Dental implant surgery

If you have gaps in your smile where your permanent teeth used to reside, you may find that more is missing from your life than just teeth. You may also miss out on good nutrition and even social engagements.

It doesn't have to be that way, though. Dental implants along with artificial teeth are often a good option to fill the gaps left by tooth loss. Many people find that dental implants are more comfortable, efficient and secure than are dentures or bridgework.

Here's a look at the dental implant surgery procedure.

Is dental implant surgery for you?

Dental implants aren't the same thing as artificial replacement teeth. Dental implants are actually the threaded metal cylinders that serve as the roots of missing teeth. The implant, sometimes called a post or cylinder, is surgically implanted in the jawbone beneath the gum tissue. An abutment, or extension, is attached on top of the metal cylinder. Finally, a realistic-looking artificial tooth (crown) is attached to the abutment, creating a three-piece device that completes your smile. You may have one tooth replaced with dental implant surgery or many.

Most healthy adults with missing teeth are able to have dental implants. Your dentist, oral and maxillofacial surgeon or periodontist can help you decide if dental implants are a good option for you.

In general, dental implants may be right for you if you:

• Have one or more missing teeth
• Have a jawbone that's reached full growth
• Have adequate bone to secure the implants, or are able to have a bone grafting procedure
• Have healthy oral tissues
• Don't have health conditions that will impair bone healing
• Are unable or unwilling to wear dentures
• Want to improve your speech
• Are willing to commit several months to the process

Your financial situation also might be a factor in determining whether dental implants are a good option. Dental implants are expensive and often aren't covered by insurance. Costs can vary widely, so you might want to consider shopping around.

Single dental implant

Single dental implant

A dental implant is a threaded metal cylinder that replaces the root of a missing tooth. An artificial tooth (crown) is placed on an abutment on the dental implant, giving you the look of a real tooth.

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How do you prepare for dental implant surgery?

Because dental implants require one or more surgical procedures, you must have a thorough evaluation in preparation for the process.

To start, you have a comprehensive dental exam. This may include taking dental X-rays and making models of your mouth. In addition, be sure to talk to your doctor about any medical conditions you have and any medications you take, including prescriptions, over-the-counter medications or supplements.

If you have certain heart conditions or vascular or orthopedic implants, your doctor may prescribe antibiotics before surgery to help prevent infection.

A treatment plan is tailored to your particular situation. This plan takes into account such factors as how many teeth must be replaced and the condition of your jawbone. This planning process may involve a variety of dental specialists, including:

• An oral and maxillofacial surgeon, a doctor who specializes in the diagnosis and treatment of injuries, diseases and other problems of the mouth, jaw and face.
• A periodontist, a dentist who specializes in the diagnosis and treatment of the structures that support the teeth.
• A prosthodontist, a dentist who specializes in making and fitting artificial replacements for missing or defective teeth.

How is dental implant surgery done?

Placement of dental implants and artificial teeth involves surgical procedures usually done in several stages. The entire process takes three to nine months, or sometimes even longer. That may sound daunting, but a lot of that time is spent on healing and waiting for the growth of new bone in your jaw.

What can you expect during dental implant surgery?

Specifically how dental implant surgery is performed depends on the type of implant used and the condition of your jawbone. In general, the dental implant cylinder is first implanted in your jawbone, and then you must sit through a period of healing for several months. After that, the abutment is placed, followed by a shorter healing period. Finally, you get your new artificial tooth, sometimes also called an implant prosthesis or crown. Some people may require bone grafting before the initial dental implant surgery, which lengthens the whole process.

When bone grafting is required
If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can proceed with dental implant surgery. That's because the powerful chewing action of your mouth exerts great pressure on your bone, and if it can't support the implant, the surgery to replace your teeth would likely be a failure. A bone graft can create a much more solid base for the implant.

With bone grafting, a piece of bone is removed from another part of your body, such as your hip, and transplanted to your jawbone. The transplanted bone will grow, but it may take six to nine months to grow enough new bone to support a dental implant. In some cases, you may need only minor bone grafting that can be done at the same time as the implant surgery. The condition of your jawbone determines how you can proceed.

Placing the dental implant
Whether you have a bone graft or not, the dental implant must be surgically placed in your jawbone. This surgery is usually done on an outpatient basis, in either a dental office or a hospital. You don't need to stay in a hospital overnight.

You get some form of anesthesia for pain control during surgery. Anesthesia options include local anesthesia, sedation or general anesthesia. Talk to your dental specialist about which option is best for you. Your dental care team gives you specific instructions about eating and drinking before surgery, depending on what type of anesthesia you have. For instance, if you're having general anesthesia, plan to have someone take you home after surgery and expect to rest for the remainder of the day.

