Dental implants: a complete smile in 8 steps or less
The crown attaches to the abutment which has either an external or internal hex to hold it in place.
Depending on the condition of your jaw, teeth and gums, a dental implant procedure can take as little as a few weeks or as long as nine months. The process involves a team comprising your dentist, an oral surgeon and a reconstructive dentist or prosthodontist.
If you and your dentist believe you may need an implant, expect some or all of the following steps.
1. Evaluating your mouth
Your first step entails a consultation with a qualified oral and maxillofacial surgeon. Your dentist will probably recommend one, and you can ask your insurance provider for a list of others in your plan. You can look up reviews of these doctors on Angie's List to see what other patients have said about their experiences. Different doctors may be equally competent, but costs can vary as well as patient experience.
Some surgeons will prepare a detailed surgical guide for the patient, describing the method and course of the planned treatment. For more complicated cases, Dr. Paul Tiernan, an oral surgeon in Santa Rosa, Calif., says he sometime prepares up to four pages of explanation for his patients. In the surgical guide, he enumerates the pros and cons of the procedure and the various options available. “I tell them to write in the margins, circle things, come back and ask me all the questions, so they know exactly what’s going on,” he says.
Many oral surgeons also use models and other visual aids to help patients fully understand what will happen during the procedure — and what might happen if complications arise. If you don't feel you're getting enough information, ask questions. If the doctor doesn't have the patience to provide satisfactory answers, perhaps you should choose someone else.
2. Extracting the existing tooth
If you need a damaged or diseased tooth removed first, you’ll need to schedule this initial surgery and account for proper healing time, which usually lasts two months or more.
Just like any other surgery, your dentist will review your medical history, current medical conditions and medications you’re taking. Most extractions require little more than a local anesthetic, but some more complicated cases might need sedation or general anesthesia during the surgery. If you opt for general anesthesia, make sure you have someone in tow to help transport you home.
3. Determining whether you need a bone graft
Another step toward preparing the area for the implant may involve a bone graft, especially if the area surrounding your tooth shows signs of bone loss. Because your teeth experience extreme pressure, especially when you chew, your jawbone and gum tissue need to be strong to support the implant and ensure success.
If you do need a bone graft, the oral surgeon will remove bone from somewhere else in your body — perhaps from your hip or elsewhere in your jaw — and place it to fuse with existing bone. You’ll need lots of time to recover from this procedure — anywhere from three to nine months — to allow for bone growth and bonding.
“I find in my end that an implant bone graft works much better in the upper jaw,” observes Dr. Tiernan. With its better blood supply, he finds the upper jaw much “more predictable and forgiving” than the lower jaw.
“If you have to bone graft the area at the time that you place the implant, you can subject yourself to a higher failure rate,” he warns. “If I have a patient who has no bone grafting, he probably can have a very successful implant.”
4. Inserting the implant
Once you have strong bone and healthy surrounding gums, you’re ready for the implant surgery. Before the operation, you’ll receive either a local anesthetic or general anesthesia.
The oral surgeon begins by making a series of incisions to create a flap of gum to retract. He or she then uses a series of progressively wider drills to open the hole gradually. When the hole in the jawbone is wide and deep enough to substitute for the tooth root, the surgeon screws in the implant, places either a temporary cover screw or healing cap in place, replaces the flap of gum and stitches it over the implant. The cover screw is flat and serves to keep the implant clean until it's time to attach the abutment. In cases where little or no bone grafting takes place, the oral surgeon may instead place a healing cap, a bullet-shaped piece similar to the shape of the abutment that lets the tissue contour around it before replacing it with the actual abutment.
If you’re getting a front tooth replaced, you won’t likely want a big gap that makes you look like a first-grader awaiting the tooth fairy. In this case, you will likely be given a retainer with a cosmetic "flipper" tooth positioned to disguise the gap. A cosmetic tooth can also be worn with transparent braces.
Another option would be a temporary crown, but most surgeons discourage this in order to keep the healing process undisturbed. “Most people don’t put (temporary crowns) in because they don’t want to spend an extra $300-400," Dr. Tiernan says. "I like it when they don’t do it because they’re not interrupting my surgical site with pressure.”
5. Recovering from surgery
After surgery, your gums may be swollen or bruised, and the implant site may be tender and painful or bleed a bit. Your surgeon may prescribe medication for pain. Stick to soft foods or cut your food up into small morsels so that you don’t disturb the surgical area as it heals. Be sure to treat the surgical area and the healing caps, stayplates or temporary crowns gingerly to guarantee effective healing.
In most cases, you’ll have stitches called absorbable sutures, which the saliva in your mouth will gradually break down in about a week to 10 days.
While your surgical site is healing, bone cells in your jaw are affixing themselves to the implant in a process called osseointegration, which should make the implant as sturdy as the root it’s replacing — and even moreso because the implant bonds with the bone rather than being a socket as with natural roots. This healing process can take about four to five months.
6. Attaching the abutment
When the surgical area has healed and the implant has bonded with the jawbone, you’ll undergo a minor surgery with either the oral surgeon or dentist, who will usually use just a local anesthetic. He or she will re-open your gum around the implant, remove the cover screw or healing cap, attach an abutment and form the tissue around it.
Some dentists will perform what's called an “immediate load” and place the abutment and temporary crown at the same time as the implant. Dr. Tiernan doesn't feel this is a good alternative because using the implant too soon can inhibit the osseointegration process and create a stability problem.
7. Affixing the crown
After the oral surgeon screws in the abutment, you’ll need to wait another week or two while your gums heal. The prosthodontist will make an imprint of your teeth and fashion a new, permanent crown that your dentist will either screw in or cement onto the abutment. Make sure you and your dentist confirm the new crown matches the color of the surrounding teeth before it's attached.
8. Maintaining your implant
To help ensure success, remember to practice attentive oral hygiene in all phases of the procedure.
Dr. Tiernan regularly reviews flossing techniques with his patients, counseling them to circle the floss around the circular portion of the implant and down underneath the gum line twice a day. After the dentist installs your new crown, be sure to maintain a thorough and consistent brushing and flossing regimen to prevent gum disease that can cause the implant to fail from bone loss and weakened gum tissue.
A classic car fanatic, Dr. Tiernan often counsels his implant patients, “If you had a chrome bumper on your hot rod, you'll want to keep it so clean.”