Overview of Implant Placement

The Surgical Procedure

The procedure to place dental implants takes 30 to 60 minutes typically, although complicated cases can take up to 2 hours. The number of appointments and time required, vary from patient to patient.

Prior to surgery, you may receive a prescription for antibiotics and a mouthwash.  For your greater comfort, you may choose to have intravenous sedation or nitrous oxide (laughing gas) during the procedure. These options will be discussed with you at your initial consultation appointment. A local anesthetic will be administered to numb the area where the dental implant will be placed.

When you are comfortable, your periodontist makes a small incision in the gum tissue to reveal the bone, creates space using special instruments, and gently inserts the titanium implant. The implant itself is buried in the bone and never visible but a secondary piece called a healing abutment will be screwed into the implant and protrude a few millimeters out of the gums.  Its purpose is to shape the gum tissue and make space for where the future ceramic crown (tooth) will go. Sometimes it is better in the early stages of healing to have the implant covered by the gum tissue completely and then add the healing abutment a few months later as a second, minor step.

Healing after Dental Implant Surgery

Now the healing begins. The length of time varies from person to person, depending upon the quality and quantity of bone. Your periodontist will advise you on follow-up care and timing. Normally, the wait is 2 to 4 months to let the bone grow around the implant and grip it. This is called the integration phase.  How long to wait is determined at the implant surgery.  We wait these few months because if pressure from a tooth is put on an implant too earlier, it could fall out.  This guideline is different for people placing multiple implants specifically to anchor a denture because the forces are different.  In this situation, a person may be restored with a new denture right after the implants are placed. 

In most cases, people will return 2 weeks after the implant surgery for an initial check of the healing and then a second check at the end of the implant integration phase to make sure the implant has integrated into the bone.  This involves an x-ray and a few measurements, typically not taking more than 15 minutes.  After that check, the person is sent back to their own dentist to finish the treatment by making and then connecting a ceramic crown to the implant.

It may be beneficial to perform a soft tissue graft to obtain stronger, more easily cleaned and natural appearing gum tissue in the area around the implant. This process involves moving a small amount of gum tissue from one part of your mouth to the area around the implant.  This can be done at the time of the implant placement or at a later date.  Similarly, additional bone grafting may be done at the same time the implant is placement to insure it has adequate bone for a good foundation.

When are dental implants placed?

Implants are often placed several months after extraction. At times, an implant may be placed immediately after extraction of a tooth. This may involve a little more risk, but it simplifies the process—you won’t have to wait for another appointment to place the implant. When infection or other problems with the bone are present, immediate implant placement is not the best treatment.

If your tooth has been missing for some time, the adjacent support bone is likely to grow thinner and shrink. This occurs because the root of the natural tooth has to be present to stimulate the bone. As much as one third of your jaw’s thickness can be lost in the year following tooth extraction. If you are missing enough bone, you may benefit from having additional bone grafted into the area. This ensures the implant will be adequately supported when it is placed in the jaw.

How many implants do I need?

For replacing a single missing tooth, one implant is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.  If multiple teeth are missing, a common solution is to place 2  implants and then the restorative dentist makes a bridge between them to replace 3 teeth.  This gives a person a maximum number of teeth while minimizing the number of implants to save money.

If a person has a denture that is too loose, 2 to 4 implants are a good way to make it more stable.  If someone is looking for a restoration to replace all of their teeth but does not come out at night, then 6-8 implants are usually needed.  

In all cases, a comprehensive treatment plan will be developed and agreed upon by your restorative dentist, periodontist, and you before beginning.