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Steps of Dental Implant Surgery
Preliminary steps
Initial examination
An initial consultation with the surgeon and the dentist is essential before considering implant therapy. Close collaboration between these two professionals is required to ensure the satisfaction of the patient and the best end result possible.
An accurate assessment of the patient
This consultation is an opportunity to make an accurate evaluation of the patient in order to recommend a detailed treatment plan.
This evaluation includes:
- a rigorous clinical examination;
- x-rays (2D OR 3D) and photos of the head, jaws and teeth, if needed;
- a medical questionnaire (known allergies, medications taken regularly and health problems that could affect the eligibility of the patient to dental implants or the way implant surgery will be performed);
- a questionnaire on the patient’s dental history to evaluate treatment options: various elements of the patient’s mouth will be evaluated to determine if a dental implant is indicated.
Gum and/or jawbone reconstruction (required in some cases only)
This step is necessary only when a lack of bone or gum tissue poses an obstacle to implant surgery.
In such a case, the surgeon must perform a gingival or bone graft in order to restore their adequate level allowing the placement of dental implants. The patient must wait for a complete healing of jaws and gums before undergoing the other stages of the treatment. This can take a period of a few weeks to several months.
Implant surgery procedure
1 – Placement of the dental implant
Implant surgery is usually performed in the dentist’s office under local anesthesia. A sedative can be administered by the surgeon to relax the patient during surgery. In rare cases, general anesthesia at the hospital can be used to perform the procedure.
- The surgeon begins by exposing the jawbone by making an incision in the gum where the dental implant will be placed.
- The surgeon then prepares a small hole in the bone of the jaw using surgical instruments, while making sure not to affect neighboring nerves and sinuses.
- Subsequently, the dental implant is placed into the site, at the same level as the bone under the gums.
- Then, a period typically ranging from three to six months is necessary for the jawbone to fuse with the implant (osseointegration). During this period, the implant attaches also to the gums that are completing their healing process.
In some cases, when teeth are extracted to be replaced by implants, it is possible for the specialist to place implants directly into the tooth sockets (holes left by the extracted teeth) immediately following removal of the teeth. This technique is called “immediate dental implant placement”. Despite the fact that the implant is inserted directly after the tooth is extracted, a period of three to six months is still required to allow bone and gum tissues to heal and osseointegration to occur.
2 – Placing the abutment
Once the surgeon has confirmed that the osseointegration is complete, an abutment (the piece where the crown will eventually attach) is placed on each dental implant. The surgeon must first reopen your gum to expose the dental implant.
This step of the treatment uses the ‘Swedish’ technique of dental implant placement, in honor of Professor Brånemark.
Abutment types
There are two types of abutments:
- Cover screw: it is buried under the gum which is then closed by stitches after its attachment to the implant. This type of abutment must be exposed by making an incision in the gum during the prosthetic restoration stage.
- Healing abutment: it passes through the mucosa, and the surrounding mucosa is adapted around it. No further surgery will be necessary to expose the abutment during the prosthetic restoration stage.
Thereafter, a period of time is required for complete healing of the gums before proceeding to the subsequent step.
Alternative
Sometimes, depending on the specialist’s preference and whether the implant is covered completely under the gumline or not, the abutment can be attached to the dental implant metal post at the same time as the post is implanted.
However, because the abutment juts past the gumline, it will be visible when you open your mouth until your dentist completes the tooth prosthesis. The patient must then pay special attention when brushing their teeth and eating, making sure not to apply pressure on the abutment while the gingiva heals around it and the osseointegration occurs.
3 – Artificial teeth
Once the healing and osseointegration process is complete, the restorative dentist installs the final artificial prosthesis (crown, bridge or denture) on the abutment of the dental implant.
The prosthesis is made in the laboratory, using dental models and pictures of the patient.
Several visits to the restorative dentist may be required to get a perfect fit of the final prosthesis on the abutment.
Depending on the method used by the surgeon, a temporary prosthesis can sometimes be attached to the implant at the same time as the implant and the abutment are placed. A close cooperation between the surgeon and the restorative dentist is required to coordinate the temporary prosthesis and implant surgery.
This last stage of the treatment enables the patient to regain normal chewing function as well as a better facial aesthetic.
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