Implant dentistry involves careful planning and highly trained and experienced dentists. The dentist must first discuss with the patient what their goals are, and then must give the patient all of their options, expected outcome, risks and benefits. The medical and social histories of the patient are also important. Diseases that affect the immune system such as diabetes, and habits that reduce blood flow and healing such as smoking, must be identified because they can reduce the success of implant surgery.
Study models of the patient's jaws are necessary for the planning stage of an implant procedure, and are made from molds (impressions) of the mouth. A surgical stent is then made from the model to give to the dental surgeon a guide when placing the implant(s). An X-ray of the jaw is required, both individual (periapical) X-rays and an X-ray of the entire mouth (panoramic). In some cases, a computer-assisted tomography (CAT scan) is advisable to give the dentist a more accurate representation of the amount of jawbone available for dental implants. The dentist will also need a clinical examination to determine if there is enough bone width to fit an implant. If the implant is being used to replace a single tooth, there needs to be adequate room between the existing teeth so that the implant does not damage the surrounding tooth roots. If the X-ray or CAT scan reveals that there is not enough bone height to place the implant, a bone graft may be required.
Although any dentist can surgically place implants into the jaw, a dental specialist called a periodontist (gum disease specialist) or an oral surgeon (specialist who does more advanced dental extractions and other dental surgery) is most commonly used for the procedure. To place a dental implant, the dentist uses local anesthesia to numb the surgical area. In most cases, the procedure is well tolerated by the patient, and can be done while the patient is awake, or with light sedation.
An incision is made into the gum to expose the underlying bone. The stent is placed over the jaw to guide the implant placement. A series of drills in progressively widening diameters are used to create a hole in the bone. The implant is then placed into the hole so that the top of the implant is at or slightly above the crest (top) of the bone, where it meets the gum line. A screw is then inserted into the implant to prevent the gum and other debris from entering the implant. The gum is then stitched up over the implant.
After implant surgery, denture wearers will be asked to not use their denture for two weeks as the implants heal. An antibiotic mouth rinse containing chlorhexidine gluconate such as Peridex® is usually given during the first few weeks after implant surgery. Antibiotics and pain medications are prescribed routinely to prevent infection and alleviate pain.
After the implants are placed, they require 3 to 9 months to connect to the jawbone. The lower jaw (mandible) generally requires 3 to 6 months, and the upper jaw (maxilla) requires 6 to 9 months. This process, where bone grows into the implant, is called osteointegration. Once connected to the bone, tooth crowns (caps), permanent dental bridges or dentures can be fastened to the implants.
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