Dental implants. Basic surgical procedure
Author: George Ghidrai, MD
The surgical placement of dental implants is a painless procedure that can last a variable time (from 10 min to 2 hours) depending on how many implants are inserted.
The dental implant procedure is normally performed by the oral surgeon or another specialized physician under local anesthesia. However, in some cases, general anesthesia can also be used.
Surgery technique
Most implant systems have five basic steps for the placement of each implant.
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Soft tissue reflection
This step aims to expose the bone in the area where the implant is placed. An incision is made over the crest of the bone, splitting the soft tissue.
incision
The edges of tissue, each referred to as a flap, are pushed back to expose the bone.
Flapless surgery is an alternate technique where a small punch of tissue (the diameter of the implant) is removed for implant placement rather than raising flaps.
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Drilling
For this operation, the oral surgeon makes use of specific titanium drills. A cooling saline or water spray keeps the temperature low to prevent bone damage caused by overheating.
titanium drills
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The surgeon may use a guidance stent to guide the optimal positioning of the implants.
guidance stent
Pilot holes are placed with precision drills at highly regulated speeds to prevent burning or pressure necrosis of the bone.
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The pilot holes are expanded using progressively wider drills. Three to seven successive drilling steps may be needed depending on implant width and length.
The last drill used matches implant dimensions (width and length)
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Placement of the implants
The implant is screwed into place at a precise torque so as not to overload the surrounding bone (which may cause osteonecrosis and implant failure). A specific screw-key is utilized for the operation.
placement of the implant phase 1
placement of the implant phase 2
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Soft tissue adaptation
After the implant placement, a specific healing device is screwed into the implant. There are two possible alternatives:
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Healing abutment
The healing abutment passes through the mucosa, and the surrounding soft tissues are adapted around it.
healing abutment
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Cover screw
The cover screw is flush with the surface of the dental implant and is designed to be entirely covered by mucosa. A second procedure would then be required to uncover the implant at a later date (two-stage procedure).
The choice of one or two-stage procedure centers on how best to reconstruct the soft tissues around lost teeth.
The gingiva is adapted around the entire implant to provide a thick band of healthy tissue around the healing abutment.
When a cover screw is used, the implant is "buried" and the tissue is closed to cover it completely.
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Temporary restoration
When the procedure is completed, the practitioner will construct a temporary restoration that will replace the missing teeth during the biological process of osseointegration (which usually takes 3 to 6 months).
commonly, a temporary partial denture will replace the missing teeth
After the operation
After the surgical procedure, the oral surgeon may prescribe pain relievers, anti-inflammatory medication, and antibiotics.
It is advisable to protect the areas where the procedure was performed in the early days after surgery. Proper and thorough oral hygiene is essential.
Most often, there are no significant side effects. Bruising and swelling of the gums and face, pain, and minor bleeding are not uncommon - and do not necessarily indicate that something has gone wrong. However, it is wise to keep the surgeon apprised of those symptoms.
Sutures are usually removed after 7-10 days. During this appointment, the doctor will also assess the healing process.
Placement of dental implants is a surgical procedure and carries the normal risks of surgery. We will discuss these risks later.
The timing of dental implant surgery
When we plan to replace one or several teeth with dental implants, there are different approaches to the placement of dental implants after tooth extraction:
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Immediate post-extraction implant placement
An increasingly common strategy to preserve bone and reduce treatment time includes the placement of a dental implant into a recent extraction site.
On the one hand, it shortens treatment time and can improve aesthetics because the soft tissue envelope is preserved.
On the other hand, implants may have a slightly higher initial failure rate. More on the subject when we discuss the Same-day dental implants.
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Delayed immediate post-extraction implant placement
The implant is placed two weeks to three months after the tooth extraction. The procedure requires bone grafting to create a bony base for the implant.
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Late implantation
The surgery is performed three months or more after tooth extraction. It is the most prudent approach; during this time, the body will grow new bone inside the alveolar socket, where the tooth was formerly held.