Dental Implant Procedure

By: Terri Briseno

The term "dental implants" actually applies to the replacement roots that provide the foundation for the permanent or removable teeth.
The term "dental implants" actually applies to the replacement roots that provide the foundation for the permanent or removable teeth.
iStockphoto/Thinkstock

It would be so much easier for millions of people if replacing teeth was simply a matter of finding new ones and popping them in place. Smile -- you're done. Of course it's a bit more involved than that, whether you opt for traditional dentures or dental implants.

Dentures and bridges are the most common and affordable option for tooth replacement, but implants are considered to be as close to natural teeth as you can get [source: JADA]. (The term "dental implants" actually applies to the replacement tooth roots that provide the foundation for the permanent or removable teeth; but it's used interchangeably for the teeth themselves, as well.) Most implants are made from titanium or titanium alloys, which are very strong and lightweight metals; the teeth are made from porcelains and other composite materials designed to look like and match real teeth.

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Think of getting dental implants like installing a fence post. The first step is to dig a hole into the ground so a supporting beam can be lowered in. Sometimes the post is secured with cement that needs to dry, and often it is packed in with dirt that gives it the foundation it needs to stand straight and tall to support the fence.

Building a good tooth implant is similar in that a trained surgeon makes a hole in the jaw bone and, after the implant is secured, the gum tissue and bone need to grow around it to give it the strength to hold the post that will in turn support the restored crown between other teeth. It's less of a cosmetic endeavor and more of a building process.

Many people are good candidates for dental implants, but a dentist, oral and maxillofacial surgeon and a periodontist often work together to ensure that an individual has the gum health and bone structure needed for a successful and long-lasting implant. This dental and surgical team will complete thorough exams and X-rays and will set a treatment plan. Implant surgery isn't accomplished in a single visit or even a couple of visits but progresses over many months [source: Mayo Clinic].

But why go under the knife at all when other options exist? And even if you are a candidate, can your wallet handle it? We'll look at the real differences in artificial tooth options, next.

Artificial Teeth Options

Dental implants fill a need, but at about $3,000 to $4,500 per implant -- and in the tens of thousands for a partial bridge or full set -- why not choose dentures instead? Well there are pros and cons to both. First, unlike implants, dentures can cost around $1,200 to several thousand for a complete set. But implants require much less maintenance and expenses over time than dentures. Also, insurance companies tend to reimburse patients for dentures and bridges at a higher percentage than implants, though some insurers may apply that coverage toward dental implants [source: Alderman].

So why do implants cost more and should you choose them instead of dentures? The higher expense is partly because implants require surgery and the expertise of two or more professionals, from dentists and prosthodontists (who work with the teeth -- both real and artificial), as well as periodontists who prepare and treat the gums, and maxillofacial surgeons who insert the posts and work with the jawbones. Not all implant surgeries require all of these specialists, but most will include appointments with both surgeons and dentists. Most patients, however, think the comfort and natural appearance of the implants make the higher cost worth it.

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Also, people with implants will likely have them for life, as fewer than 5 percent of surgeries fail. Dentures and bridges, on the other hand, need to be replaced after about five years. Implants don't slip the way dentures and bridges can, rarely lead to dental work to adjoining teeth, and patients with implants tend to have healthier gums and bones [source: Alderman].

We'll look at how dental implants get implanted and how they stay in place so well, next.

Placing Dental Implants

Choosing dental implants to replace lost teeth means starting a journey of several months. Implants last a long time but they also take a long time to set correctly. After initial exams to assess gum and bone health and density, a dental team of specialists -- including a dentist, surgeon, periodontist and restorative dentist or prosthodontist -- will set a surgical and care plan based on a person's overall oral health and tooth replacement needs.

If bone health and thickness, or density, is sufficient to go ahead with the procedure, surgery can start. In cases where gum tissue health or bone density are lacking, further steps toward periodontal care or bone grafting may be necessary before starting the process. (We'll look at bone-building options later.) Because dental implantation is a surgical procedure, it's also important for individuals to be in good physical health.

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A first step in getting implants is having the surgeon cut into the gum tissue to expose the bones underneath. Patients will of course have the area completely numbed to eliminate most or all pain during the procedure. (Types of anesthesia will vary from general anesthesia to localized numbing treatments like Novocain.) Then a hole is drilled into the jawbone, and the screw-shaped titanium implant is inserted into the bone. Implants are sized to fit the tooth opening and scaled for a person's mouth and jawbone thickness, and extend just above the top of the bone [source: Mayo Clinic].

