A dental implant is an artificial tooth root replacement, and is used in prosthetic dentistry to support restorations that resemble a tooth or group of teeth.

Our dentists are experts at all stages of the dental implant procedure. You can learn more about the procedure on these pages, or contact us now for more information.

There are several types of dental implants. The major classifications are divided into osseointegrated implant and the fibrointegrated implant. Earlier implants, such as the subperiosteal implant and the blade implant were usually fibrointegrated. The most widely accepted and successful implant today is the osseointegrated implant, based on the discovery by Swedish Professor Per-Ingvar Brånemark that titanium can be successfully fused into bone when osteoblasts grow on and into the rough surface of the implanted titanium. This forms a structural and functional connection between the living bone and the implant. A variation on the implant procedure is the implant-supported bridge, or implant-supported denture.

A typical implant consists of a titanium screw (resembling a tooth root) with a roughened or smooth surface. The very first implants were made out of commercially pure titanium, however since it was discovered that the TiAl6V4 alloy offered the same osseointegration level as commercially pure titanium, more and more implants were made out of TiAl6V4 alloy due to its better tensile strength and thus fracture resistance. Today most implants are made out of the TiAl6V4 alloy and treated either by plasma spraying, etching or sandblasting to increase the surface area and, thus the integration potential of the implant. An osteotomy or precision hole is carefully drilled into jawbone and the implant is installed in the osteotomy.

Implant surgery is typically performed as an outpatient under general anesthesia or with local anesthesia. The most common treatment plan calls for several surgeries over a period of months, especially if bone augmentation (bone grafting) is needed to support implant placements. At the other end of the surgery scale, some patients can be implanted and restored in a single surgery, in a procedure labeled "immediate function" and "teeth in an hour."

A single implant procedure that involves an incision and "flapping" of the gum or gingiva (to expose the jawbone) takes about an hour, sometimes longer; multiple implants can be installed in a single surgical session lasting several hours. At the conclusion, the patient goes through a period of recovery, returns to consciousness and is sent home with a relative or friend.

Healing and integration of the implant(s) with the jawbone occurs over several months in a process called osseointegration. At the appropriate time, our highly trained dentist uses the implant(s) to anchor crowns or a prosthetic restoration containing several "teeth". Since the implants supporting the restoration are integrated, which means they are biomechanically stable and strong, the patient is immediately able to masticate (chew) normally.

In an immediate function procedure, the gingiva is not flapped (Flapless). Instead, your dentist removes a small plug of gingiva directly over the drilling site. The site is drilled and the implant is installed. Then a crown is immediately added. Patients are cautioned to give their new "teeth in an hour" ample healing/integration time (weeks or months) before attempting normal mastication.

There are different approaches to placing dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction implant placement
2. Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction)
3. Late implantation (3 months after tooth extraction)

According to the timing of loading of dental implants, the procedure of loading could be classified into:

1. Immediate loading procedure
2. Early loading (1 week to 12 weeks)
3. Staged loading (3-6 months)
4. Late loading (more than 6 months)

Most patients need the longer treatment plan, which has an excellent history going back many years. Before surgery, with the patient fully awake or during an earlier office visit, we will conduct a neurosensory examination to rule out altered sensation, thus setting a base line on nerve function. Also prior to surgery, a panoramic X-ray will be taken using a metal ball of known dimension so that calibrated measurements can be made from the image (to accurately locate "vital structures" such as nerves and the position of critical anatomical features such as the mental foramen, which is the transit point in the jawbone for the nerve which innervates the lip and chin).

At edentulous (without teeth) jaw sites, a pilot hole is bored into the recipient bone, taking care to avoid vital structures (in particular the inferior alveolar nerve or IAN within the mandible). A zone of safety, usually 2 mm, is the standard of care for avoiding vital structures like the IAN. When computed tomography (3D X-ray imaging) is used preoperatively to accurately pinpoint vital structures, the zone of safety may be reduced to 1 mm through the use of computer-aided design of surgical guides.

Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblast or bone cells by overheating. A cooling saline spray keeps the temperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit). The implant screw can be self-tapping, and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone). Typically in most implant systems, the osteotomy or drilled hole is about 1mm deeper than the implant being placed, due to the shape of the drill tip. Surgeons must take the added length into consideration when drilling in the vicinity of vital structures.

Once properly torqued into the bone, a cover screw is placed on the implant, then the gingiva or gum is sutured over the site and allowed to heal for several months for osseointegration to occur between the titanium surface of the implant and jawbone.

After several months the implant is uncovered in another surgical procedure, usually under local anesthetic, and a healing abutment and temporary crown is placed onto the implant. This encourages the gum to grow in the right scalloped shape to approximate a natural tooth's gums and allows assessment of the final aesthetics of the restored tooth. Once this has occurred a permanent crown will be fabricated and placed on the implant.

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants.

In all of these approaches, computer-based guidance has thrust itself onto the treatment stage. Not only will 3D digital imagery yield critical treatment guidance, the digital data can be used to manufacture precision drilling guides, virtually eliminating surgical errors.