What are dental implants?
Dental implants as we know them today were invented in 1952 by a Swedish orthopaedic surgeon named Per-Ingvar Brånemark. Today, they are considered the standard of care for prosthetic replacement of missing teeth in dentistry. A dental implant is a surgical fixture that is placed into the jawbone and allowed to fuse with the bone over the span of a few months. The dental implant acts as a replacement for the root of a missing tooth. In turn, this "artificial tooth root" serves to hold a replacement tooth or bridge. Most dental implants are made of titanium, which allows them to integrate with bone without being recognized as a foreign object in our body. Over time, technology and science have progressed to greatly improve the outcomes of dental implant placement. Today, the success rate for dental implants is close to 98%.
Why would you need a dental implant?
Dental implants can be used to replace a single tooth, several teeth, or all of the teeth. The goal of teeth replacement in dentistry is to restore function as well as esthetics.
When it comes to tooth replacement, generally, there are three options:
Dentures are the more affordable option for replacement teeth but are the least desirable because of the inconvenience of a removable appliance in the mouth. Furthermore, dentures can affect one's taste and sensory experience with food.
Dental bridgework was the more common restorative option prior to the relatively recent shift to dental implant treatment. The main disadvantage to bridgework is the dependence on existing natural teeth for support. Implants are supported by bone only and do not affect surrounding natural teeth.
There are great advantages to choosing a dental implant for tooth replacement over the other options. Dental implants are conservative in that missing teeth can be replaced without affecting or altering the adjacent teeth. Furthermore, because dental implants integrate into the bone structure, they are very stable and can have the look and feel of one's own natural teeth.
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 aesthetic 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.
Dental implant surgery is usually performed under local aesthetic, and therefore, no pain should be felt during the procedure.
After the local aesthetic has worn off, the post-surgery discomfort will vary with each individual case.
However, in general, most people will feel discomfort similar to a tooth extraction afterward.
A cold ice pack is placed on skin over the area of surgery immediately after treatment to help reduce swelling.
This pain typically can be managed with over-the-counter pain medications such as ibuprofen (Advil) or acetaminophen (Tylenol).
More invasive surgery may require a stronger prescription pain medication and more recovery time.
Aside from pain medications, prescriptions for antibiotics and oral rinses may be needed to support healing of the area for the following few weeks.
What follow-up care is necessary after getting a dental implant?