What happens before, during, and after dental implant surgery?
During the consult and planning stage, the dental surgeon will visually examine the site in the mouth where a dental implant is being considered as well as look at dental imaging studies (X-rays, panoramic films, and/or CT scans). At this time, the quality and quantity of jawbone is assessed to determine if more bone is needed at the site. Once it has been established that a dental implant can be placed in the desired location, the patient will return for surgical procedures for the dental implant(s). During all surgical procedure appointments, the patient is usually given local anesthetic to numb the surgical area as well as any other sedatives necessary for comfort and anxiety.
The first stage of oral surgery often involves a tooth or teeth extraction. Oftentimes, the site of a dental implant still has an existing damaged tooth present. In order to prepare for placement of a dental implant, the tooth will need to be extracted. More often than not, an "alveolar bone graft" (cadaver or synthetic bone) is placed to achieve a solid base of bone for the implant. This site will be allowed to heal for two to six months. For a site that has no tooth and bone loss is present, it will require a different bone graft that is placed on top of existing jawbone ("onlay bone graft"). This procedure is more involved and usually requires about six or more months of healing. In some instances, when enough bone is present, the damaged tooth can be extracted followed by the implant placement procedure at the same appointment. This procedure is called "immediate implant" placement.
In the situation where an implant is to be placed in the maxilla (upper jaw) in the back or posterior region, sometimes the available amount of bone may be limited by the presence of the maxillary sinus (air-filled space found in the bones of the face). "Sinus augmentation" or "sinus lift" is performed to raise the sinus floor and graft more bone into the sinus. This will make more bone available to support a dental implant.
Once adequate, strong bone is present, the site is ready for the implant. At the implant placement appointment, the dental implant (titanium post) is placed into the bone with a special drill and tools. A "healing cap" is placed over the implant, the gum is stitched up, and the healing phase begins. During this healing phase, a temporary denture can be made to replace missing teeth for esthetic purposes. Healing time depends greatly on the quality of bone present. Healing time is usually anywhere from two to six months. During this time, the implant becomes integrated with the bone. It's important to avoid placing any force or stress on the dental implant as it heals. Follow-up appointments to check the surgical site are typically done to ensure that no infection exists and healing is taking place.
After the required healing period, the dental implant is tested to determine whether it was successfully taken up by the surrounding bone. Once this has been confirmed, a prosthetic component is connected to the dental implant via a screw. This component is called an "abutment." It will serve to hold the replacement tooth or "crown." The dentist will take an impression (mold) of this abutment in the mouth and have the implant crown custom-made to fit. The implant crown is either cemented on or secured with a screw to the abutment.