Dental Implant Procedure

How to prepare for a dental implant procedure
and what to expect?

Once you decide to go for dental implants and prosthetic teeth, the initial consultation with dental
surgeon involves preoperative tests. These include:

  1. Before a dental implant procedure, the dental surgeon prescribes certain diagnostic tests as
    part of preoperative preparation.
  2. Existence of any chronic condition is ascertained with past medical history. History of
    smoking/tobacco or alcohol is noted. If needed, patient might have to undergo some blood tests.
  3. As discussed earlier, people with cardiovascular diseases, autoimmune conditions, conditions of
    nervous system, and blood clotting diseases are advised against dental implants.
  4. Radiographic tests are conducted as part of dental diagnostic tests. This determines condition
    of the jawbone, oral structures, smile line, gums, and surrounding teeth. These are examined in
    order to prevent chances of dental implant failure.

Some tests before dental implant procedure
  • Complete blood count (CBC)
  • Urinalysis
  • Hepatitis test
  • Hormonal/thyroid tests (in case of women)
  • Coagulation tests (blood clotting tests)
  • Bone mineral density test
  • Intraoral radiographic tests
  • Extraoral radiographic tests
  • X-ray
  • CT scan
  • Cone beam CT-scan

The team of dental surgeons including oral & maxillofacial surgeon, prosthodontist, periodontist,
and cosmetic dentist examine radiographic images. Parameters that are inspected include:

  • Bone Angulation (extent & quality of jawbone)
  • Presence of gum disease
  • Presence of bone loss in jawbone
  • Presence of any previous dental implants, bridges, crowns, root canal treatment, or veneers
  • Bite pattern (presence of bite issues like overbite, Underbite, crossbite)
  • Inspection of proposed dental implant site
  • Inspection of proposed surgery sites
  • Aesthetic planning
  • Surgical safety

With the help of radiographic images, dental implant specialists decide the implant site along with
the final outcome in terms of functionality and aesthetics. This is commonly done using software and
computerized reconstruction.

Planning a dental implant site

A major aspect of ensuring a high dental implant success rate is to plan the treatment. Dental
implant specialists study the radiographic images to determine suitable dental restoration. These
include:

  • Type of dental implant
  • Dental Implant site/sites
  • Patient’s desired outcome & wishes (final aesthetic result desired by patient)
  • Mock up reconstruction using 3-D software to visualize the best possible outcome (using CAD/CAM
    Dentistry)
  • Bone quality (volume & density)
  • Need for bone augmentation surgery

Dental implant specialists plan the dental implant site based on:

  • Bone volume, height, & alveolar ridge
  • Distance between the teeth
  • Shape of teeth
  • Width available for placement of dental implants
  • Scope for precise placement of artificial teeth
  • Implant site measurements
  • Nerve mapping (location of nerves in the oral structures)
  • Sinus health

Apart from these factors, the timing of dental implant procedure is a very important consideration
for dental implant specialists. This is because the stability of dental implant depends upon the
health of jawbone and tissues after a tooth is removed or lost.

Early implant placement

Dental implants tend to have a high success rate if they are fixed immediately after tooth
extraction. In such cases, after tooth/teeth are extracted, any chance of infection is eliminated as
it can lead to peri-implantitis, a dental implant complication.

Late implant placement

In cases where there is a delay after teeth extraction/loss, dental implant procedure takes more
time. However, this is preferred in cases where the patient has frequent teeth infections, multiple
dental implants, and when bone regeneration takes time.

Dental implant surgery – dental implant procedure

Initial procedure protocols
  1. Once preoperative considerations are inspected, the patient is completely explained about dental
    implant procedure. Patient’s desired result is taken into consideration before treatment
    planning.
  2. Dental surgeons consider the patient’s suitability for dental surgery with anesthesia.
  3. Patient is advised to become medically fit for the procedure. This includes controlling
    conditions like diabetes and blood pressure.
  4. In case the patient is on any kind of medication, dental surgeons advise on the right dosage.
  5. Teeth cleaning and scaling & root planing are conducted in order to keep the teeth clean for the
    surgery. This is because presence of tartar or plaque can influence the final result.
  6. Dental surgeons may prescribe painkillers like NSAIDs (non-steroidal anti-inflammatory drugs)
    and antibiotics or anti-microbials to ensure there is no infection before surgery.
  7. For men, dental surgeons may also ask to shave off any beards or mustaches. This would ensure a
    reduced bacterial count.
Dental implant surgery

Dental implant surgery is to be done strictly as per the protocols. As per dental implant surgery
protocols, experienced oral & maxillofacial surgeons should head the surgery team along with
prosthodontists, periodontists, and anesthesiologists.

