Safe and Successful Dental Implant Surgery
Increasingly, dentists are expressing their excitement for dental implants. Implants allow dentists to replace missing teeth and to serve as an anchor for various dental prosthesis such as a crown, bridge, or denture device. The key to dental implant surgery is having them placed correctly, you want to trust this procedure in the hands of a dentist who has been trained, has done them before, and is confident in their work. The placement of implants is a process, and you don’t want a step in this process missed or sped up. Our team at The Center for Implant and General Dentistry can walk you through the steps, helping you with the correct, stable placement of your tooth implant. Dr. Clay Keith and Dr. Paul Denson are happy to meet with you, evaluate your situation and help design a treatment plan that best suits your specific needs.
When natural teeth are missing from the mouth, artificial substitutes to replace the root portion of teeth are put into the bone and gums of the mouth. Replacement teeth are then fixed onto these new roots. Dental implants allow people who are missing teeth to be able to smile, speak, and chew well and comfortable.
Successful dental implant surgery has dramatically improved the quality of life for many people. With proper planning and care, implants can be an excellent answer to the problems associated with missing natural teeth.
What Mouth Conditions Might Require Dental Implant Surgery?
In you are missing a tooth or teeth, or even parts of your jaw, these could be replaced with dental implant surgery. First, there are a few very important factors that must be considered.
Experiments and practical experience have shown that dental implant surgery works best when there is enough dense, healthy jawbone in a mouth that will support an implant.
Healthy, disease-free gum tissues are also necessary. The long-term success of a dental implant depends upon keeping the gums and bone around the implant healthy. People who have implants must keep them clean and should return regularly to their dentist for checkups, because any problems that might threaten the health of the implant must be corrected.
Who Should Not Have Dental Implant Surgery?
If you have any of the following conditions, dental implant surgery may not be for you.
Crippling or uncontrolled disease. Conditions that affect the body's ability to heal and repair itself may have a negative effect on the placement and health of an implant. Persons with diseases (such as diabetes) that are not under control are not good candidates for dental implants because the uncontrolled disease keeps the body from healing itself normally. However, a diabetic person under proper control by a doctor could be treated successfully with dental implant surgery.
Other diseases such as leukemia or hyperparathyroidism (abnormal activity of the parathyroid glands) also may affect the outcome of implant treatment. Persons who are undergoing chemotherapy or radiation therapy for cancer should not have treatment procedures that are advantageous but not urgent (such as dental implants) until cancer treatment is completed and the doctor says it is safe to proceed. If you have any questions about how your general health might affect dental implants in your mouth, you and your dentist should discuss this with your doctor.
Women who are pregnant should not undergo any treatment such as dental implant surgery until after the first three months of their pregnancy. It is best to wait until after delivery to start dental implant treatment.
Psychiatric or emotional treatment
People with psychiatric disorders such as chronic depression or personality changes requiring treatment, or people undergoing severe emotional stress, should avoid situations that may complicate or disturb their lives. Dental implant therapy may place additional stress on persons who are unable to tolerate it. As with other diseases, open discussion of the problem should involve the patients, dentist, and doctor before a dental implant surgery is considered.
Poor motivation to accept and follow needed treatment
For dental implants to be successful, you must be committed to following all the necessary steps before, during, and long after treatment. People who are not able or not willing to undergo the necessary treatment, or to take care of their new teeth on a regular basis, should not consider implant therapy.
Lack of muscular coordination to manage oral hygiene procedures
To keep the bone and gums around dental implants healthy, you must carefully clean the implants. This means that you must be able to handle a tooth brush, dental floss, or other cleaning tools to remove food and plaque. Persons with severe arthritis or other handicaps that affect the hands and arms may not be good candidates for implant treatment.
Are Dental Implants For Me?
• Are you missing all natural teeth in one or both jaws?
• Are you missing one or more teeth in a jaw?
• Are you having difficulty wearing a regular removable denture because you gag, find the denture is too bulky, feel pain, or generally dislike something movable in the mouth?
• Do you have an oral defect or missing mouth part because of an injury, surgery to treat disease, or birth defect?
