onto the abutment.
Alternatives to the Three-Step Procedure
Alternatively, your dentist may choose to attach the abutment at the same time the post is inserted. This is known as “immediate loading” or “same day dental implants“. However, the implant post still needs time to osseointegrate with your jawbone and must be protected against the forces created by biting and chewing. To achieve this while maintaining aesthetics, you may be supplied with a temporary tooth that is positioned in such a way that it cannot come into contact with opposing teeth.
Making Your New Teeth
Once your gums have healed, they will take impressions of your mouth which are used to fabricate your new tooth or teeth, which can either be removable or fixed.
An implant-retained denture can be a removable prosthesis. It has special attachments in the base of the denture which can clip onto the abutments or over a bar that is attached to the abutments.
A fixed prosthesis is a crown or bridge that is screwed or cemented into place and can only be removed by your dentist.
What is One-Stage Surgery?
This method uses a one-piece dental implant (post and abutment combined) that eliminates the need for a second surgical procedure to expose the implant. The implant protrudes above the gum tissue and has a collar that helps to shape the gums as they heal. Once the post has integrated with the bone, the replacement tooth is connected.
An alternative technique is to attach a temporary healing cap to the post. The cap protrudes through the gums in a similar way to the one-piece dental implant. Once it has integrated, the healing cap is removed and the abutment and restoration can be connected. Both techniques have similar success rates, but it is likely they will prefer one method over the other.
It is important to follow all instructions given by your dentist. You will need to stick to eating soft foods for the first few days after surgery, gradually re-introducing harder foods as the implant site begins to heal. Good oral hygiene is essential as the surgery site must remain clean and free from infection so it can heal properly. They may provide you with a prescription for medicated mouthwash which should be used as directed. Discomfort should be minimal and easily managed with over-the-counter painkillers. Common side effects after the surgery include:
- Minor bleeding
- Minor bruising
- Slight facial swelling and swelling of the gums
Almost all of the swelling should be gone in the first 3-5 days after the surgery and the pain should be almost completely gone after 7-10 days.
It can take between three to six months for the post to completely integrate with the surrounding bone and reach full strength, then another two months for the crown to be made and fitted. This timeframe varies from person to person and your dentist should be able to give you a reasonably accurate idea of how long it will take to complete treatment.
Follow-up & Aftercare – What is the Success Rate?
Dental implant surgery is generally very successful with rates typically between 95% and 97% (see this study and this one for statistics), but everyone is different and your dentist can discuss your suitability as well as their personal success rate. The procedure is more likely to be problem-free if you:
- Have excellent oral hygiene. It is vital to ensure you clean around your implant thoroughly so it is kept free from plaque and food debris. They will show you the best way to clean an implant and give you special interdental brushes or soft/water picks to help you clean the area more effectively. Failure to brush and floss properly is the main reason for implant failure as it can cause the bone and gum tissue surrounding the implant to become infected.
- Have regular check-ups. Visit the dentist every six months for check-ups and cleanings, or more frequently if recommended. This will help keep your mouth healthy and catch any problems that arise.
- Avoid habits that could damage your dental implants. Don’t chew on ice, hard candy or other hard substances as this could damage your implant crowns, or even your natural teeth.
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