After the implant is inserted, it needs to be left in place so the bone will fuse with it in a process called osseointegration. Gum tissue will be stitched up at the incision site and will need time to heal and tighten around the implant site, which is why it's important that the gums are healthy before surgery. All of this healing and fusing can take three to nine months or more, during which time the patient typically wears a temporary cosmetic overlay or partial denture in place of permanent teeth [sources: ADA; JADA; Mayo Clinic].

According to Dr. Ira Cheifetz, former president of the American Association of Oral and Maxillofacial Surgeons, this bone growth and healing continues long after the implant is complete because the screw in your jawbone tricks the body into thinking you still have teeth [source: Alderman].

Although the bone-drilling is complete, there may be some more cutting before getting new teeth. We'll discuss that next.

Dental Implant Abutments

After an implant is surgically placed into the jawbone, an abutment is then attached to the titanium implant. It's to the abutment(s) that the  custom-fitted crowns are attached.
After an implant is surgically placed into the jawbone, an abutment is then attached to the titanium implant. It's to the abutment(s) that the custom-fitted crowns are attached.
iStockphoto/Thinkstock

Dental implant procedures are increasingly two-step processes, but they can take three -- and often it's by choice. After an implant goes into the bone, a post, or abutment, needs to be attached to the titanium implant. The abutment is what will hold the new crown or false tooth and it's often added with the implant, but sometimes it's during a second, minor surgery when the gums are opened again, and the abutment is fastened to the implant. The gums are given several more weeks to heal around the abutment -- but not over it -- before the next step [source: NIDCR].

Because the abutment extends up out of the implant and through the gums, it shows and can't be as easily concealed. An implant alone does not show, so some individuals opt for having the second minor surgery to add the abutment later so they don't have the abutment, well, butting out of the gums for the months it takes for the implant to set into the bone [source: Mayo Clinic]. Often, though, just as with a one-step procedure, a temporary crown or denture can be fitted and worn during the healing process.

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Whether the procedure is done in a one- or two-step process, it is very important to be exceptionally thorough in keeping the mouth, teeth and gums clean and healthy. As the bones heal and the gums close up around the abutment, a firm foundation is being set for the crowning piece of the process: the dental crown itself. When all of the bone-cutting, gum-incising work is over, the human body responds by growing bone and plumping and firming gum tissues to receive new teeth.

After the gums have healed completely, a dentist or other specialist can then make impressions of the mouth and set the custom-fitted crown -- or implant prosthesis -- onto the abutment and make adjustments as needed. If replacing a single tooth, often a fixed implant is fashioned and screwed and glued onto the post. Removable implants are an option if replacing several teeth or even a full set, and these types of prosthetics are similar to bridges in that they can be snapped on and off for cleaning or repair. Aside from follow-up exams to check healing and progress, after this final step of restoration, the new tooth or teeth are good to go, often for a lifetime [source: Mayo Clinic].

Sometimes, before making it to the crowning, even getting to the initial first-step implant surgery requires some additional work. We'll look at other prep and failure issues, next.

Jaw Bone Growth and Grafting

Dental implant surgeries have a very high success rate, but several factors influence how well they will work and how long they will last. Having enough bone density where the implant is being inserted, as well as having the health needed for the bones to heal and "accept" the titanium, is one of the most important factors. Sometimes bone grafts are required before a person can be considered a good candidate for the procedure and, in rare cases when implants fail, maxillofacial surgeons will graft in bone to strengthen the area before trying again.

If bone density is a problem or bones are too soft, surgeons can remove a piece of bone from another site, such the hip, and transplant it to the jawbone where it can fuse with the existing bone for about six to nine months. For minor bone issues, some grafts are completed when the implant is placed, and the fusion between the bones and the implant happens during the same osseointegration period [source: Mayo Clinic]. Synthetic materials instead of bone are also options for building up bone mass in some cases.

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While all of these steps may seem complicated, costly and time-consuming, they also can lead to a permanent solution for lost teeth. Implants look and feel natural, and with conscientious care after they're implanted, they really can last a lifetime with little maintenance. Smoking and poor oral hygiene are two factors shown to lessen the success and longevity of implants, but few other issues are documented in medical and dental studies.

Implant dentistry is a solid alternative to traditional partial bridges and dentures, but, over time, its growing popularity may lead to improved insurance coverage and a lower cost -- perhaps in time to meet the dental needs of an aging population.

More on keeping and fixing a smile, next.

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More Great Links

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