What happens during the dental implant surgery?
The dental implant procedure is usually done on an outpatient basis in multiple stages, with healing time between certain steps. The complete process can take many months from start to finish. Most of this time is accounted for allowing the healing and fusion of the implant and growth of the new bone in the jaw. The procedure is personalized for the patient based on their condition, specific needs and the materials used. Sometimes, two or more steps can sometimes be combined to save time.
The process of placing a dental implant has many steps, including:
- Removal of damaged tooth
- Preparation of jawbone – using bone graft, if required
- Placement of Dental implant
- Period of bone growth (fusion) and healing
- Placement of Abutment
- Placement of the chosen Artificial tooth
Bone grafting in the jawbone
The bone grafting procedure might be required if the jawbone does not have required thickness or is too soft. Bone grafting is done before the dental implant placement to prepare the jawbone for implant. This is required because the chewing action of the mouth put excess pressure on the jawbone, and if it is unable to support the implant, the surgery is likely to fail. Therefore, bone graft is used to create a solid base for the implant.
A bone graft can be made of various kinds of materials, including a natural bone piece from another part of the body or a synthetic bone graft. The bone-substitute material is selected with an aim to provide structural support for the new bone growth. The doctor will discuss these options with the patient and help select the best one.
The transplanted bone graft takes several months to grow and form enough new bone which can support a dental implant. For some people, this can be achieved by a minor bone grafting only, usually done at the same time as the implant surgery. This will depend on the condition of the jawbone – its quality as well as quantity.
Dental implant placement
The procedure for dental implant placement involves fixing the screw like titanium prosthetic into the jawbone. The dental surgeon will make an incision on the gum to expose the bone beneath. Then, the surgeon will drill holes into the bone where the dental implant post will be inserted. The implant will serve as the tooth root, and so it’s implanted deep into the jawbone.
The gap from the missing tooth will still be there after this step. Sometimes, the doctor places a type of partial or temporary denture for appearance. This denture is removable and can be cleaned or removed while sleeping.
Bone growth or osseointegration
Osseointegration is referred to the process of fusion of the metal implant post with the jawbone. In this, the jawbone grows into and around the surface of the dental implant and ultimately forms a solid base. The entire process may take several months to complete. After this, a stable foundation from the fused implant is ready for the new artificial tooth and it works just as roots do for the natural teeth.
After the osseointegration process, an additional surgery might be needed to place the abutment, the material or piece where the tooth crown will be attached. It is a minor surgical procedure performed in an outpatient setting and typically using a local anaesthesia.
The dental surgeon will reopen the gum to expose the dental implant and bone. The abutment is attached to the dental implant and the gum tissues are closed around, but not over the abutment.
The abutment might also be attached to the dental implant metal post while the post is being implanted. That bypasses the need of an extra surgical procedure. As the abutment protrudes from the gum line, it can be when the mouth is open. The dentist will complete the procedure after placing the replacement tooth. Many people prefer to have the abutment placed in a separate procedure rather than with dental implant as they don’t like the jutted out appearance of the abutment.
The gums will heal within two weeks after the abutment is placed, then the artificial tooth can be attached.
Choice of new artificial teeth
The dental surgeon will take impressions of the mouth and the remaining teeth to produce a new artificial tooth or crown. The impressions to make the crown might also be taken digitally nowadays. The crown will only be placed after the jawbone is strong enough to support the new tooth.
The implant specialist will discuss the various types of tooth crown, dentures and bridges available, and help choose the artificial teeth most suitable to the patient.
The replacement tooth can be removable, fixed or a combination of both.
Removable tooth replacement: This is similar to the traditional removable dentures. It typically comprises an artificial white tooth which is surrounded by a pink plastic gum. The replacement can be a partial or full denture. The prosthetic is mounted on a metal frame which is already attached to the abutment, and it encloses the removable artificial tooth securely into place. The advantage is that it can be easily removed for repair and daily cleaning.
Fixed tooth replacement: This type of artificial tooth is permanently fixed, screwed or cemented onto the implant abutment. It can’t be removed for cleaning, during sleep or other purposes. Usually, each crown is separately attached to a dental implant. As the dental implants are very strong, several teeth can be bridged together using one implant only.