Dental Implants are fast becoming the first choice to restore missing teeth. The cost of getting implant surgery has come down considerably over the last decade, while the procedure itself has become much more predictable and easy to perform.
The biggest advantage that an implant has over all other tooth-restorative methods is that it does not involve or compromise healthy teeth to support the prosthesis. This is what makes it attractive to doctors and patients alike. Dental implants are also extremely versatile in their use and can thus provide an acceptable solution in a variety of clinical settings.
Once the patient has consulted the doctor and decided that getting an implant (or multiple ones for that matter) is the best treatment option available, there are certain things that can be expected before, during and immediately after the procedure.
Usually a set of peri-apical radiographs, OPG or a cone beam CT scan is done prior to the procedure to help ascertain the kind of bone available at the proposed surgical site. Specialized software that helps the implantologist make accurate measurements about implant length and width, however sometimes these have to altered somewhat depending upon the clinical situation faced at the time of surgery.
The doctor may also choose to fabricate a pre-surgical stent that will act as a guide to help get the ideal angulation during the surgical procedure. All of this will be done prior to the date of surgery and should not require more than a single visit under most circumstances. Impressions may also be taken for the fabrication of any immediate post-operative prosthetic devices if planned for the patient. An immediate prosthesis can also be fabricated after implant placement depending upon the surgical plan.
A thorough medical history will be taken to ensure that there are no contra-indications to the placement of dental implants. A patient with a history of diabetes and smoking in particular will be explained how they are at a higher risk of implant failure than any other patient subset. If however, a patient is a well controlled diabetic and is an occasional smoker then the chances of successful integration of the implant with the jaw bone are similar to any other patient. Investigations for bleeding time, clotting time, blood sugar levels as well as blood pressure readings will be taken as a routine procedure before the surgery.
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Absolute contra-indications for the placement of implants include a patient who is undergoing or has recently undergone radiation therapy, an uncontrolled diabetic patient or one who is not mentally fit enough to give informed consent for the procedure.
Dental Implant Surgery And Post Surgical Care
The placement of a dental implant in the desired position can be achieved in a number of different ways. The most popular ways in which implant surgery is carried out all over the world are:
- Two Stage Implant Surgery
- One Stage Implant Surgery
Two Stage Implant Surgery
This is the most common way by which implant placement is done. It basically involves two surgical procedures. The first is where the implant is placed into the bone and then the surgical site is closed to be allowed to heal over the next few months. The second step is uncovering the integrated implant to begin the prosthetic rehabilitation of the surgical site.
Here is what you can expect as a patient: Once adequate anesthesia has been achieved (by use of Local Anesthetic injection or Gas) you will have to open your mouth wide for around ten minutes. There will be some mild sensation of pressure that will be felt during the procedure. That is it. Everything else that takes place is useful to know and understand however plays no role in your experience of the procedure.
The surgical procedure takes place in several stages.
Incision: It begins with the placement of a small incision in the overlying gingiva which will then be reflected to achieve direct visual contact with the underlying bone. The kind of incision will vary according to site of surgery as well as preference of the surgeon, however there is a trend towards minimally invasive reflection techniques.
Sequential drilling and Implant placement: This is the part where the surgeon will use a set of surgical drills in a sequence of increasing size to a predetermined depth. The final drill will be slightly smaller in diameter than the implant so that a good amount of immediate stability can be achieved. This is that part that scares patients, however it lasts for just a couple of minutes and is absolutely painless.
Suturing: Once the implant has been placed, sutures will be placed to ensure that the implant is completely covered by the patient’s gums. These sutures will need to be removed after a week or ten days. They can cause some irritation to the patients during this time, although nothing too major.
The implant will remain in the same position for 3-6 months to allow it to integrate with the jaw bone.
One Stage Implant Placement
Up until this point the procedure for the one stage implant placement and the two stage procedure is absolutely the same. The difference comes in the time taken to place a prosthetic restoration. In the one stage procedure, a temporary restoration which is not subjected to too many forces in the mouth is placed at the time of implant placement itself.
This is very attractive to the patient if the implant is to be placed in an anterior region of the mouth and also because it prevents another surgical procedure.
The prosthetic rehabilitation phase involves a minor excision to uncover the implant from its surgical site, where it would have healed undisturbed, and then fixing the necessary attachments, followed by accurate impressions to allow the fabrication of a high quality crown.
A high level of oral hygiene is a must for the survival of the dental implant over a long duration of time. This is because the dental implant does not have the same mechanisms to cope with bacterial plaque accumulation as natural teeth.
A visit to the dentist for regular cleaning and follow up of the implant is a must. A dental implant which serves the patient well for around ten years is considered to be a success under ideal conditions. It is not uncommon for patients to retain their implants for much longer with proper care and maintenance.