Dental Implants
Table of Contents:
Steps In Obtaining Dental Implants
1. Examination/consultation
A thorough
oral examination and medical consultation by the dental team responsible
for implant treatment is necessary to determine if you are a candidate
for dental implants. This team consists of your oral and maxillofacial
surgeon, and your restorative dentist. Working as a team, the
oral and maxillofacial surgeon places the implants and, after
healing takes place, the restorative dentist designs and places
the artificial teeth that are supported by the implants.
During the examination, you will give a complete medical history.
Be sure to give all information, including any health problems,
allergies or medications you are taking. Your examination may
include several types of x-rays to provide essential information
about the jawbone and its anatomy, models of your jaws, and possibly
certain blood tests. Based on the results of this examination,
the dental team will discuss all aspects of your case with you.
Together you will decide if dental implants are appropriate for
you. 
The dental
team responsible for implant treatment
will determine if you are a candidate for dental
implants.
2. Preparing for Implant Surgery
Following are tips to help you prepare for your implant surgery
appointment:
Clothing - Wear loose, comfortable clothing with sleeves that can be easily rolled up. If intravenous anesthesia or sedation will be administered, tight sleeves can make this difficult.
Transportation - Arrange to have someone accompany you to your surgical appointment and drive you home afterward. You may be drowsy for awhile after anesthesia, and driving yourself is unsafe.
Diet - If intravenous anesthesia or sedation will be administered, do not eat or drink for at least 6 hours prior to your surgery appointment.
Medications - Adhere to any medication schedule that is prescribed by your surgeon prior to surgery.
Anesthesia - Modern anesthesia technology
now makes it possible to perform even complex surgery in the dental
office with little or no discomfort. During surgery, one or more
of the following is used to control pain and anxiety: local anesthesic that numbs the surgical
area; nitrous oxide-oxygen (sometimes called "laughing gas")
to relax you; intravenous sedation for relaxation; and general anesthesic that puts you to sleep.
Your surgeon will fully explain the type of anesthesia that is
most appropriate for your needs. 
With the use
of modern anesthesia technology, complex
surgery can be preformed in the dental office with little or no
discomfort.
3.Implant Surgery
The placement
of endosteal dental implants requires two different surgical procedures.
In "Stage 1" surgery the implants, or "fixtures,"
are placed in the bone. In "Stage 2" surgery, which
takes place after osteointegration is complete and the submerged
implants are solidly anchored in bone, the fixtures are uncovered
and special posts called "abutments" are attached to
the implants. These abutments project above the gumline into the
mouth, and the final artificial teeth will be fitted onto them.
The portion of the implant
that is fitted onto the abutment(s) and is visible in the mouth
is called the prosthesis - they can be either of a "fixed"
or "removable" type. A fixed implant prosthesis can
involve a single tooth (top left) or several teeth (bottom left).
A fixed prothesis can only be removed by your dentist, but is
desgned to allow you to clean it. A removal prosthesis (right)
is similar to a full denture and can be removed from your mouth
for cleaning.
Stage 1 Surgery
The first
surgical procedure for endosteal implants involves placing the
implants in the bone. This surgery can take place in the oral
and maxillofacial surgeon's office, or in a hospital setting.
Local anesthesia with a mild sedative may be used, or in certain
cases general anesthesia may be recommended. After you are anesthetized,
the surgeon will lift back the gum tissue to expose the bone and
place one precisely measured hole in the bone where each implant
will be inserted. The implant fixtures are inserted in the holes,
then the gum tissue is replaced over the fixtures and sutures
(stitches) are placed. The surgical procedure may take several
hours if multiple implants are placed, and following surgery you
will spend some time "in recovery" before going home.
Osteointegration will begin taking place as healing progresses,
and the fixtures should be firmly anchored by bone within four
to six months. 
Stage 1 surgery
involves placing the implant
fixtures in the jaw bone.
Following Stage
1 Surgery
Immediately following surgery you may be asked to bite on some
gauze to stop any bleeding, and an ice pack may be used during
the first 24 hours to help reduce swelling. Expect some swelling
in the area of the implant surgery for up to 72 hours following
the procedure, as well as some discoloration of the skin and gums
for a few days.
Pain medication prescribed by your surgeon will help alleviate any discomfort, and you should be able to resume normal activities within a day or two. Your surgeon may also prescribe antibiotics. Expect some minor bleeding on the day of surgery, but report excessive bleeding to your surgeon immediately. During this time a soft diet is recommended that doesn't place undue stress on your new implants, and your surgeon will give you important instructions on how to clean your mouth. If you have been wearing a denture, the surgeon or restorative dentist may place a soft lining in it so you can wear it comfortably during the healing period or it may be necessary to leave it out for a short period of time. If spaces due to missing teeth must be filled in while healing takes place, temporary teeth that appear natural can be made.
Sutures that were placed after surgery will either dissolve or you will return to your surgeon to have them removed.
Stage 2 Surgery
The second surgical procedure takes place after healing from Stage
I surgery is completed. For endosteal implants which osteointegrate,
healing usually takes 4-6 months. At the second surgical appointment,
usually performed in the surgeon's office using local anesthesia,
the gum tissue is opened to expose the implant fixtures. The fixtures
are examined to verify satisfactory osteointegration, and then
healing posts are attached to the fixtures. If sutures are placed,
they will either dissolve or you will return to have them removed
by your surgeon. This second stage of surgery is a relatively
short procedure, and you can expect to return to normal activities
within one or two days if not sooner. 
In Stage 2
Surgery healing posts are attached to
the implant fixtures.