Steps of dental implant surgery

Depending upon the types of dental implants opted for, dental implant procedure varies. While mini
implants and teeth in a day can be fixed in a day, endosteal dental implants and subperiosteal
dental implants take more time.

Here is a step-wise guide of dental implant surgery:

  1. For infection control, the oral cavity, dental implant site, and surrounding tissues are
    sterilized
  2. Anesthesia is administered. In case patient is on local anesthesia, anxiety and pain are managed
  3. Once patient is under anesthesia, an incision is made in the gums to reach jawbone. This is done
    using dental scalpels
  4. Flap of gum tissue is peeled and pushed aside to expose the jawbone
  5. Once jawbone is exposed, it is evaluated for flatness in order to seat the dental implant firmly
  6. As the dental implant site is ascertained, dental drills are used to make a hole so that the
    dental implant can be inserted
  7. Hole is drilled as per the diameter and length of the dental implant that has to be placed
    (generally, 4mm, 3.5mm)
  8. Adjustments are made during the drilling procedure till the drill reaches ideal depth and
    alignment. Dental surgeons ensure there is no excessive drilling as this can lead to bone cell
    death, a dental implant complication
  9. Once drilling is done, a dental x-ray is taken in order to ensure the depth and alignment of the
    drilled hole
  10. A screw thread-forming tool is used to create threads in the hole
  11. Now, the dental implant is inserted into the hole either with a tool or with a hand wrench
  12. After the dental implant is firmly inserted, the cover screw is placed
  13. Later, the surgical site is stitched after repositioning the gum tissue
  14. After the surgical site is stitched, patient is educated on postoperative care

When it comes to dental implant recovery time, it generally takes six months for total restoration.
Once dental implant procedure is done, it generally takes around 10 to 15 days for the surgical
wounds to heal.

After the wounds are healed, stitches are removed. Later, the dental implant is left for a period of
three to six months to fuse with the jawbone. This process is called osseointegration.

What is osseointegration?

Osseointegration is the process of the jawbone fusing with the dental implant. When cells of jawbone
slowly to adhere to the dental implant, there is no space left between the dental implant and
jawbone. This allows both the dental implant and jawbone to fuse and function as a single unit.

Osseointegration is important for dental implants as interface between the bone and dental implant
is vital for the load-bearing strength of a dental implant. This ensures higher success rate of
dental implants.

Since both titanium and Zirconium are biocompatible materials, they are opted as dental implant
materials. Both these materials are ideal for osseointegration; however, ceramic, and polymer
implants also tend to integrate with the jawbone.

Osseointegration is essential for the strength, stability, and survival of a dental implant.
Improper osseointegration can lead to dental implant complications.

Dental implant surgery – Postoperative Care

Like after every surgery, postoperative care after a dental implant surgery deals with bleeding,
curtailing infection, swelling, numbness, and suture break down. These conditions are cared for with
antibiotics, and follow-up care.

In the case of dental implant surgery, certain complications might arise. These include:

  • Infection
  • Effect to adjacent teeth
  • Damage to the nerve (alveolar nerve)
  • Jaw fracture
  • Pain
  • Numbness
  • Tingling sensation

These conditions are treated with medications or microsurgery.

Second dental implant surgery

Dental implant surgery is generally done twice. In the first surgery, the dental implants are placed
and gum tissue that is cut open is completely covered on top of the dental implants.

A second surgery is performed during the placement of crowns or dentures. In this minor surgery, the
gum tissue that is totally covered up on dental implants is cut open. This is to expose the cover
screw cap placed on dental implant.

Once the screw cap is exposed, a temporary restoration is done with the help of a temporary crown.
After the dental implant stabilizes, permanent crowns or dentures are placed.

Temporary Crown after dental implant surgery

A temporary crown is placed during the dental implant recovery time. Temporary crowns help in
protecting the implant post from the forces in the mouth. They also help in preventing misalignment
of adjacent teeth.

