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Dental Implants

What are Dental Implants?

Dental implants may be thought of as replacement tooth roots. Although they are available in many shapes and sizes, depending on the specific problem to be solved, by far the most common type in use today is the “root-form” implant. Dental implants are among the most significant advancements in the history of dentistry for their versatility at replacing one tooth, several teeth — even all of the teeth.

Implants are a viable treatment option for most patients, regardless of how many teeth are missing.

The process of placing a dental implant

A cover screw for a dental implant.

A cover screw is used to prevent the gums from growing down into the dental implant while it is healing into the jaw.

Before a dental implant is placed, your dentist will review your medical and dental history thoroughly to rule out any contraindications to the procedure. These are discussed more fully below. If you have replacement joints (for example, total knee replacement, hip replacement, etc.), you may be pre-medicated with specific antibiotics for the procedure. If you have certain types of heart murmurs or replacement heart valves, you may also need to take a specific antibiotic pre-medication prior to the procedure. Due to the risks and complications of infections with dental implants, your dentist may place you on antibiotic medication a day or two prior to the procedure, and for a week or so afterwards.

If you are anxious about dental procedures, your dentist may recommend sedating you for the procedure. There are several methods of relaxing patients for dental treatment, including oral anti-anxiety pills; inhaled anti-anxiety medication like nitrous oxide; and intravenous anti-anxiety medication. Your dental plan may not pay benefits toward sedation.

If you decide to be sedated with oral medication (pills), you will arrive at the dentist’s office with some degree of sedation already having taken effect. This may inhibit your ability to understand the “informed consent” paperwork you will be required to read and sign. Therefore, the dentist will likely have you read and sign the paperwork ahead of the surgical appointment. You will be given an opportunity to discuss any questions you may have ahead of time, so that you are not signing consent forms while under the effects of sedation. If you are sedated, you will also be required to have an escort to and from the dental office.

When you arrive at the dentist’s office for placement of the implant(s), you will rinse your mouth thoroughly with an antiseptic rinse, and wash your face with an antibacterial scrub.

If you are to be sedated by a method other than ingestion of a pill, the sedation procedure will be performed next.

Local anesthetic will be given in the area of implant placement, both to numb the surgical area and to minimize bleeding for good visibility of the implant site. Bleeding from an implant surgical site is normally insignificant anyway, but can be reduced even more by the vasoconstricting ingredients found in certain local anesthetics.

Dental implant abutments are fastened to the fixture with a retaining screw.

A prosthetic abutment is used to attach the dental restoration (crown, partial denture, etc.) to the implant. Shown here is an abutment for a single crown. Dental implant abutments (2) are fastened to the fixture with a retaining screw (1). Implants are also available which incorporate the abutment and implant in one solid piece. Two-piece arrangements offer greater flexibility.

With traditional implant surgery, an incision through the gums is generally made, exposing the underlying bone. Implants are currently available which are designed to be placed without the need for an incision, but they are meeting with mixed success. Your dentist will be able to provide more information on such techniques.

A series of successively larger drills are used to establish and enlarge the hole into which the implant is placed. The hole is called the “osteotomy”. Depending on the type of implant being placed, and the density of the bone, a bone tap (thread forming device) may or may not be used to establish threads in the osteotomy. The implant is then inserted into the osteotomy. A “single-stage” implant is one that extends through the gums, and is not covered by them during the healing and osseointegration period (while the implant is fusing to the bone).

A “two-stage” implant (the traditional kind) will have a very thin cover screw inserted into the implant at the time of placement, and the gums will be closed over it with stitches (sutures). The cover screw keeps the gums from growing down into the center of the implant during the healing phase. Several radiographs may be exposed during the surgery, to allow your dentist to visualize the depth and angulation of the implant as it goes into place.

A transparent view showing a dental implant with ceramic abutment restored with a porcelain crown.

A transparent view of a dental implant (1) with a ceramic abutment (2), restored with a porcelain crown (3). Use of ceramic abutments instead of titanium or gold allows a much more natural-appearing translucent porcelain to be used for the finished restoration. The result can be very difficult to distinguish from the natural tooth.

About four to six months after placement into the jaw (depending on the density of the bone and other factors), the implant will be ready to be restored. There are several variations on implant placement that your dentist will discuss with you. When the implant is ready to be restored, it is uncovered, and a temporary crown may be placed on the implant to sculpt the gums to proper shape. Crowns, fixed bridges and removable dentures are attached to implants by means of “abutments.”

Abutments can be made of white ceramic or metal. The abutment is attached to the implant with a retaining screw. Generally, silicone, wax, or other soft compound will be placed in the head of the retaining screw to keep cement from the crown from filling it. Crown cement dries extremely hard, and can be difficult to remove from the retaining screw if this step is not done.

In the case of single tooth replacement, the final crown will generally be made in a lab and cemented onto the abutment. Implant crowns can also be screw-retained, with the advantage of easy retrievability and the possible disadvantages of bulkiness and compromised esthetics. With screw-retained implants, the screw head extends through to the surface of the crown. Your dentist can help you decide which type would work best for you.

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Author: Thomas J. Greany, D.D.S. / Editor: Ken Lambrecht

This page was last updated on December 13, 2018.

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