Implant Process
Start to Finish
Unless you’ve gone through a dental implant process before, it can be very confusing what steps are performed when, especially when dental media promises ‘one day treatment’ that is usually very misleading. I’ve put this together to show the process from a specialist’s perspective.
1
Consultation and Planning
The process begins with a consultation with myself or a referring doctor. We will evaluate your overall treatment goals, take a 3-D radiograph if indicated, and determine a preliminary treatment plan with referrals if needed. I perform 50% of my own surgeries and will refer to an oral surgeon or periodontist if the situation requires, typically for major medical issues or delicate gum tissue issues.
2
Tooth Extraction and Bone Grafting
If the tooth needing replacement is still present, it must be extracted before placing the implant. This is done with local anesthesia with or without sedation, which is patient specific. In some cases, the implant can be placed immediately after the extraction, but most often, a healing period of around 2-3 months is necessary to allow the extraction site to heal before proceeding. Three to four or even more months are needed if a large infection is present or if you have medical factors that delay healing, such as advanced age or diabetes.
3
Implant Placement
After healing, I’ll take a CT scan and an optical impression of the mouth to make a piece that fits over the other teeth to use as a drill guide for exactly where the implant needs to go. This is one step that sets me apart from many dentists (the planning). Once the jaw is ready, the implant is placed. Local anesthetic is used to numb the area, with or without sedation. The dental implant itself is a small medical grade titanium post not unlike a drywall anchor that is surgically implanted into the jawbone after a sequence of small drills are used to create a hole in the bone. Titanium is used because it is biocompatible and integrates well with bone tissue. This integration process, called osseointegration, is essential for the implant's stability. After the implant is placed, it needs to heal for several months to allow the bone to fuse with the implant securely. Three months for normal healing is considered the standard
4
Uncovery/Clearance/Impression
After the implant has successfully integrated with the jawbone, a very minor surgery is performed to uncover the implant if it has been ‘buried’ in the gums. I use a sophisticated machine that taps on the implant and gives a measurement of stability, ranging from zero to ten, with anything above a seven being a ‘pass’. If the uncovery is clean enough, I’ll make impressions at the same appointment to make the teeth. The impression process is with an optical scanner rather than traditional ‘goop’. If the case is a removable snap in denture case, this is when I’ll make measurements for the snap abutments and order them.
5
Optional Temporary Placement
With front teeth, in nine of ten situations, a temporary made from plastic is needed to shape and mold the gums. Gum training takes about a month, sometimes two, and is a vital step to ensure a good esthetic outcome in the front of the mouth. Back teeth, conversely, do not usually require this extra step.
6
Crown or Bridge Placement
The final step in the dental implant process is the placement of the crown. Impressions of the patient’s mouth are taken to create a custom-made crown that matches the shape, size, and color of the natural teeth. Once the crown is ready, it is attached to the abutment, completing the restoration. The material I use is zirconia, which is a very durable and strong ceramic with amazing esthetic qualities.
Random Important Information
Taking all medications for surgery as indicated is very important; disregarding post op instructions for medication use can result in infection and early failure of whichever procedure is undertaken.
Large infections into the bone that are caused by the teeth are sometimes best dealt with by removing the tooth and letting the bone heal naturally for a period of about 6 weeks before attempting to graft. I’ve managed multiple situations over the last few years by allowing the body to take care of itself, which takes longer, but ultimately can provide a predictable result.
Implant failure does occur. The body will sometimes reject an implant for seemingly no reason despite our best efforts. If this happens, we will typically replace the implant at a greatly reduced cost, typically the cost of the materials used.
After treatment is finished, hygiene is critically important. You must clean well around the implant, with floss if possible, and regular brushing. This is true for crowns, bridges, snap in dentures, and permanent dentures. Regular checkups are important as well, and if you notice any looseness in the implant, it’s critical to return to me to diagnose (and fix) the problem.