Placing Dental Implants

To place the implants, the surgeon first will make an incision (cut) in your gums to expose the bone. He or she then will drill a hole in the bone and place the implant in the hole. The surgeon probably will take an X-ray of the area to make sure the implant is where it should be. The surgeon will then stitch your gum closed over the implant.

The time required for this procedure depends on:

  • The number of implants
  • Whether or not you get a bone graft at the same time

In most cases, placing a single dental implant requires about one hour. You will feel some pain after this procedure. The level of discomfort depends on the person, but generally it has been described as relatively mild.

If the implant is placed in the front of your mouth, your dentist will give you a temporary denture or bridge so that you do not have to be without teeth. He or she will discuss options with you before the surgery.

After the surgery, your surgeon will give you antibiotics and pain medicine. You also will get instructions to follow. These will include:

  • Don’t spit, suck on straws or smoke. This can dislodge blood clots and slow healing.
  • Eat only soft food to avoid injuring your gums.
  • Don’t try to clean the implant area for the next one to two weeks, but clean the rest of your mouth normally. Your dentist may give you an antibacterial rinse to help keep the area clean.

You will return to the surgeon 7 to 10 days later to have your stitches removed.

After the implant is placed in your jaw, you will have to wait several months for the bone to bond with the implant. This usually takes 3 or 4 months in the lower jaw and 5 or 6 months in the upper jaw. During this time, the head of the implant usually remains hidden under your gum.

Second surgery
After the implants have integrated with (attached to) the surrounding bone, you are ready for the second surgery. After giving you local anesthesia, your surgeon will make a small cut in the gum. This exposes the implant. This surgeon will remove a protective screw from the implant and replace it with a metal healing cap (collar). The healing cap looks like a small metal cylinder that sits above your gums in the area where your tooth would be. It maintains the space so that the gum heals correctly around the implant.

In a very small percentage of cases, the implants will not successfully integrate with the bone. If this happens, your dentist can do one of the following:

  • Remove the implants and immediately replace them with slightly wider ones.
  • Remove them and allow the area to heal for several months before making a second attempt.

Some dentists are now using one-stage implants. These implants are placed in the jaw and remain exposed in the mouth so that no second surgery is needed.

Restoration
Generally, you will go to your dentist or prosthodontist two or three weeks after the second surgery to start the process of having your crown, bridge or denture made.

Complications From Surgery

Any surgery carries the possibility of complications. Problems that can occur with implant surgery include:

  • Bleeding
  • Infection
  • Injury to nerves, sinuses (located above your upper teeth) or the nasal cavity

When implants are used to replace lower teeth, your dentist could nick the nerve that runs through the jawbone during drilling. This can cause pain or numbness. If numbness occurs, it usually affects the lower part of the lip and chin or one side of the tongue. It can last for several months until the nerve heals. In some cases, it may be permanent.

In the upper jaw, there is the possibility of drilling through the jawbone into one of your sinuses or nasal cavity. This could result in an infection. To avoid this, special X-rays are taken before your surgery to help the surgeon determine where the nerves, sinuses and nasal cavity are located.

Implant Failure

Implant surgery is successful more than 90% of the time.

Occasionally, an implant fails to integrate with the surrounding bone. This is usually discovered at the second stage surgery when the implant is uncovered and the surgeon finds it is loose. In this case, the “failed” implant has to be removed. Another implant can be placed either immediately or at a later visit.

Sometimes implants fail to integrate with surrounding bone after the first stage of surgery. Potential reasons include:

  • Surgical trauma
  • Infection around the implant
  • Smoking — This appears to decrease blood flow to the healing gums and bone, which could interfere with the bonding process.
  • Lack of healthy bone — If there is not enough bone for the implant to remain stable, the implant may move around within the bone and integration will not occur.
  • Titanium allergies — These are extremely rare.
  • Excessive or uneven force on the implants because of the way the teeth come together during chewing and speaking (the bite).

Problems also can develop years after implants are placed. For example, just like natural teeth and gum tissue, the gum around implants can become infected by bacteria. This leads to a form of periodontal disease called periimplantitis. If left untreated, this condition can cause bone loss. Then the implant can become loose and have to be removed. Generally, this situation can be treated in a way very similar to treatments for periodontal disease affecting natural teeth.

Another type of complication that can happen over time is breakage. Either the implant or the implant-supported restoration (crown, bridge or denture) can break. This usually happens if your bite (the way your teeth come together) is not aligned properly. If your bite is off, too much force might be placed on the restoration or implant. Broken restorations often can be repaired. However, a fractured implant has to be removed.

A implant that breaks or fails because of an infection can be replaced with a new implant.

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