If you answered yes to any of the above conditions or preferences, you may be a candidate for dental implants. Your age generally will not prevent the placement or use of dental implants. However, pre-adolescent or very elderly person may not be good candidates for treatment.
Are There Any Risks To My Health With Dental Implant Treatment?
Some health factors are important when considering dental implants:
Surgery or anesthetic
Usual precautions associated with a local or general anesthetic must be taken. Sometimes an opening into the sinus cavity above the upper teeth or a nerve injury can occur. These incidents seldom result in permanent damage.
People who experience abnormal psychological stresses or are not motivated may have problems with dental implant surgery and may not be able or willing to follow oral hygiene instructions. However, persons who avoid contact with other people because they are concerned about their missing or unattractive teeth may be helped.
There are some temporary conditions that can result from implant placement: pain and swelling of gums, lip, tongue; speech problems; and inflammation (heat, redness, swelling, and pain) of the gums. Possible long-term difficulties may include nerve injury, bone loss if the implants fail, overgrowth of gums, and mouth or general bacterial infection. For those people who have other body part replacements or heart valve problems, endocarditis (inflammation of the inside lining of the heart) or infection may be a risk.
What is Osseointegration?
When dental implants that have been placed in your jawbone are successful, Osseointegration occurs. This term means bone connection. The metal or ceramic part of the implant is placed into your jawbone, then the bone actually attaches itself directly to the implant, growing all around it and supporting it firmly.
Some implant systems encourage a soft tissue scar layer between the implant and bone; it is suggested that this scar tissue serves like a ligament in connection a natural tooth root to its bony socket. However, this theory has not been scientifically proven. In addition, a scar layer contributes to implant movement, permitting undesirable communication between bone and the mouth, and does not react well to biting forces.
Scientific data do tell us that implant systems based on osseointegration are predictable and highly successful.
How Long Will Dental Implants Last?
With advances in the science of implant dentistry, you can now expect that most implants will function indefinitely. However, like any dental restoration, the teeth may wear or break and need to be repaired or replaced. After you have been examined by your dentist and before you make any decision on implant treatment, you must consider cost. Just like any complicated and time-consuming medical or dental procedure, implant treatment is moderately expensive. You should be aware of all the costs involved. If you will be treated by a team of dentist, make sure that you receive cost estimates from each one involved. For example, if an oral surgeon will be placing the implants into your jaw and a prosthodontist or your personal dentist is going to make the restoration prosthesis to replace the teeth, you should get cost estimates from both.
If you have dental insurance, you or your dentist should contact the insurance company before you start treatment to find out whether or how much of the treatment might be covered. Insurance policies vary in their coverage of elective procedures such as implants. It is important that, before you agree to proceed, you fully understand how much your insurance company will pay and how much you yourself will have to pay.
Timetable Of A Typical Course of Implant Treatment
Examination and Diagnosis
Within 6 months before surgery............X-rays
Stage 1 Surgery
Date of surgery...................................
4-5 days after surgery.........................
7 days after surgery............................
10-14 days after surgery.....................
4-6 weeks after surgery .....................
3-6 months after surgery.....................Implants placed in jaw
Old denture is lined with soft material for
Sutures dissolve or are removed
You must eat a soft diet during this time period
Healing is completed
Stage 2 Surgery (Not required for some implant types)
Day of surgery...................................
4-5 days after surgery.........................
10-14 days after surgery.....................Implants uncovered
Healing caps or revised denture placed
X-rays to check implant-abutment connection
Impressions of mouth made
Sutures dissolve or are removed
1 month after Stage 2 Surgery.............New prosthesis is completed
Temporary seating of new teeth on implant abutments
Final attachment of prosthesis
1 month, 3 months, and 6 months
after restorative treatment
(and yearly thereafter).........................
Examination and diagnosis
When you first see your dentist to talk about the possibility of implant therapy, you mouth will be thoroughly examined. X-rays will be taken of you head, jaw, and teeth so your dentist can determine the type, amount, and location of bone that is available. You may have to undergo other tests to check blood characteristics, heart function, lung condition, and general health status.
Molds of the teeth and jaws are also necessary. Using these impressions, the dentist will then make plaster-like models so he or she can plan the treatment and make surgical guides. Such surgical guides help the surgeon to properly place the implants.
