Dental implants are surgically placed directly into the jawbone from within the mouth, under anesthesia. Small posts (abutments) are then attached to the implants, which protrude through the gums. These posts provide stable anchors for artificial replacement of teeth. Prosthetic options include single crown (cap) for one tooth implant, bridgework or implant-retained over-dentures, based on patient needs. There are two distinct phases for every implant procedure – the first is the surgical procedure for placement of the implant and the second is the prosthetic procedure to load the implant(s) with missing tooth/teeth.
A key to implant success is the quantity and quality of the bone where the implant is to be placed. If there is insufficient bone or if the bone quality is poor, various bone enhancing procedures may have to be performed prior to the implant placement. These include procedures such as bone-grafting, bone-substitute grafting, Guided Tissue Regeneration (GTR), sinus-lift & ridge-modification procedures. “Inferior alveolar nerve trans-positioning” may have to be employed to move a nerve that may be in the way.
Sinus Lift / Augmentation
The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality. The close proximity to the maxillary sinus is one of the factors leading to this problem. Sinus augmentation can help correct this problem by raising the sinus floor thereby providing provision for increased bone height providing an ideal scenario for placement of dental implants.
Deformities in the upper or lower jaw can leave you with inadequate bone to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.
The surgery commences with administration of local anesthesia. If you are really scared about the surgery procedure or if several implants are to be placed in a single sitting (ie involving major surgical work), general anesthesia may be required. The gum tissue is surgically pushed back to expose the jawbone where the implant is to be placed. Surgical stents may be used to assist in guiding the placement of implants at the right place. The implants are placed into bone as previously planned. The gums are then sutured back. Absorbable sutures do not require removal whereas non-absorbable ones have to be removed after about a week. Check Xrays are taken at various stages to confirm the position of the implant(s). Most patients experience no major discomfort during or after the procedure. Some patients do report minor pain and swelling immediately after the procedure but most experience no change in their daily routines. Pain medications and/or antibiotics along with antibacterial mouthwashes are usually given after the procedure. Usually soft food intake is recommended during the healing process.
A temporary denture may be given if necessary, to ensure that the patient is able to smile confidently. If the bone into which the implant has been placed is excellent in texture and favorable in all respects, “immediate-loading” implants may be considered, eliminating a waiting period for loading of the implants with permanent crowns / bridgework.
HEALING (OSSEOINTEGRATION) PERIOD
After successfully placing the dental implant, it has to be left undisturbed in the jawbone for a period of three to six months. During this phase, the surrounding bone attaches and integrates onto the implant surface by a process called “osseo-integration”. During this phase, most patients do not experience any disruption in their normal day-to-day activities.
The osseo-integration period of implants differ from patient to patient. However, once it is complete, the surgeon exposes the top of the implant and attaches a small metal post termed “abutment”. In this minor surgical procedure, the abutment that will support the restoration is attached. This surgery is less invasive than the first, but still may require local anesthesia. An incision is made in the gum to expose the head of the implant. Then, the “cover screw” is replaced with a “healing abutment”, which protrudes above the gum. This allows the gum to heal in the correct shape around the abutment before the crown, bridge or denture is attached. Since this is not as extensive as the surgery to place the implant, the patient will typically feel less discomfort. However, the dentist will still usually prescribe pain medications and recommend soft food during the healing process. This abutment passes through the gum and ultimately supports the new tooth. The abutment can be seen projecting through the gum after fixation. After this second minor surgical treatment, the gums take few days to weeks to heal.
FINAL PROSTHETIC RESTORATION
This is the final step in the implant procedure. An impression of the abutments is made for the lab technician to make the new implant-supported crowns / bridgework. The final prosthetic tooth/teeth may be screwed into place or cemented. The new tooth/teeth are firmly anchored into the bone and gums, and will look and feel just as natural teeth.