What is a dental implant and why
is it necessary?

A dental implant is an artificial tooth
root replacement and is used in prosthetic dentistry. Implants can provide
people with dental replacements that are both functional and aesthetic.
A dental implant involves a titanium screw that is placed into the jaw
bone. It acts as an anchor for a false tooth or a set of false teeth. 

Implants can provide people with dental
replacements that are both functional and esthetic. After a dental implant
restoration is perfectly constructed, neither the patient nor anyone
else should have any hint that an implant is there. 

Who is a candidate for dental implants? 

Anyone in reasonable health who wants
to replace missing teeth is a candidate for dental implants. You must
have enough bone in the area of the missing teeth to provide for the
anchorage of the implants. If you do not have enough bone to support
a dental implant, bone grafts can be placed. Implants are used to replace
small bridges, removable partial dentures and even missing single teeth. 

Details of the procedure

What happens during the dental
implant procedure, and how is it performed?

A typical implant consists of a titanium
screw, with a roughened surface. This surface is treated either by plasma
spraying, etching or sandblasting to increase the integration potential
of the implant. At edentulous (without teeth) jaw sites, a pilot hole
is bored into the recipient bone, taking care to avoid vital structures
(in particular the inferior alveolar nerve within the mandible). 

This pilot hole is then expanded by using
progressively wider drills. Care is taken not to damage the osteoblast
cells by overheating. A cooling saline spray keeps the temperature of
the bone to below 117 degrees Fahrenheit (approx) or 47 degrees Celsius.
The implant screw can be self-tapping, and is screwed into place at
a precise torque so as not to overload the surrounding bone. Once in
the bone, a cover screw is placed and the operation site is allowed
to heal for a few months for integration to occur. 

After some months the implant is uncovered
and a healing abutment and temporary crown is placed onto the implant.
This encourages the gum to grow in the right scalloped shape to approximate
a natural tooth’s gums and allows assessment of the final aesthetics
of the restored tooth. Once this has occurred a permanent crown will
be constructed and placed on the implant. 

What type of anesthesia will be
used?

A dental implant is surgically placed
under local anesthesia causing the procedure to be generally not at
all painful. 

How long after a dental implant
is placed can it be used to anchor my new teeth?

In earlier days, the waiting time was
three months in the lower jaw and six months in the upper jaw before
beginning to construct the new dental prosthesis that is supported by
the implants.

In recent years, an increasingly common
strategy to preserve bone and reduce treatment times includes the placement
of a dental implant into a recent extraction site. In addition, immediate
loading is becoming more common as success rates for this procedure
are now acceptable. This can cut months off the treatment time and in
some cases a prosthetic tooth can be attached to the implants at the
same time as the surgery to place the dental implants. 

What precautions will I need to
take after the procedure?

Dental implants are not susceptible to
dental caries but they can develop a periodontal condition called peri-implantitis
where correct oral hygiene routines have not been followed. Risk of
failure is increased in smokers. For this reason implants are frequently
placed only after a patient has stopped smoking as the treatment is
very expensive. 

What are the risks/complications
associated with dental implants?

Although there are not many things that
can go wrong with dental implants, some of the problems could be:

• Failure to integrate into
  the bone resulting into the falling out of the implant.
• A fracture or breaking of
  the implant.
• Problems with the connection
  between the implant and the prosthesis.
• An infection or an inflammatory
  condition in the soft tissue and sometimes in the bone as a result of
  the implant placement.
• Damage to the nerves in the
  lower jaw and to the maxillary sinus or the nasal cavity.

All of these complications are rare and
can usually be easily corrected. 

Does it hurt after the dental implants
have been placed?

Some discomfort may occur once the effect
of the anesthesia wears off about three or four hours after the procedure.
Most patients do not have significant problems although the level of
discomfort varies from patient to patient. Some patients do have varying
degrees of pain or discomfort which may last for several days. Swelling
and black and bluing may also develop. 

What should I watch out for?

You should call upon your dentist when
there is prolonged pain as this is not a good sign with dental implants.
Having prolonged pain does not always mean failure but the cause of
the pain should be determined as soon as possible.

The implant may have to be removed if
an infection develops or if the implant is not properly integrating
into the adjacent bone. 

What happens if my dental implants
are rejected?

In occasional cases when the dental implants
fail or are rejected, they can be replaced with another implant, usually
of a slightly larger size. The rate of failure is only about 1-5%. This
might be somewhat higher in smokers and people with compromised immune
systems. The key element to determining implant success is proper diagnosis
and treatment planning.