Basic remedial treatment – before
Before you can proceed with implants, all remaining teeth, the gums and the jawbones have to be restored to a healthy state. There is no point in inserting an expensive dental implant next to an old and defective amalgam filling or if the gums are inflamed and thus endanger the healing process. This means that the costs of the preceding remedial treatment have to be added to the costs of the implant and its superstructure in form of a crown or a bridge.
In some people, the bone is simply too narrow and/or shallow to provide a stable foundation for an implant. The problems or insufficiencies in the underlying bone structure do not automatically eliminate you as a candidate for dental implants. With modern bone grafting (bone augmentation) techniques, you can still benefit from the superior qualities of dental implants over dentures or removable bridges.
A bone graft is a way of building up your existing bone so that it can provide a suitable base for implants. The bone in your jaw can be stimulated to grow either through natural or synthetic means. Your dentist will be able to help you determine the best method of bone grafting for your specific case. One or more of the following might be appropriate:
- Collecting bone from your own mouth as the implant site is prepared and reusing that bone for grafting purposes. This is the simplest method of bone grafting and can be done from the dental chair.
- Synthetic materials are sometimes used to stimulate bone growth, or your own blood factors can be used to help promote growth or accelerate the process.
- In cases where the top jaw above the back teeth has insufficient bone to hold implants, the sinuses are lifted and bone is inserted into the sinus chambers to grow enough structure to secure dental implants.
- Occasionally, it may be determined that the best course of treatment is to take bone from another part of the body (the hip is common) and use it to build the necessary bone in the mouth for dental implants. In this case, the dentist will work alongside a surgeon in a hospital setting. This option may be the lengthiest in terms of surgical time, but the success rates are high.
- Sinus lifting is another surgical procedure for bone augmentation in the upper jaw. The dental surgeon thickens the inadequate part of atrophic upper jaw towards the sinus with the help of bone transplantation or synthetic bone, which lifts the bottom of the sinus and uses the sinus cavity to augment the bone. This allows dental implants to be placed in the bone of the upper jaw.
The goal in each of these cases is to help the patient grow new and healthy bone tissue that will support the dental implant procedure. Depending on the type and extent of bone grafting, the healing period can be three to four months. In some cases where the scope is less, bone grafting and setting of the implant can be done in one session.
Insertion of implants
This stage involves boring one or more holes into the recipient bone and inserting or screwing in the implant(s). The surgeon stitches the gums over the implants. The procedure is done under local anaesthesia – or rarely general anaesthesia or sedation. Light pain, swelling and/or haematoma can be expected immediately after the surgery. As with all other surgeries, the recovery depends on a number of individual factors, such as the general health of the patient, complexity and extent of surgery. Dental surgeons say that removal of a wisdom tooth is more unpleasant. Some patients are incapacitated for a week and others, especially after immediate placement, as it is called, go to work the next day without any noteworthy problems. On average, patients qualify the pain as a 3 on a scale of 1 to 10.
Whether all the above treatment steps are carried out in a sequence with longer intervals in between them or in one single surgery depends on the case in question. The implant, mostly made of titanium alloy, grows together with the bone in a process called bone integration (osseointegration). The time required for an implant to become bone integrated is two to three months for the lower and five to six months for the upper jawbone. After this period the implants are loaded with the planed restoration and the treatment completed.