Typical steps in the installation of dental implants
An initial consultation with the surgeon and the restorative dentist, in the case that it is not the same dental professional who does both steps, is essential before considering implant treatment. A close collaboration between these two professionals is required to ensure patient satisfaction and the best possible final result.
This consultation is an opportunity to perform a precise evaluation of the patient in order to formulate a detailed treatment plan adapted to his or her situation. This assessment includes, among other things:
- a rigorous clinical examination;
- taking x-rays (two- or three-dimensional) and photos of the patient’s head, jaws and teeth as needed
- a questionnaire on the patient’s medical history, specifically targeting known allergies, regular medications, and medical conditions that may affect the patient’s eligibility for implant surgery or the way the implant surgery will be performed;
A dental history questionnaire to evaluate treatment options. Various elements of the patient’s mouth will be evaluated to determine whether or not dental implants are appropriate for the patient
Preparation of the gums and/or jawbone
(required in some cases only)
This step is only necessary if a lack of gum and/or bone is an obstacle to implant surgery.
In such a case, the surgeon must perform a gingival and/or bone graft in order to restore adequate volume to allow the placement of dental implants. The patient must wait for a complete recovery of the gum and/or jawbone, which can take anywhere from a few weeks to several months, before undergoing the other stages of treatment.
Steps related to implant surgery
1- Placement of the dental implant
Implant surgery is usually performed . Sedation may be administered by the surgeon to relax the patient during surgery.
In rare cases, general anesthesia in the hospital may be used to perform the procedure.
The surgeon first exposes the jawbone by making a incision in the gum where the dental implant will be placed. He then makes a holeThe dental implant is inserted into the jawbone using surgical instruments capable of drilling into the bone, while making sure not to reach nearby anatomical structures, such as certain nerves and the maxillary sinuses. The dental implant is then screwed in place so that it is flush with the bone below the gum line.
Then, a period typically varying from three to six months is necessary for the bone to bond to the implant through the phenomenon of osseointegration. During this period, the implant also attaches to the gum and the gum completes its healing process.
In cases where teeth must be extracted to be replaced by implants, it is possible for specialists, in some cases, to place the implants directly into the tooth socket (the hole left by the extracted tooth) immediately after the removal of the tooth and its root. This technique is called the “immediate technique“. Although the implant can be placed at the time of extraction of the tooth it replaces, a period of three to six months is still required for the bone and gums to heal and for osseointegration to occur.
2- Adding an abutment to the dental implant
After the surgeon confirms that the osseointegration of the implant with the bone has occurred properly and that the tissues are completely healed, an abutment, which will later accommodate the crown, prosthesis or artificial bridge, is screwed onto each dental implant installed in the previous step; the surgeon must first remove the gum tissue that covers the implant.
This stage of the treatment is the placement of the implant according to the “Swedish” technique of dental implant placement, in honor of Professor Brånemark.
Two types of abutments exist and the choice to use one type of abutment or the other is up to the surgeon according to his or her preference and the patient’s case.
- Healing abutment: it is buried under the gingiva which is then closed with stitches after its installation on the implant. This type of abutment will need to be exposed by making an incision in the gingiva during the subsequent prosthetic restoration step.
- Healing abutment: the gingiva goes around it and no further surgery will be required to expose the abutment during the prosthetic restoration phase.
Afterwards, a period of time is required for the gums to heal completely before proceeding to the next step.
Sometimes, depending on the procedure of the specialist and whether or not the implant used is covered by gingiva when it is installed, the installation of the abutment on the implant may be done at the same time as the implant placement.
If the abutment is installed at the same time as the implant, it will be visible in the mouth during the osseointegration process. The patient will need to take special care when brushing and eating so as not to apply pressure to the abutment while the gingiva around the abutment heals and osseointegration takes place.
3- Prosthetic restoration
After the healing and osseointegration process is complete, the restorative dentist installs a final artificial prosthesis, that it is a crown(for the replacement of a single tooth), a bridge or a prosthesis (for the replacement of several teeth), on the pillar of the dental implant.
The prosthesis is fabricated in the laboratory using dental models and patient photos.
Several visits to the restorative dentist to adjust the final prosthesis to the abutment may be required to achieve an ideal fit.
Occasionally, a temporary prosthesis may be installed in the mouth at the same time as the implant and abutment, depending on the method used by the surgeon. Close collaboration between the surgeon and the restorative dentist is required to coordinate the fabrication of the temporary prosthesis and the implant surgery.
This last step of the treatment allows the patient to regain normal masticatory function, as well as a better aesthetic of the mouth and face.