The procedure to place an implant takes 30 to 60 minutes for one implant and only 2 to 3 hours for multiple implants. The number of appointments and time required, vary from patient to patient. The surgeon will bring great precision and attention to the details of your case.

Prior to surgery, you may receive antibiotics and for greater comfort, intravenous sedation or nitrous oxide (laughing gas). These options are discussed with you at your consultation appointment. A local anesthetic will be administered to numb the area where the implant will be placed.

When you are comfortable, the surgeon makes a small incision in the gum tissue to reveal the bone, creates space using special instruments, and gently inserts the titanium implant. The top of this implant is often visible through the gum. Sometimes it is better in the early stages of healing to have the implant covered by the gum tissue.

The Healing Phase

Now the healing begins. The length of time varies from person to person, depending upon the quality and quantity of bone. In some cases, implants may be restored immediately after they are placed. The surgeon will advise you on follow-up care and timing. After the initial phase of healing, the surgeon places an abutment (support post) or a healing cap onto the implant during a brief follow-up visit. This allows gum tissue to mature and provides access to the implant.

Occasionally, impressions are made at the time the implant is placed. This enables the crown to be ready when the implants have healed. How long your mouth needs to heal is determined by a variety of factors. Follow-up care (one to four appointments) is usually needed to ensure that your mouth is healing well and to determine when you are ready for the restorative phase of your treatment.

It may be beneficial to perform a soft tissue graft to obtain stronger, more easily cleaned and natural appearing gum tissue in the area around the implant. This process involves moving a small amount of gum tissue from one part of your mouth to the area around the implant. Most often, it is a brief and relatively comfortable procedure.

Whether it’s one tooth or all of your teeth that are being replaced, your dentist will complete the restoration by fitting the replacement tooth (crown) to the dental implant.

When Are Dental Implants Placed?

Implants are often placed several months after extraction. At times, an implant may be placed immediately after extraction of a tooth. This may involve a little more risk, but it simplifies the process—you won’t have to wait for another appointment to place the implant. When infection or other problems with the bone are present, immediate implant placement is not the best treatment.

If your tooth has been missing for some time, the adjacent support bone is likely to grow thinner and shrink. This occurs because the root of the natural tooth has to be present to stimulate the bone. As much as one third of your jaw’s thickness can be lost in the year following tooth extraction. If you are missing enough bone, you may benefit from having additional bone grafted into the area. This ensures the implant will be adequately supported when it is placed in the jaw.

How Many Implants Do I Need?

Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.

If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.

What are the advantages of a single-tooth implant over a bridge?

A dental implant provides several advantages over other tooth replacement options. In addition to looking and functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that adjacent teeth be ground down to support the cemented bridge.

Because a dental implant will replace your tooth root, the bone is better preserved. With a bridge, some of the bone that previously surrounded the tooth begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.

In the long term, a single implant can be more esthetic and easier to keep clean than a bridge. Gums can recede around a bridge, leaving a visible defect when the metal base or collar of the bridge becomes exposed. Resorbed bone beneath the bridge can lead to an unattractive smile. And, the cement holding the bridge in place can wash out, allowing bacteria to decay the teeth that anchor the bridge.

How will the implant be placed?

First, the implant, which looks like a screw or cylinder, is placed into your jaw. Over the next two to six months, the implant and the bone are allowed to bond together to form an anchor for your artificial tooth. During this time, a temporary tooth replacement option can be worn over the implant site.

Often, a second step of the procedure is necessary to uncover the implant and attach an extension. This temporary healing cap completes the foundation on which your new tooth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.

There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.

Finally, a replacement tooth called a crown will be created for you by your dentist and attached to a small metal post, called an abutment. After a short time, you will experience restored confidence in your smile and your ability to chew and speak. Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.

If you are missing multiple teeth, they may be replaced with multiple single-tooth implant restorations or with an implant fixed partial denture (or bridge). Alternatively, this space may be replaced with a removable partial denture, or a conventional bridge using your natural teeth.

​What are the advantages of implant bridges?

Implant bridges replace the support lost as a result of missing teeth, avoid the need to drill or file down adjacent teeth, and do not require an implant for every missing tooth. Implants are placed in strategic positions based on factors such as bone quantity/quality, bite requirements, esthetic requirements, etc. When the implants are stable and ready for loading, abutments can be attached to the implants that will connect the final bridge (prosthesis) to the implants. An impression is made recording the contours of the abutments or the position of the implant tops. The implant bridge is then fabricated and retained in place using cement or screws.

An implant bridge is not susceptible to cavities but may develop complications if oral hygiene is not maintained. This implant restoration should be routinely evaluated – the time interval dependent upon the conditions of the remaining natural teeth and the implant bridge. Restorations using porcelain may be susceptible to a low incidence of porcelain fracture. Patients with large functional forces, including bruxism, may require stronger metal chewing surfaces.

Implant-assisted removable partial dentures (IRPD) utilize a few implants to secure a removable partial denture.

These key implants may eliminate unsightly clasps, reduce the display of metal parts on the RPD, and will increase the amount of support, stability and retention to the final restoration.

Although many patients have no problem wearing an upper denture, some people find it difficult to wear and eat with lower dentures. Several implant-supported replacement options are available if you are missing all of your lower teeth.