Following Stage 2 Surgery
After returning
home, eat a soft diet and follow your surgeon's oral hygiene instructions.
Expect some minor bleeding, but report excessive bleeding or swelling
to your surgeon. You will return to your surgeon
within a few days so that healing progress can be monitored, and
if you wear a denture, it may be placed immediately or shortly
after surgery. This will be determined by your dentist on an individual
basis. Ice packs applied to the face following surgery can help
reduce swelling.
When your gum tissues have completely healed after Stage 2 surgery, you are ready to visit your restorative dentist and begin fabrication of your new artificial teeth. Your dentist will make impressions of your mouth, and bite registrations that record the way your jaws fit together, then the impressions are used to make models of your jaws and any remaining teeth. Your artificial teeth will be made based on these models. Your artificial teeth (called "restorations" or a "prosthesis") will be either removable, fixed, or a combination of both.
A removable prosthesis is similar to a conventional denture or partial denture, in that you can remove it from the mouth to clean it, but it has the advantage of being fastened to the implant abutments by clips, magnets or other devices. Artificial teeth and gum tissue are mounted on a metal framework, and the framework attaches to the implant abutments.
A fixed prosthesis can replace
one tooth, several teeth, or even all of your teeth. The artificial
teeth are screwed into the abutments, or cemented onto the abutments,
and held firmly in place. If some natural teeth remain in the
mouth, parts of the prosthesis may be connected to some of these
teeth. A fixed prosthesis can only be removed by your dentist,
and it is specially designed to allow you to clean it. If a fixed
prosthesis is replacing many teeth, the artificial teeth will
be mounted on a metal
frame that must fit the implant abutments precisely. Your restorative
dentist may have you wear the prosthesis for a while to make sure
it fits properly, before final attachment to the abutments. It
may take several appointments to complete your prosthesis, depending
on the complexity of your case.
Return to topDental implant surgery has a high rate of success, but as with any surgical procedure, certain side effects or complications are possible. You should understand these before you consent to implant surgery. Your surgeon will answer any questions you have about the following possible risks.
Swelling is a normal reaction
to any surgical procedure and the amount of swelling depends on
how extensive the surgery was. Normal swelling should peak within
about 48 hours, then gradually subside. If swelling worsens after
48 hours, contact your surgeon.
Bruising occasionally develops
in areas close to the surgical site. Any discoloration from bruising
should disappear within a few days following surgery.
Moderate pain is common for 24-48 hours following surgery, and pain medication may be required. If intense pain persists that cannot be relieved by prescribed pain medication, contact your surgeon.
Trismus or stiffness of the jaw
muscles, may be caused by swelling following surgery. As the swelling
decreases, trismus should disappear.
Infection is very rare following
implant surgery, but occasionally an infection can occur. If fever,
persistent swelling/ pain or pus develops following surgery, contact
your surgeon immediately.
There is always
a potential that an implant
may fail.
This can be caused by a number of factors, among them are rejection
by the body or inadequate maintenance by the patient following
surgery
Injuries can potentially occur
to adjacent teeth and roots, fillings or bridgework.
Loss or alteration
of nerve sensation,
resulting in numbness or a tingling sensation in the lower lip,
tongue, cheek, chin, gums or teeth is rare but can occur if implants
are placed in the lower jaw and a nearby nerve is irritated. Usually
this is temporary, although in very rare cases it can be
permanent. Every precaution is taken by your surgeon to avoid
these nerves.
Sinus complications, such as drainage or
pain (sinusitis), occasionally occur if implants are placed in
the upper jaw and the sinuses become involved. This may or may
not require further treatment, but any sinus symptoms should be
reported to your surgeon.
Bleeding can be expected following
any type of surgery, but it should be easily controlled and consist
of occasional oozing during the first 24-48 hours. In the rare
instance that bleeding is excessive or prolonged, contact your
surgeon immediately.
TMJ (Jaw Joint)
pain or abnormal
function is rare following implant surgery, but this can occur.
If it does, further treatment may be necessary.
Bone loss is rare, but may occur
around the implant if proper hygiene is not maintained or if excessive
stress is placed on the implant.
Jaw Fracture - In very rare cases the manipulations required for placement of the implants in the lower jaw can fracture the jawbone, particularly if the jaw is thin. X-rays will reveal the location of the fracture, and your oral and maxillofacial surgeon can treat the problem.
Maintaining
Your Implants And Restorations
Your surgeon and restorative dentist will schedule periodic check-up visits to make sure your jaws are healthy and the implants and prosthesis are functioning properly. Just as important as regular professional care, however, is your own care of your implants and prosthesis. Following are guidelines for proper maintenance of your implants.
Practice meticulous home oral hygiene, following the instructions of your dentist and hygienist. Abutment posts, beneath the prosthesis, artificial teeth, and gum tissue must be kept clean. Home care aids such as special brushes and floss holders will help you accomplish this. If you do not keep your implants and prosthesis clean, your implants may fail.
Smoking and excessive alcohol consumption as well as chewing hard foods such as ice or hard candy may result in damage to your implants or cause them to fail.
While there is
no guarantee of 100 percent success with dental implants, with
careful planning by your surgeon and restorative dentist prior
to surgery, and proper maintenance by you, you can expect many
years of use from your implants. In fact, current literature reports
that 90 percent or more of implants have been successfully retained
for up to 15-20 years. Thousands of people have rediscovered the
joy of eating properly, speaking clearly and laughing comfortably
through the use of dental implants. 
Special brushes
and flosses help maintain
good oral hygiene.