Dental Implants

dental implant is an artificial tooth root replacement and is used to support restorations that resemble a tooth or group of teeth. There are several types of dental implants; the most widely accepted and successful is the osseointegrated implant, based on the discovery that titanium can be successfully fused into bone. This forms a structural and functional connection between the living bone and the implant. A variation on the implant procedure is the implant-supported bridge, or implant-supported denture.

Implant Image 1  Implant Image 2
Above: X-rays of implants.

A typical implant consists of a titanium screw (resembling a tooth root) with a roughened surface. An osteotomy or precision hole is carefully drilled into jawbone and the implant is installed in the osteotomy.

Implant surgery is typically performed as an outpatient under general anesthesia or with local anesthesia by trained and certified clinicians including general dentists, oral surgeons, and periodontists. An increasing number of general or cosmetic dentists as well as prosthodontists are also placing implants in relatively simple cases. The most common treatment plan calls for several surgeries over a period of months, especially if bone augmentation (bone grafting) is needed to support implant placements. At the other end of the surgery scale, some patients can be implanted and restored in a single surgery, in a procedure labeled “immediate function” and “teeth in an hour.”

A single implant procedure that involves an incision and “flapping” of the gum (to expose the jawbone) takes about an hour, sometimes longer; multiple implants can be installed in a single surgical session lasting several hours. At the conclusion, the patient goes through a period of recovery, returns to consciousness and is sent home with a relative or friend.

Healing and integration of the implant(s) with jawbone occurs over several months in a process called osseointegration. At the appropriate time, the restorative or cosmetic dentist or prosthodontist uses the implant(s) to anchor crowns or a prosthetic restoration containing several “teeth”. Since the implants supporting the restoration are integrated, which means they are biomechanically stable and strong, the patient is immediately able to masticate (chew) normally.

In an immediate function procedure, the gum tissue is not flapped (Flapless). Instead, the surgeon removes a small plug of gum tissue directly over the drilling site. The site is drilled and the implant is installed. Then a crown is immediately added. Patients are cautioned to give their new “teeth in an hour” ample healing/integration time (weeks or months) before attempting normal chewing.

Most patients need the longer treatment plan, which has an excellent history going back many years. During the initial surgery, the titanium screw, or implant, is carefully screwed into the jawbone. Once properly torqued into the bone, a cover screw is placed on the implant, then the gum is sutured over the site and allowed to heal for several months for osseointegration to occur between the titanium surface of the implant and jawbone.

After several months the implant is uncovered in another surgical procedure, usually under local anesthetic by the restorative dentist or prosthodontist, and a healing abutment and temporary crown is placed onto the implant. This encourages the gum to grow in the right scalloped shape to approximate a natural tooth’s gums and allows assessment of the final aesthetics of the restored tooth. Once this has occurred a permanent crown will be fabricated and placed on the implant.

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants.

For dental implant procedure to work, there must be enough bone in the jaw, and the bone has to be strong enough to hold and support the implant. If there is not enough bone, more may need to be added with a bone graft procedure discussed earlier. Sometimes, this procedure is called bone augmentation. In addition, natural teeth and supporting tissues near where the implant will be placed must be in good health.