Placing Dental Implants
When you get implants, more than one dental professional may treat you. An oral surgeon, periodontist or general dentist with training in implants will place the implants in your jawbone. A prosthodontist or general dentist will make your crowns, bridges or dentures, which will look like natural teeth. The dental specialist who places your implants will coordinate your treatment with your general dentist or prosthodontist. He or she will decide what implants to use, how many you need and where they should be placed.
There are different types and manufacturers of implant devices. Therefore, the approach your dentists use may differ from the description presented here. The following describes the steps that a dentist typically takes when placing an implant.
Before Placing an Implant
Most people are good candidates to get dental implants. You must have enough bone in your jaw to allow an implant to be placed in the jawbone. You should be free of periodontal disease. Implants are not recommended for:
- People who have autoimmune diseases or take medicines used for these conditions
- People who have had radiation therapy to the head and neck
- People with uncontrolled diabetes
A dental professional will examine you and determine if you are suitable to get implants.
Some people want implants to replace teeth that have been missing for years. Others may need implants to replace teeth that were extracted recently because of severe decay, periodontal (gum) disease, infection or injury. In some cases, the teeth can be extracted and the implant placed at the same time. However, if you have a severe infection in a tooth root or your gums, your dentist may wait a few months after removing the teeth to allow the area to heal.
If you do not have enough bone to support an implant, you may be able to have the bone in the area built up. This is a common procedure called bone grafting or augmentation. If a bone graft is done, you will need four to eight months to heal before having the implants placed in your jawbone. You can wear dentures or a bridge during this time, so you won't be without teeth.
Placing the Implants
Most implants are placed using a two-step process, although some newer implants can be placed in one step. What follows, is a description of how the two-step process works.
You may be given antibiotics and pain medicine to take before the procedure. Your dentist will use local anesthesia and may offer you sedation if you want it. You can be sedated by taking medicine by mouth, or through an intravenous line. This is a needle attached to a small tube placed in a vein in your arm.
To place the implants, the surgeon first will make an incision (cut) in your gums to expose the bone. He or she then will drill a hole in the bone and place the implant in the hole. The surgeon probably will take an X-ray of the area to make sure the implant is where it should be. The surgeon will then stitch your gum closed over the implant.
The time required for this procedure depends on:
- The number of implants
- Whether or not you get a bone graft at the same time
In most cases, placing a single dental implant requires less than one hour. You will feel some pain after this procedure. The level of discomfort depends on the person, but generally it has been described as relatively mild.
If the implant is placed in the front of your mouth, your dentist will give you a temporary denture or bridge so that you do not have to be without teeth. He or she will discuss options with you before the surgery.
After the surgery, your surgeon will give you antibiotics and pain medicine. You also will get instructions to follow. These will include:
- Don't spit, suck on straws or smoke. This can dislodge blood clots and slow healing.
- Eat only soft food to avoid injuring your gums.
- Don't try to clean the implant area for the next few days, but clean the rest of your mouth normally. Your dentist may give you an antibacterial rinse to help keep the area clean.
You will return to the surgeon 7 to 10 days later to have your stitches removed.
After the implant is placed in your jaw, you will have to wait several months for the bone to bond with the implant. This usually takes 3 or 4 months in the lower jaw and 5 or 6 months in the upper jaw. During this time, the head of the implant usually remains hidden under your gum.
After the implants have integrated with (attached to) the surrounding bone, you are ready for the second step. After giving you local anesthesia, your surgeon will make a small cut in the gum. This exposes the implant. This surgeon will remove a protective screw from the implant and replace it with a metal healing cap (collar). The healing cap looks like a small metal cylinder that sits above your gums in the area where your tooth would be. It maintains the space so that the gum heals correctly around the implant.
In a very small percentage of cases, the implants will not successfully integrate with the bone. If this happens, your dentist can do one of the following:
- Remove the implants and immediately replace them with slightly wider ones.
- Remove them, place grafts of bone in the empty spaces and allow the area to heal for several months before making a second attempt.
Some dentists are now using one-stage implants. These implants are placed in the jaw and remain exposed in the mouth so that no second surgery is needed.
Generally, you will go to your dentist or prosthodontist two or three weeks after the second surgery to start the process of having your crown, bridge or denture made.
Complications From Surgery
Any surgery carries the possibility of complications. Problems that can occur with implant surgery include:
- Injury to nerves, sinuses (located above your upper teeth) or the nasal cavity
When implants are used to replace lower teeth, your dentist could nick the nerve that runs through the jawbone during drilling. This can cause pain or numbness. If numbness occurs, it usually affects the lower part of the lip and chin or one side of the tongue. It can last for several months until the nerve heals. In some cases, it may be permanent.
In the upper jaw, there is the possibility of drilling through the jawbone into one of your sinuses or nasal cavity. This could result in an infection. To avoid this, special X-rays are taken before your surgery to help the surgeon determine where the nerves, sinuses and nasal cavity are located.
Implant surgery is successful more than 90% of the time.
Occasionally, an implant fails to integrate with the surrounding bone. This is usually discovered at the second stage surgery when the implant is uncovered and the surgeon finds it is loose. In this case, the "failed" implant has to be removed. Another implant can be placed either immediately or at a later visit.
Sometimes implants fail to integrate with surrounding bone after the first stage of surgery. Potential reasons include:
- Surgical trauma
- Infection around the implant
- Smoking — This appears to decrease blood flow to the healing gums and bone, which could interfere with the bonding process.
- Lack of healthy bone — If there is not enough bone for the implant to remain stable, the implant may move around within the bone and integration will not occur.
- Titanium allergies — These are extremely rare.
Problems also can develop years after implants are placed. For example, just like natural teeth and gum tissue, the gum around implants can become infected by bacteria. This leads to a form of periodontal disease called periimplantitis. If left untreated, this condition can cause bone loss. Then the implant can become loose and have to be removed. Generally, this situation can be treated in a way very similar to treatments for periodontal disease affecting natural teeth.
Another type of complication that can happen over time is breakage. Either the implant or the implant-supported restoration (crown, bridge or denture) can break. This usually happens if your bite (the way your teeth come together) is not aligned properly. If your bite is off, too much force might be placed on the restoration or implant. This can cause the implant to fail (lose its integration with the bone). Broken restorations may result, but can often be repaired. However, a fractured or failed implant has to be removed. A implant that breaks or fails because of an infection can be replaced with a new implant.
A implant that breaks or fails because of an infection can be replaced with a new implant.
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