Dental implant surgery

Definition

Dental implant surgery is a procedure that replaces damaged or missing teeth with artificial teeth that look and function much like real ones. Dental implant surgery can offer a welcome alternative to ill-fitting dentures or bridgework.

How dental implant surgery is performed depends on the type of implant and the condition of your jawbone. But all dental implant surgery occurs in stages and involves several procedures. The major benefit from implants is solid support for your new teeth — a process that requires the bone to heal tightly around the implant. Because this healing requires time, the process can take many months.

Dental implant surgery

Dental implant surgery

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 ...

Why it's done

Dental implants are surgically placed in your jawbone, where they serve as the roots of missing teeth. Because the titanium in the implants fuses with your jawbone, the implants won't slip, make noise or cause bone damage the way fixed bridgework or dentures might. And the materials used can't decay like your own teeth that support regular bridgework can.

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 graft
• Have healthy oral tissues
• Don't have health conditions that will affect bone healing
• Are unable or unwilling to wear dentures
• Want to improve your speech
• Are willing to commit several months to the process

Dental implant surgery

Dental implant surgery

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 ...

Risks

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 or blood vessels
• 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

How you prepare

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

• Having a comprehensive dental exam. This may include dental X-rays and having models made of your mouth.
• Getting a treatment plan. Tailored to your situation, this plan takes into account factors such as how many teeth you need replaced and the condition of your jawbone. The planning process may involve a variety of dental specialists, including an oral and maxillofacial surgeon, a doctor who specializes in conditions of the mouth, jaw and face; and a periodontist, a dentist who works with the structures that support teeth.

Be sure to tell your doctor about any medical conditions you have and about any medications you take, including prescription and over-the-counter medications and supplements. If you have certain heart conditions or orthopedic implants, your doctor may prescribe antibiotics before surgery to help prevent infection.

You will be given 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 will instruct you about eating and drinking before surgery, depending on what type of anesthesia you have. 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.

What you can expect

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

Typically, the dental implant cylinder is first implanted in your jawbone. This is followed by a healing period that may last several months. After that, the abutment is placed, followed by your new artificial tooth (also called an implant prosthesis or crown).

When bone grafting is required
If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can have 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 likely would fail. A bone graft can create a more solid base for the implant.

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

Placing the dental implant
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.

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. At this point, however, you still have a gap where your tooth is missing.

Usually, a type of partial, temporary denture can be placed for appearances. You can remove this denture for cleaning and while you 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, which usually takes two to six months, helps provide a solid base for your new artificial tooth — just as roots do for your natural teeth.

Placing the abutment
When osseointegration is complete, you may 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 many cases, the abutment is attached to the dental implant cylinder when the cylinder is implanted. That means you won't need an extra surgical step. Because the abutment juts past the gumline, however, 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 heal, you'll 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 until your jawbone is 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 are 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.

After 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

If swelling, discomfort or any other problem gets worse in the days after surgery, contact your implant surgeon. You may need 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.

Results

Most dental implants are successful. Sometimes, however, the bone fails to fuse sufficiently to the metal implant. Smoking, for example, can contribute to implant failure and complications.

If the bone fails to fuse sufficiently, the implant is removed, the bone is cleaned up, and you can try the procedure again in a month or two.

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.