Know more about Dentel Place/Replace/Implement Process

All about Placing Dental Implants

Getting dental implants is the procedure requiring more than just one type of professional expertise. The oral surgeon (also called periodontist) will place the implants in the jawbone. General dentist, called prosthodentist will prepare crowns, bridges or dentures which are made to look like natural teeth. Also, the procedure of placing implants needs the coordination by surgeon with the general dentist or prosthodentist regarding the questions of how many implants are needed and also on the question of where they are to be placed.
This article discusses the commonly adopted procedures and steps performed by a dentist for placing an implant. However, as there are different types of implant devices and manufacturers of variety of such devices, the actual procedure your dentists follow may be different from what is described here. These are the typical steps generally followed.
Before Placing Implant
Everyone does not qualify to get the dental implant and be benefitted from this procedure. The success of the process and getting the desired benefits depends on whether the person is having good health, possesses healthy gums and has the required quantity of the bone material present in the jaws to permit an implant be fitted in the jawbone. A dental professional can examine you on these grounds and will assure you that your conditions qualify for successful adoption of dental implants.
There are different reasons and circumstances in which people consider dental implant. It could be for replacement of teeth lost long back for over several years. In some cases it could be to replace the teeth very recently extracted due to severe tooth decay, gum disease (periodontal disease), infection or accidental injury to gum or teeth. Some may opt for simultaneous extraction of the tooth and placing implant in place. In case you are having gums or root of the tooth severely infected you may be asked to wait for a few months after removing the underlying teeth and allow the area to completely heal.
An important step in placing the dental implant is to have the bone in the jaw area built up that increases the success rate of placing the implant. Technical name for this procedure is called bone augmentation or grafting. Your dentist may decide to conduct the bone grafting and getting the implants at the same time or he may get the bone grafting done first and after sufficient time allowed for the bone to heal he may go for placing the implants. In case it is decided to opt for bone grafting done prior to the implant operation, you may need 4 to 12 months for complete healing of the bone and then placing the implants in the jawbone. But you need not be without the teeth during the period as you can wear the dentures or bridges during the intervening period.
Placing the Implants
Normally implants are placed in the procedure involving two-step method. But there are new processes that can be accomplished in a single step. Here, the commonly employed two-step method is briefly explained. 
The First Surgery 
The patient is administered antibiotics and pain relieving medication before the commencement of surgery. Normally dentists use local anesthetics during the surgical operation but you may elect sedation by request. The sedatives can be given as an oral medicine or be intravenously administered (it involves the medicine injected by the needle through a small tube, the needle being injected in the veins in arm directly). To accurately determine the position where the implant needs to be placed, it will be necessary to get an X-ray or possibly CAT scan of the area. Before the implant is placed, the surgeon makes an incision in the gums to access the bones. A hole is then drilled into the bone for the implant to be fixed in it. Then the gum is then closed over the implant with a suture or stitch. The time needed for this procedure depends on the total number of implants to be placed. The time required for this will contingent if a bone graft is carried out. Usually the surgeons can complete a single implant in an hour. All people exhibit different tolerance levels, however, this procedure are usually described by most patients as being comparatively ‘mild’.
In case an implant is going to be placed in the prominent portion of the mouth, temporary dentures or bridge will be fitted so that during the healing period. The dentist will discuss this option prior to the procedures of placing implants. After finishing the surgery you are given the antibiotics and pain relief medication. You are also advised to observe following instructions. Some of the important ones are:

• If you spit, suck with straw or smoke, the blood clots can be dislodged and the healing will be delayed for long.
• Consume only soft food and to prevent possible injuries to gum tissues.
• The implant area must not be cleaned directly for a period of one to two weeks. You can clean the other portion in the mouth as usual.  You may be given antibacterial solutions for rinsing and cleaning the affected area.

After the surgery, you are may need to visit the surgeon after 7 to 10 days to get the stitches removed.
Some stitches are designed to be naturally absorbed by the body.
Once the implant is placed, it takes several months for the bonding of the bone with the implant. Usually the bonding period for the lower jaw is 3 to 4 months and 5 to 6 months if the implant is in upper jaw. Note that during this period, the head of the implant is not visible, as it is covered and hidden under the gums. 
The Second Surgery 
The second phase of placing implants begins after the implants have integrated with the surrounding bone on which it is fitted. The second surgery is then performed after the attachment or bonding of the implant to the bone. After administering the local anesthesia the gum portion is opened with incision. Surgeon will remove the protective screw and replace it with a metal healing collar.  This healing collar has the appearance of a hollow metal cylinder that sits like a cap over the gums in the area where the tooth is going to be fitted. Also it maintains the space to enable the gums to heal correctly around the implant. But in some cases, the implants might be found not be successfully bonded to the bone. In which case, the dentist will remove them and replace with wider implants. Alternatively, it may be removed entirely and allow the area to heal once again in few months and the second attempt tried.
Now-a-days very few dentists are using the single stage implants. In this case the implants are fitted in the jaws and they are openly accessible in the mouth and thus avoid the second surgery. 
Restoration 
Two to three weeks after the second surgery (or immediately following the second procedure) you must visit your dentist or prosthodontist, for fixing the crown, bridge or denture.  
Complications from Surgery
Like any other surgery placing implant too has a risk of running into complications. These risks may include bleeding, infection and injury to nerves and additionally, surrounding organs such as sinuses or nasal cavity located above the upper mouth. During the surgery it is possible that the dentist could scratch the underlying nerves below the jawbones during drilling. This could cause pain or numbness as the nerves could be touched or damaged. The numbness can affect the lower lip portion, chin or the lateral part of tongue. This condition can last for months and in some extreme cases it may be permanent.
In case of the upper jaws, the drilling could reach into sinuses or nasal cavities. If this happens, it could lead to infection of those areas. Such severe complications are avoided by having special X-rays taken before the surgery to identify the exact location of the nerves, sinuses and the nasal cavities. 
Implant Failure
The overall success rate of implant surgery is more than 90%. However, sometimes the implant does not bond with the surrounding bone structure. But if this discovered at the time of the second surgery, then there is no alternative than to remove the “failed” implant. As mentioned previously the dentist may decide to immediately replace with a new implant or wait a few months before attempting again.
What are the possible reasons for the failure of Implants to integrate with the surrounding bone? Possible reasons for complications are:

• Surgical trauma
• Inability to eliminate the Infection at the implant location
• Smoking in the interim period – Smoking may cause decreased blood flow to gums and bone at the implant location inhibiting effective bonding process.
• Lack of sufficient bone mass – If there is less bone at the base of the implant, it is found that the implant may shift around and thus is unable to bond.
• Titanium allergies – very rarely reported.

You must be aware that some problems can develop even years following the surgery. Like natural teeth and gums, the implants too can be attacked and affected by micro organisms. This leads to a disease called periimplantitis. This disease, if left untreated, can cause bone loss and subsequently the loosened implant, resulting in its removal may have to be removed. Normally this is treated just like the periodontal diseases affecting the natural teeth.
There is yet another complication related to the crown, bridge and/or dentures. These are restored on the support of implants and they themselves can break. The implant also could fracture. It can occur if the alignment of teeth is improper and the bite causes severe stress. Such misaligned teeth will exert very large unsupported forces causing the implant fracture.
It is possible to repair the broken restorations. But a fractured implants need to be removed. The broken implant or those affected by infections will be replaced by a new implant.