During the surgery, your gum is cut open to expose the bone. Holes are then drilled into the bone where the dental implant cylinder will be placed. Since the cylinder will serve as the tooth root, it's implanted deep into the bone. Once the dental implant is securely in place, your gums are stitched closed over the cylinder. The cylinder sits below the surface of your gum, so it's not visible when you open your mouth.

At this point, however, you still have a gap where your tooth is missing. Usually, a type of partial, temporary denture can be placed to look more aesthetically pleasing. This denture is removable for cleaning and to sleep.

Waiting for bone growth
Once the metal dental implant cylinder is placed in your jawbone, osseointegration begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process usually takes three to six months. This is an important step because it helps provide a very solid base for your new artificial tooth — just as roots do for your natural teeth.

Placing the abutment
Once osseointegration is complete, you need additional surgery to place the abutment, to which the crown will eventually be attached. To place the abutment, your gum is reopened to expose the dental implant. The abutment is attached to the dental implant. This minor surgery is typically done with local anesthesia in an outpatient setting. Once the abutment is placed, the gum tissue is then closed around, but not over, the abutment.

In rare cases, the abutment is attached to the dental implant cylinder at the same time that the cylinder is implanted. That means you won't need an extra surgical step. However, because the abutment juts past the gumline, it's visible when you open your mouth — and it may be that way for six months or so. Some people don't like that appearance and prefer to have the abutment placed in a separate procedure.

Choosing your new artificial teeth
After the abutment is placed, your gums must heal for one or two weeks before the artificial tooth can be attached. Once your gums have healed, you have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth, or prosthesis. The crown can't be placed earlier in the process because your jawbone isn't yet strong enough to support use of the new tooth.

You and your dental specialist can choose from two main types of artificial teeth. They are:

• A removable implant prosthesis. This type is similar to a conventional removable denture. It contains artificial white teeth surrounded by pink plastic gum. It's mounted on a metal frame that's attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning. It's often a good choice when several teeth in the lower jaw are replaced, largely because it's more affordable than multiple individual dental implants and yet more secure than a traditional denture.
• A fixed implant prosthesis. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can't remove the tooth for cleaning or during sleep. If affordability isn't a concern, you can opt to replace several missing teeth this way. Each crown is attached to its own dental implant.

What happens after dental implant surgery?

Whether you have dental implant surgery in one stage or multiple stages, you may experience some of the typical discomforts associated with any type of dental surgery. These may include:

• Swelling of your gums and face
• Bruising of your skin and gums
• Pain at the implant site
• Minor bleeding

Very rarely, stiffness of your jaw muscles may occur, or an inability to fully open your mouth. When these do occur, they're usually a result of passing a surgical needle through jaw muscle.

If swelling, discomfort or any other problem gets worse in the days after surgery, contact your implant surgeon. He or she may prescribe pain medications or antibiotics.

After each stage of surgery, you may need to eat soft foods for five to seven days. Typically, stitches that dissolve on their own are used. If your stitches aren't self-dissolving, your doctor removes them in about 10 days.

Making your dental implant surgery a success

Most dental implants are successful. Still, you can help your dental work — and remaining natural teeth — last longer if you:

• Practice exceptional oral hygiene. Just as with your natural teeth, implants, artificial teeth and gum tissue must be kept clean. Specially designed brushes, such as an interdental brush that slides between teeth, can help clean the nooks and crannies around teeth, gums and metal abutments.
• See your dentist regularly. Schedule dental checkups every six months to one year to ensure the health and proper functioning of your implants.
• Avoid damaging habits. Don't chew hard items, such as ice and hard candy, which can break your crowns — or your natural teeth. Avoid tooth-staining tobacco and caffeine products. Get treatment if you grind your teeth.

When dental implant surgery doesn't work

In some cases, dental implants don't work. Usually that happens when the bone fails to fuse sufficiently to the metal implant cylinder. In this case, the implant is removed, the bone is cleaned up, and you can try the procedure again in a month or two.

In addition, the implant may become loose. If this happens, the implant can be removed and replaced with a new one.

What are the risks and downsides of dental implant surgery?

Like any surgery, dental implant surgery poses some health risks. Problems are rare, though, and when they do occur they're usually minor and easily treated. Risks include:

• Infection at the implant site
• Injury or damage to surrounding structures, such as other teeth, blood vessels and the nasal cavity
• Nerve damage, which can cause pain, numbness or tingling in your natural teeth, gums, lips or chin
• Sinus problems, when dental implants placed in the upper jaw protrude into one of your sinus cavities