A dental implant is a titanium or zirconia anchor that is surgical placed into your jawbone surgically placed to fill the gap left by the missing tooth. An implant is analogous to the tooth’s root. After a few months of healing, the implant can have a special dental crown screwed to the top to make it functional in your smile and bite. Dental implants have many benefits, including improving your appearance and self-esteem, chewing and eating without worry, improving speech, and can be cared for similarly to a natural tooth.

Diagnostic procedures are needed prior to dental implant placement. Your surgical consultation will involve a CBCT, a 3D radiograph of the areas where implants are proposed to assess anatomy, space, and bone volume. Learn more about our CBCT imagine here. The outcome of the surgical consultation and review of the CBCT may indicate that in order to place and/or maintain a healthy implant, additional bone or gum grafting may be needed prior to, during, or after the implant placement surgery, or may not be possible.

These procedures may graft bone or tissue into your sinus or jawbone to increase bone or gums in the vertical and horizontal direction. Healing time for these additional procedures may range from 3-8 months. These procedures will require bone graft, biologics, membrane materials, or may be taken from other areas of your mouth. These procedures will add additional healing time to your implant.

Your implant procedure will take place over several appointments with your surgeon and general dentist. After any surgeries that are necessary to prepare the proposed implant site take place (i.e., bone grafting, gum grafting), the implant can be placed. Usually, the gum tissue is pushed out of the way to expose the bone to allow the surgeon to place the implant. A hole is drilled into the bone with a lot of water spray to cool the bone and the implant is placed. You may have sutures placed afterwards.

When the implant is placed, the surgeon opts for one of two options: 1.) they can leave the implant exposed with a “healing abutment” cap over the implant that you can visualize in your mouth or 2.) bury the implant with your gum tissue. If the implant is 2.) buried under gum tissue, a second surgical procedure, an uncovery, will be necessary, after the implant has osseointegrated. At least three months after the initial surgery, the uncovery will expose the implant and a healing abutment will be placed. Sometimes, more bone grafting and/or more gum grafting may be needed at the time of implant placement or after, during the uncovery surgery.

The time needed for implants to heal is, at the very best, three months. If the quality of the bone is poor, or there is extensive bone or gum grafting performed prior to, during, or even after the implant placement surgery. the time required for implant healing and osseointegration can take even longer than 3 months, ranging from 4 months to 8 months.

Your referring general dentist is responsible for overseeing your care outside of the implant surgery, including routine cleanings, restorative work (fillings and crowns), and placement of your final implant prosthetic. As with any other dental procedure, you are responsible for the maintenance of your implant and its associated prosthetic. Regular cleanings and fabrication of an occlusal guard (night guard) are necessary for the long-term success of your implant and its associated prosthetic.

referring general dentist will place the final implant prosthetic. For a single implant crown or implant bridge, at least two components are placed on top of the implant to make a functional prosthetic. These components are called the “abutment” (different from the surgeon’s healing abutment) and the “crown.” Your general dentist will take an impression, like a traditional crown impression, to locate the implant relative to the adjacent teeth, and send it to the lab. Finally, you will receive an implant prosthetic, which includes the abutment and the crown. They may be screwed or cemented onto the implant that is healed in your jawbone.

Dental implants, bone grafts, and gum grafts can fail. While success rates are high, between 94-97% when placed by periodontal specialists, it is always important to acknowledge the chance of failure. Sometimes, after implants are placed, bone loss around the implant can occur. The quality of the bone around an implant is affected by risk factors for failure include but are not limited to smoking, periodontal disease, uncontrolled systemic disease including but not limited to diabetes, poor oral hygiene, poor follow-up care, and parafunctional grinding or clenching habits. In certain instances, the risk for implant failure may be high enough for the surgeon to recommend against the use of implants as part of your treatment plan. There is no guarantee or warranty for the success of the implant and/or the implant-supported restoration.

Implants, like teeth, if not properly cared for or maintained, can become diseased. Like with gingivitis around teeth, the first sign of implant disease is inflammation of the soft tissue. If we catch implant disease in this early stage, it can be treated with deep cleaning and prescription medications applied locally or taken systemically.

However, when implant disease progresses beyond that of soft tissue inflammation and bony breakdown around the implant is appreciated, additional interventions, including potentially surgery, should be considered. Implant debridement surgery is similar to that of tooth and root debridement surgery; however, its long-term success and predictability is not as good as that of teeth.

The best treatment for implant disease is prevention. It is important to take care of and maintain your implant with routine professional cleanings and excellent home oral hygiene.

To learn more about cleaning around your dental implant, click this link.

Treating peri-implant disease is different from treating periodontal disease around teeth. The soft tissue connection between implants and teeth is very different. Connective tissue fibers around an implant are oriented in a more parallel direction, making implants more susceptible to bacterial insult. The connective tissue fibers around a tooth are oriented in oblique and perpendicular directions, making the seal around a tooth better than that of an implant.

Further, implants are microtextured and microrough to encourage osseointegration to the bone, but these qualities also make implants very difficult to clean and debride of plaque and bacteria.

The best way to treat peri-implant disease, peri-implantitis, is to avoid it altogether! It is critical for you to maintain your implant with routine professional cleanings and excellent home oral hygiene.

To learn more about cleaning around your dental implant, click here.

Treating peri-implant disease is complex and multifactorial and often requires surgery, which may include deep cleaning with a laser, bone grafting, and membrane placement. Even with surgery, treating peri-implant disease is not as predictable as treating periodontal disease around teeth.