Dental Implant


What are dental implants and why are they used?
Dental implants are artificial tooth root that are surgically placed into the jaw to hold a replacement tooth or bridge. 


When are dental implants necessary?

  • Dental implants are done when the following occur
  • loose or poor fitting dentures due to flat ridges
  • multiple missing teeth needing support for crowns and bridges
  • missing teeth


Who are the best candidates for a dental implant?

  • The candidate must be in good general and oral health
  • Candidates missing one or all of his teeth
  • Candidates who have enough bone in the area of the missing tooth to facilitate the anchorage of the implants. In the absence of adequate bone, a bone graft would be necessary.
  • Candidates having healthy gum tissues that are free of periodontal disease


What are the risks and complications of a dental implant?

  • Bleeding 
  • Infection 
  • Numbness 
  • Muscle injury 
  • Sinus cavity injury 
  • Incomplete healing of the bone around the implant, leading to implant failure 
  • Nerve damage 


What are the different types of dental implants?

  • ENDOSTEAL IMPLANTS – implants placed in the jaw bone. They can be further classified as

         Root form implants – where there is sufficient bone width or the area is suitable for bone grafting

         Plate form implants – where the jaw bone is narrow and the area is not suitable for bone grafting

  • SUBPERIOSTEAL IMPLANTS – implants placed on the jawbone, where the jaw bone lacks sufficient depth or width to receive endosteal implants


What are the diagnostic tests performed?

  • X-rays
  • Panographic x-rays
    Provides a view of the entire mouth, location of sinuses, nerves and indicates any bone problems
  • Cephalometric x-rays
    Provides side images of the height of the jaw and checks if the jaws come together properly.  
  • Computerized tomography x-rays (CT scan)
    Provides cross- sectional and other views that measure the precise jaw height, width and bone density
  • Blood tests


What are the pre-treatment procedures (same for stage 1 and stage 2 of endosteal implant surgery)?

  • During the initial consultation, a thorough discussion on the expectations of the patient is understood
  • The dental history, complete medical history and x rays are taken
  • A thorough oral examination and medical consultation is done by the dental team consisting
  • A thorough dental examination is performed where the structure and health of the mouth, gums, teeth, jaws, head and neck will be examined and models will be made of the bite, upper and lower jaws.
  • The examination may include several types of x-rays to provide essential information about the jaw bone and its anatomy, models of the jaws, and certain blood tests
  • Photographs are taken for further comparison after procedure.
  • The dentist discusses and advises on options of treatment, type of facilities, risks, anaesthesia, limitations and cost with the patient.
  • The patient may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.
  • The patient must inform the dentist if he/she has high blood pressure or knows that they have problems with epinephrine in local anaesthetics
  • The patient must not eat or drink for at least 6 hours prior to the surgery.
  • The patient must arrange for transportation and assistance to leave for home after the surgery.


How is a dental implant done?

1)  ENDOSTEAL IMPLANTS

Stage 1

  • Local anaesthesia with a mild sedative or general anaesthesia is administered
  • Incisions are made on the gum to expose the area of the jawbone and holes are placed in the bone to receive the implants
  • The implant used is either ROOT FORM IMPLANTS or PLATE FORM IMPLANTS
  • The implant is placed in the hole and the gums are sutured.
  • The procedure may take two to three hours
Stage 2
The second stage surgery takes place after 4-6 months when the patient has healed from the first surgery.
  • Local anaesthesia with a mild sedative is administered
  • Incisions are made to expose the implant fixtures
  • If sufficient bone has grown in and around the implant creating a strong structural support, abutments are attached to the implant fixtures
  • The procedure takes less than one hour
Stage 3
The third stage takes place after the patient has healed from the second surgery
  • The dentist will make impressions of the mouth, and bite registrations to make artificial teeth which are attached to the abutments.  They maybe removable, fixed or a combination of both.

2) SUBPERIOSTEAL IMPLANTS      

Method 1 (Dual surgery method)              

Stage 1

  • Local anaesthesia with a mild sedative or general anaesthesia is administered
  • Incisions are made to expose the jaw bone 
  • Impressions of the jawbone are taken and the incisions are closed.
  • A custom made implant is created in the dental lab which can sit on the top of the bone but below the gums.