Ball Attachment Denture

One option is to have two implants placed in your lower jaw and a denture made that snaps onto these implants. This option allows your lower denture to be more stable while chewing than without implants. However, there will still be movement of your lower denture, and sore spots will occur if any food particles, especially seeds, are caught under it. As with all removable replacement teeth, you still will need periodic appointments for denture adjustment.

Bar Attachement Denture

Another option involves placing four to six implants, depending on your jaw size or shape, into your lower jaw. After healing is complete, the implants are connected with a custom-made support bar. Your denture will be made with special internal retention clips that attach onto the support bar, enabling the denture to snap firmly into place. This is called an “overdenture.” The advantage of this option is that it is much more stable than the first option and allows very little denture movement. Your denture is still removable for easy cleaning and maintenance.

Screw Retained Denture

One option is to have two implants placed in your lower jaw and a denture made that snaps onto these implants. This option allows your lower denture to be more stable while chewing than without implants. However, there will still be movement of your lower denture, and sore spots will occur if any food particles, especially seeds, are caught under it. As with all removable replacement teeth, you still will need periodic appointments for denture adjustment.

Individual Implants

The final option is to have all your teeth individually replaced so that they will appear to be growing out of your gum tissue and will most closely resemble the appearance of your natural teeth. This option usually requires eight or more implants. Separate abutments or support posts for each one of these implants will be made and crowns for each missing tooth will be placed. The teeth are often joined together for sinus grafting to replace bone height strength and support. Overall, this is the most costly option, because it requires the most implants and individual replacement tooth fabrication. Your replacement options may also be limited by the current size and shape of your jawbone.

What If I'm Missing All Of My Upper Teeth

A similar range of treatment options is also available for your upper jaw. However, because the bone is not as hard as that in the lower jaw, people often need more implants to support their new replacement teeth. Depending upon the number of implants to be placed, it may be possible to eliminate the need for covering the roof of your mouth with a complete denture. This option allows you to fully taste your food and gives you a better sense of its temperature. Your denture will feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier.

This is the pinnacle of dental implant treatments. In the past, when a person was faced with having to lose all of their teeth, removable dentures were our only option. Today, we are able to transfer people from having no teeth, or a set of failing teeth, to a fixed set on implants, oftentimes on the same day!

Why replace teeth?

One option is to have two implants placed in your lower jaw and a denture made that snaps onto these implants. This option allows your lower denture to be more stable while chewing than without implants. However, there will still be movement of your lower denture, and sore spots will occur if any food particles, especially seeds, are caught under it. As with all removable replacement teeth, you still will need periodic appointments for denture adjustment.

Treatment Alternatives

Removable Options (You remove your teeth at night-time)

• Complete denture
• Overdenture

Fixed Options (Your teeth stay in at night, every night)

• Fixed bridge 
• Hybrid, All-on-4

All-on-4 is a revolutionary approach to replace a full arch of teeth with only 4 implants. It is a concept that combines surgical, prosthetic and laboratory services to deliver fixed teeth to patients immediately as teeth are removed. Patients are therefore able to save time and money with increased comfort. This procedure was developed in the 1990’s as a collaboration between Nobel Biocare and a Portuguese dentist named Paulo Malo.

Hallmarks of this procedure include:

• Immediate placement of implants
• Immediate Loading (placement) of fixed bridge
• Tilted posterior (back) implants to avoid vital structures such as nerves and sinuses
• A CAD-CAM designed and milled titanium bar with resin teeth

Advantages

• High success rates- 98%
• May eliminate the need for bone grafting (making the procedure more comfortable, faster, and less expensive)
• Procedure is well-tolerated
• Splinting or connecting implants allows for treatment of patients with diabetes, osteoporosis or other health conditions which are often contraindications for bone grafting
• Teeth-in-a-day procedure! ONE surgery!
• Natural-looking, fixed teeth that look and function like your own teeth
• Easy to maintain and clean bridges
• Cost-savings– typically about half the cost of alternative techniques (saving on bone grafting and additional implants)

After tooth extraction, if the walls of the socket are very thick, they will usually fill naturally with bone in two to three months. However, when the walls of your socket are very thin (such as in your upper and lower front teeth), this type of healing will not be as predictable. In these situations, a bone graft is often placed at the time of tooth extraction to help your body fill in the empty socket with bone. This step will maintain the width and volume of bone you will need for implant placement several months later.

There may be inadequate bone for implant placement if your tooth was removed many years ago and your bony ridge is extremely thin. In this case, a bone graft can be placed next to the thin bone and allowed to heal for up to six months. After the graft has fused to your pre-existing bone, the ridge will be re-entered and the implant placed. Bone grafting is usually a relatively comfortable office procedure. Many different bone-grafting materials are available, including your own bone.

You may also need bone grafting if the sinus cavities in your upper jaw are very large, or very low, and extend into the tooth-bearing areas. This often occurs when teeth in the back of a person’s upper jaw have been removed many years before, and the amount of bone available for implant placement is limited. A “sinus grafting procedure” is then required. Most often, it is performed in the office with local anesthesia and perhaps sedation. During this procedure, the membrane that lines the sinus will be located and elevated. Bone will then be added to restore the bone height and ensure that dental implants of an adequate length can be placed. This procedure often can be performed at the time of implant placement.