In addition, a psychological test may be given. This provides the dentist with insight into particular personality problems a person may have that could cause the treatment to be less successful than expected.
Once you and your dentist have that implant therapy is right for you, the examination has been done, and you dentist has chosen the appropriate implant system, surgery will be scheduled. The surgical treatment is usually performed in one or two stages depending on the implant system chosen by your dentist.
The surgery may be performed in an office setting with local anesthesia and perhaps mild sedation. Or, it can be performed in a hospital setting with general anesthesia. A sterile environment and gentle and cautious surgical procedure are essential to success. If the surgery is performed in a hospital, a one-night stay in the hospital after the procedures may be required.
Stage 1 surgery
During the first operation, implants will be placed into the jawbone, underneath the gum tissues. They will stay "buried" under the gums for a healing time - from 3 to 6 months. ( In the upper jaw and back part of the lower jaw, complete healing usually takes longer.)
Some implants are not buried; they are left uncovered during the healing period. With these implants a second surgery is not required, but a healing period of 3 to 4 months is still necessary.
Two-Stage Procedure / One-Stage Procedure
The day after surgery, you can expect some swelling of the gums in the area of implant placement. You may also be able to feel the sutures (Stitches) that were used to close the incision. The gums may be discolored as they start to heal. When you had teeth removed before, you probably remember the pain experienced; the immediate discomfort at this time will likely be similar or less pronounced. Medication can be used to lessen the pain.
Within 4 to 5 days, the initial swelling will be gone and the surgical area will be less painful. The denture that you may have been wearing can be lined with a soft material and placed back in your mouth to improve your speech and appearance. You should be able to return to work or resume normal daily activities comfortably by this time.
If the stitches closing the wound have not come out on their own by this time, you dentist or surgeon may remove them after 10 to 14 days.
You must not use your denture to chew solid foods until your dentist says you can do so. The ability of your mouth to successfully accept implants depends on their not being disturbed during the first 4 to 6 weeks after surgery. A soft diet must be continued during this period.
Stage 2 surgery (For those implant types requiring a second surgery)
The second stage of surgical treatment can usually be done on an outpatient basis in a dental office setting 3 to 6 months after the implants have been placed. The surgeon will numb the area of previous surgery with a local anesthetic to make you more comfortable. The gum tissue is then opened in the area of the implants to expose them. Extension posts called abutments, are attached to the implants. (Eventually your new teeth will be attached to these abutments.) At this time, the implants are examined to be certain of their firmness and integration with the bone. The gums are then put back in place around the abutments and suture (stitched) closed. Protective caps are screwed onto the abutments, and a surgical packing or your old denture with a soft lining is then placed over the abutments to help the gum tissues heal and to lessen discomfort.
At this phase of treatment, the dentist will want to determine that osseointegration has been achieved and that the abutments are firmly and accurately attached to the implants. This requires and X-ray
Several days after the abutments are attached, the surgical pack can be removed. If you are wearing a denture with a temporary lining, your dentist will continue to refit the lining to keep your mouth comfortable.
As with the stitches place in your first surgery, those used to close the soft tissues during abutment connection will usually come out by themselves within 10 to 14 days. If not, or if a non-dissolving type of material is used, your dentist or surgeon will remove them.
At least several days after the abutments have been attached to the integrated implants, impressions are again make of your mouth. Plaster-like models of the jaws and any teeth that you may still have can then be made from the impressions. The new replacement teeth (bridge or denture, also called a prosthesis) will eventually be made on these models.
If no natural teeth are present, bite records are made on temporary denture bases with wax rims. Artificial teeth are arranged on the bases so that the correct position of the teeth can be determined in your mouth.
A metal frame work is then made, and the artificial teeth are attached to this framework in the previously determined positions.
This whole assembly of framework and teeth will be tried in your mouth to see how it fits and looks. When the teeth look satisfactory and function properly, the prosthesis is completed.
At last, the final prosthesis is secured on the abutments with small screws ( or in situations where natural teeth also remain, with dental cement). This is called a fixed prosthesis
The final fixed prosthesis (bridge) is shown above in place in the mouth. Note that abutment posts are not visible when you smile.