Temporary crowns are fit with the help of dental cement. They are later replaced with permanent
crowns or dentures. In the interim, the patient can brush, floss teeth despite the presence of
temporary crown.

It is also recommended to use an antibacterial mouthwash or warm water with salt and rinse it. Only
in rare cases, these temporary crowns are at a risk of falling off. In such cases, it is better to
consult the dental surgeon as soon as possible.

Placement of permanent crowns or dentures

The ultimate goal of dental implants is restoration with prosthetic artificial teeth. These teeth
should help the patient chew food and speak properly.

After the dental implant is stable, it is time to replace the temporary crown with permanent
dentures or crown.

Crowns or dentures would have been ordered as per dental impressions taken earlier. These
impressions are sent to a dental laboratory so that crowns of the desired materials are crafted.

Usually, crowns come in materials like gold, palladium, porcelain fused to metal, porcelain,
ceramic, resin, and Zirconia. Dental crown materials are chosen based on the location of teeth, and
the affordability of the patient.

Permanent crown placement procedure

This is the last step of dental implant procedure. The steps include:

  • Dental surgeon removes temporary crown
  • Healing screw cap is removed
  • Abutment is placed on top of the dental implant
  • Next, the permanent crown is cemented on top of the dental implant

This completes the dental implant surgery.

Dental implant complications

The success rate of dental implants is quite high and can go up to 98%. However, there are cases
when things can go wrong.

In fact, the possibility of dental implant complications can be predicted even before the surgery.
This happens in people with distinct shapes of the oral structures. These include excess or
inadequate space and limited jaw opening among others.

Improper implant angle

In other cases, dental implant can go wrong after the procedure because of improper implant angle.
This can lead to fracture of the implant, fracture of the abutment, and fracture of retaining screw.
It can also lead to deposits of plaque. This dental implant complication requires repositioning.

Implant displacement

There is a chance that an implant is displaced from its original position between the first dental
implant procedure and the second. This displacement can also occur after the second surgery. This is
attributed to improper osseointegration. In some rare cases, the implant is known to get displaced
into the sinuses. This needs to be removed with endoscopic surgery.
Mechanical, technical complications of dental implants

Fractures of the components of a dental implant are mechanical complications. These include:

  • Loosening of the screws
  • Fracture of implant, abutment, & screw
  • Adhesive resin cement failure

Technical failures of dental implants include:

  • Fracture of the crown
  • Fracture of the dentures

Other dental implant complications include:

  • Gum recession
  • Gum disease
  • Soft tissue lesions
  • Peri-implantitis
  • Infections
  • Bone loss
  • Nerve damage and subsequent numbness/tingling
Peri-implantitis – Dental implant Complication

Among dental implant complications, peri-implantitis is a common condition. Surrounding tissues near
the dental implant gets inflamed. It is accompanied with bleeding and bone loss.

This condition is bacterial in nature, and is known to affect the patient within five years of
getting a dental implant. However, people with smoking, diabetes, or osteoporosis are at a higher
risk of getting it.

Antibiotics, oral rinses, and surgical wound clearing are done to treat this condition.

Dental implant failure

Dental implant failure is one of the dental implant complications. These include early dental
implant failure and late dental implant failure.

Early dental implant failure

A dental implant can fail in the early stages within the first few months. Early dental implant
failure can occur due to:

  • Surgical causes
  • Infection
  • Displacement of dental implant due to wider implant holes
  • Improper angle of implant placement
  • Stress of chewing forces due to poor load-bearing capacity

These conditions arise with pain, bleeding, infection and other symptoms. They can be rectified using
medication and surgery.

Late dental implant failure

Late dental implant failure refers to dental implant failure that occurs in a time span of five
years. The reasons for this are:

  • Sinus complications
  • Poor osseointegration (implant does not fuse with jawbone)
  • Peri-implantitis
  • Poor root support
  • Fractures of implant components
  • Gum lesions

Again, these causes for dental implant failure can be treated with the help of medications and
surgery.
In order to avoid these complications, it is vital for the dental surgeons to plan the treatment in
advance, and choose the right approach for dental implant procedure in order to provide prosthetic
restoration.
Dental implant procedures depend upon many factors including the type of dental implant opted for,
the extent of bone volume the patient has, and the approach that can provide best possible results
in terms of prosthetic and esthetic results.