Dental implant surgery is a procedure that replaces tooth roots with metal, screw-like posts and replaces damaged or missing teeth with artificial teeth that look and function much like real ones. It offers a welcome alternative to dentures or bridgework that doesn't fit well.
How dental implant surgery is performed depends on the type of implant and the condition of the jawbone. But all dental implant surgery occurs in stages and may involve several procedures. The major benefit of implants is solid support for the 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.
Why it's Done
Dental implants are surgically placed in the 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 can't decay like own teeth that support regular bridgework can.
In general, dental implants may be right if one has:
- 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 speech
- Are willing to commit several months to the process
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 to Prepare
Because dental implants require one or more surgical procedures, one must have a thorough evaluation to prepare for the process, including a:
Tell the dental doctor about any medical conditions and any medications that is being taken, including prescription and over-the-counter drugs and supplements. In case of certain heart conditions or orthopaedic implants, the doctor may prescribe antibiotics before surgery to help prevent infection.
- Comprehensive dental exam. Have dental X-rays taken and models made of teeth and mouth.
- Treatment plan. Tailored to the situation, this plan takes into account factors such as how many teeth need replaced and the condition of the jawbone. The planning process may involve a variety of dental specialists, including a doctor who specializes in conditions of the mouth, jaw and face (oral and maxillofacial surgeon) and a dentist who works with the structures that support teeth (periodontist).
To control pain, anaesthesia options during surgery include local anaesthesia, sedation or general anaesthesia. Talk to the 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 anaesthesia you have. If you're having general anaesthesia, plan to have someone take you home after surgery and expect to rest for the remainder of the day.
What One Can Expect
Dental implant surgery is usually an outpatient surgery performed in stages:
The entire process can take many months from start to finish — three to nine months and sometimes longer. Much of that time is devoted to healing and waiting for the growth of new bone in the jaw.
- Damaged tooth is removed.
- Jawbone is prepared for surgery, a process that may involve bone grafting.
- After jawbone heals, the oral surgeon places the dental implant metal post in the jawbone.
- One goes through a healing period that may last several months.
- Oral surgeon places the abutment — an extension of the implant metal post — followed by the new artificial tooth (crown).
When Bone Grafting Is Required
If the jawbone isn't thick enough or is too soft, one may need bone grafting before one can have dental implant surgery. That's because the powerful chewing action of the mouth exerts great pressure on the 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 the jaw or the body —hip, for example — and transplanted to the jawbone. It may take up to nine months for the transplanted bone to grow enough new bone to support a dental implant. In some cases, one may need only minor bone grafting, which can be done at the same time as the implant surgery. The condition of the jawbone determines how one proceeds.
Placing the Dental Implant
During surgery to place the dental implant, the Oral surgeon makes a cut to open the gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed. Since the post will serve as the tooth root, it's implanted deep into the bone.
At this point, one will still have a gap where the tooth is missing. Usually, a type of partial, temporary denture can be placed for appearance. One can remove this denture for cleaning and while sleeping.
Waiting for Bone Growth
Once the metal implant post is placed in the jawbone, osseointegration begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process, which can take up to six months, helps provide a solid base for the new artificial tooth — just as roots do for natural teeth.
Placing the Abutment
When osseointegration is complete, one may need additional surgery to place the abutment — the piece where the crown will eventually attach. This minor surgery is typically done with local anaesthesia in an outpatient setting.
To place the abutment:
In many cases, the abutment is attached to the dental implant metal post when the post is implanted. That means one won't need an extra surgical step. Because the abutment juts past the gum line, however, it's visible when one opens the mouth — and it will be that way until the dentist completes the tooth prosthesis. Some people don't like that appearance and prefer to have the abutment placed in a separate procedure.
- Oral surgeon reopens the gum to expose the dental implant
- The abutment is attached to the dental implant
- The gum tissue is then closed around, but not over, the abutment
Choosing New Artificial Teeth
After the abutment is placed, gums must heal for one or two weeks before the artificial tooth can be attached. Once gums heal, more impressions are made of mouth and remaining teeth. These impressions are used to make the crown —realistic-looking artificial tooth. The crown can't be placed until the 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:
- 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, mainly because it's more affordable than multiple individual dental implants and yet more secure than a traditional denture.
- Fixed implant prosthesis. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. One can't remove the tooth for cleaning or during sleep. If affordability isn't a concern, one can opt to replace several missing teeth this way. Each crown is attached to its own dental implant.
Whether one has dental implant surgery in one stage or multiple stages, one may experience some of the typical discomforts associated with any type of dental surgery, such as:
If swelling, discomfort or any other problem gets worse in the days after surgery, contact the oral surgeon. One may need pain medications or antibiotics.
- Swelling of gums and face
- Bruising of skin and gums
- Pain at the implant site
- Minor bleeding
After each stage of surgery, one may need to eat soft foods while the surgical site heals — as long as 10 to 14 days. Typically, Oral surgeon will use stitches that dissolve on their own. If stitches aren't self-dissolving, the doctor removes them in about 10 days.
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 one 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 excellent oral hygiene. Just as with your natural teeth, you must keep implants, artificial teeth and gum tissue clean. Specially designed brushes, such as an inter-dental brush that slides between teeth, can help clean the nooks and crannies around teeth, gums and metal posts.
- 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 nuts, which can break your crowns — or your natural teeth. Avoid tooth-staining tobacco and caffeine products. Get treatment if you grind your teeth.