How are dental implants placed?
Most of the surgical procedures for the placement of dental implants are performed in the dentist’s office and only occasionally, in a hospital setting. In general, local anesthesia is suitable for these outpatient procedures, but other ways can be used to sedate the patient (such as nitrous oxide and oral and / or intravenous sedation).
Each surgical procedure is different, depending on the clinical situation, as well as the preferences of the patient and the dentist. It is possible to perform complementary surgical procedures such as bone augmentation, in the form of separate procedures or at the same time as the dental implant is placed.
[Dental implant placement process]
Why is the surgical procedure a three step process?
The most practiced method for the placement of dental implants is a “step surgery.” The first stage is to bury the dental implant (which replaces the root of the tooth) at the level of the bone, but below the gum. This protects the dental implant from forces while it heals. At the end of this healing process, the dental implant must be surgically exposed when removing part of the superimposed gum.
In the second stage, the dentist checks if the dental implant was successfully integrated and connects some type of post that penetrates through the gum into the mouth. This post is called the pillar. The abutments come in many forms and can be manufactured as part of the inventory or can be custom modeled by your dentist and a laboratory. The gum is allowed to heal around the abutment and form a crease or flange through which the dentist has access to the dental implant while preparing the final stage of restoration consisting of placing the prosthetic tooth or teeth.
Research has shown that it is often possible to place a suitable abutment at the same time as the dental implant. This has certain limitations, but it can eliminate the need for a second surgery. However, the dental implant in any way requires sufficient healing time to make the bone osteointegrate.
The abutments must also be protected from the forces of chewing during this period to ensure effective bone integration and successful healing. Once the dental implants have had the opportunity to heal and their integration has been proven, the final step of the restoration is carried out. This stage consists of manufacturing and connecting the prosthetic teeth to the osseointegrated dental implants successfully.
What is a single stage surgery?
This method employs a single-piece non-submerged dental implant that has a metal flange designed to protrude through the gum while the bone adheres to the dental implant. After an adequate period of healing, an abutment can be connected to the dental implant, which allows the crown to be manufactured to replace the missing tooth. Alternatively, a one-stage technique can be achieved by immediately connecting a temporary healing abutment to a two-piece dental implant that protrudes through the gum, much like a one-piece dental implant. Both single and two-stage dental implants have similar success rates and you need to ask your dentist what systems you use and which of the procedures is right for you (the one or two stages).
What is the overall success rate of dental implants?
Success rates have improved substantially since the introduction of dental implant surgery and can now proudly communicate success rates well above 90% in most patients with dental implants. Similarly, long-term success rates are in the upper range of 90% and continue to improve. In the event that a dental implant has not been successfully integrated, it may be necessary to remove it, since it cannot be osseointegrated as it should. Your dentist will offer you the best guidance in this regard. One possibility is to place a replacement dental implant, but it may take a few months to heal and bone augmentation (graft repair). Similarly, if a previous placed dental implant has lost significant amounts of support bone, there are no treatments that now predictably restore lost bone once it has worked in the mouth.
Healing and treatment care
How long does it take to heal dental implants?
The healing time of dental implants varies depending on the quality of the patient’s bone and generally lasts in cases where it is necessary to perform complementary procedures. In general, dental implants requires around two to four months for the bone to heal (without being exposed to the additional forces of chewing). The investigation of the mechanisms of adhesion of bone to titanium has improved the healing process to the degree that some dental implant manufacturers claim to have greatly shortened the healing time of their products (but it is not the norm in general). In recent years, research has shown that under certain controlled circumstances, dentists can immediately load dental implants (connect prosthetic teeth), either the same day or shortly after being placed. While this becomes increasingly common, many cases requires a healing period of two to four months before the prosthetic reconstruction be completed.
How do I take care of my dental implants?
Proper care of your dental implants is important for your good health and continued function. Although they are not prone to decay such as natural teeth, not giving them proper maintenance can develop inflammation of the gums and even infection and bone loss. While inflammation and infection located around the teeth is known as parodontal disease, a similar process can occur around dental implants, known as periimplantitis. Your dentist should review the proper techniques to keep the dental implants clean and the surrounding tissue healthy, but first of all, routine brushing and flossing are necessary. Your dentist can show you other tools that helps keeping your teeth and dental implants clean and healthy.
Your new teeth will require periodic check-ups by your dentist to ensure that the surrounding gums and bone are preserved and healthy. This also requires periodic radiographs to assess the level of bone around your dental implants. Dental restorations placed on dental implants will also require periodic check-ups by the dentist to verify that they are firm and functioning properly.
It is not unusual for the screws that fix the restoration to the dental implants themselves or the abutments to loosen from time to time. This usually involves simply removing the dental restoration, cleaning it and placing it with new screws or re-tightening the same screws. Similarly, if the dental restoration is cemented to the underlying dental implant, it may become loose from time to time. If this happens, your dentist will have to remove the restoration, clean it, make sure it fits as designed and re-cement it to the dental implant. While these are minor complications, but inconveniences, they should not be ignored. It can create more important problems allowing the restoration to remain in place when it is not properly fixed to the dental implant.