Stage 2

  • Local anaesthesia with a mild sedative or general anaesthesia is administered
  • Incisions are made to expose the jaw bone 
  • The custom made implant is place on the jaw and the incisions are sutured
  • Replacement teeth are installed in place

Method 2 (single surgery method)

  • A special CAT scan of the  jawbone is taken to create  a model of the jawbone 
  • The model is used by a dental laboratory to fabricate the custom subperiosteal implant to fit the jaw.
  • Local anaesthesia with a mild sedative or general anaesthesia is administered
  • Incisions are made to expose the jaw bone 
  • The custom made implant is place on the jaw and the incisions are sutured
  • Replacement teeth are installed in place


What are the postoperative symptoms, procedures and guidelines following endosteal implants?

Stage 1

  • The patient may be asked to bite on some gauze to stop any bleeding, and an ice pack may be used during the first 24 hours to help reduce swelling.
  • The patient may have some minor bleeding on the day of surgery.
  • The patient may have some swelling in the area of the implant surgery for up to 72 hours following the procedure and some discoloration of the skin and gums for a few days.
  • Pain medication is prescribed by the surgeon to alleviate any discomfort
  • The patient will be able to resume normal activities within a day or two. Any excessive bleeding must be reported to the surgeon immediately.
  • A soft diet is recommended that doesn't place undue stress on the new implants
  • The patient will be given important instructions on oral hygiene, prescriptions for pain medication and antibiotics and follow-up appointments to check on the healing process.   
  • For patients wearing a denture, the surgeon or restorative dentist may place a soft lining in it so it can be worn comfortably during the healing period
  • It may be necessary to stop the use of dentures in certain cases for a short period of time
  • Temporary teeth that appear natural may be made to fill the spaces due to missing teeth 
  • If non dissolving sutures were placed the patient will have to return to the surgeon to have them removed.

     - The patient can help the implants take hold by 
     - avoiding unnecessary pressure on the jawbone 
     - keeping the gums and remaining teeth clean and eating soft foods.     

Stage 2

  • If non dissolving sutures were placed the patient will have to return to the surgeon to have them removed.
  • The patient can expect to return to normal activities within one or two days.
  • Abutments must be cleaned with a very soft toothbrush


What are the postoperative symptoms, procedures and guidelines following subperiosteal implants?

  • The patient may be asked to bite on some gauze to stop any bleeding, and an ice pack may be used during the first 24 hours to help reduce swelling.
  • The patient may have some minor bleeding on the day of surgery.
  • The patient may have some swelling in the area of the implant surgery for up to 72 hours following the procedure and some discoloration of the skin and gums for a few days.
  • Pain medication is prescribed by the surgeon to alleviate any discomfort
  • The patient will be able to resume normal activities within a day or two. Any excessive bleeding must be reported to the surgeon immediately.
  • A soft diet is recommended that doesn't place undue stress on the new implants
  • The patient will be given important instructions on oral hygiene, prescriptions for pain medication and antibiotics and follow-up appointments to check on the healing process.   
  • For patients wearing a denture, the surgeon or restorative dentist may place a soft lining in it so it can be worn comfortably during the healing period
  • It may be necessary to stop the use of dentures in certain cases for a short period of time
  • Temporary teeth that appear natural may be made to fill the spaces due to missing teeth 
  • If non dissolving sutures were placed the patient will have to return to the surgeon to have them removed.
  • The patient can help the implants take hold by
      - avoiding unnecessary pressure on the jawbone 
      - keeping the gums and remaining teeth clean and eating soft foods. 


What are the recuperative guidelines?  

  • The patient must practice meticulous home oral hygiene, following the instructions of the dentist and hygienist.
  • Abutment posts, beneath the prosthesis, artificial teeth, and gum tissue must be kept clean.
  • Home care aids such as special brushes and floss holders must be used.
  • Smoking and excessive alcohol consumption as well as chewing hard foods such as ice or hard candy must be restricted as they may result in damage to the implants or cause them to fail.
  • The patient must brush after every meal.   
  • The patient must use special cleaning aids such as

     - A small tooth brush or special interdental brush to clean the abutments.    
     - A brush with a bent handle to reach behind the teeth to clean the abutments   
     - Use gauze or special floss with a foam coating to clean around gums, abutments and prosthetic teeth

  • Routine checkups - the patient must have the prosthesis checked at least twice a year to check how well it fits in the mouth, make any repairs, clean the abutments and to check the stability of the anchors and the health of the gums and jaw.




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