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Dental Implants

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 the 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 entire process can take many months.

Although most adults are candidates for the procedure, dental implant surgery is expensive and often not covered by insurance. Still, if you have difficulty eating or talking or simply want better looking teeth you may find that dental implant surgery is well worth the time and expense.

Why it's done?

For years, people with missing permanent teeth had to use fixed bridges or dentures to restore their smile. But both of these options have drawbacks. Fixed bridgework can damage healthy teeth, and dentures can slip, make embarrassing clicking noises, or contribute to bone loss. Dental implants avoid all these problems.

Instead of resting on your gumline or using adjacent teeth as anchors, dental implants are surgically placed in your jawbone, where they serve as the roots of missing teeth. Because the metal in the implants fuses with your jawbone, the implants won't slip, make noise or cause bone damage.

Once the metal cylinder is in place, an abutment (also called an extension) is fitted on top of it. Then, an artificial tooth (crown) is attached to the abutment, creating the polished look of a real tooth. You may have one tooth replaced with dental implant surgery, or many.

Am I suitable for dental implants?

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

What are the 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 do I prepare?

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

To start, you have a comprehensive dental exam. This may include taking dental X-rays and making models of your mouth. In addition, be sure to talk to your doctor about any medical conditions you have and 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.

A treatment plan is tailored to your particular situation. This plan takes into account such factors as how many teeth must be replaced and the condition of your jawbone.

What can I expect?

Placement of dental implants and artificial teeth involves surgical procedures usually done in several stages. The entire process takes three to nine months, or sometimes even longer. That may sound daunting, but a lot of that time is spent 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).

Do I need bone graft?

If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can proceed with 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 would likely fail. A bone graft can create a much 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. The transplanted bone will grow, but it may take six to nine months to grow enough new bone to support a dental implant. In some cases, you may need only minor bone grafting that can be done at the same time as the implant surgery. The condition of your jawbone determines how you can proceed.

How is it done?

Implant surgery

Whether you have a bone graft or not, 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 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 gives you specific instructions 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.

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.

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 usually takes two to six months. This is an important step because it 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 at the same time that the cylinder is implanted. That means you won't need an extra surgical step. Because the abutment juts past the gum line, 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 have healed, you 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 earlier in the process because your jawbone isn't yet 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.

What happens 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.

How successful is it?

Most dental implants are successful. Sometimes, however, the bone fails to fuse sufficiently to the metal implant. In that case, 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.