Dental implant procedure
After discussing the potential courses of treatment open to you, your dentist or periodontist will conduct a thorough examination of your mouth. He/she will then take radiographs of your jaws to assess the shape and condition of your bone tissue and locate the positions of any important structures, such as nerves and sinuses, which may be close to the intended implant site. This allows the dentist to plan exactly how the implants will be placed. Rarely, if X-rays are not adequate, a computed tomography (CT) scan may be used to provide three-dimensional images, but this is an expensive procedure and exposes you to more radiation than standard radiographs.
Implant surgery can be carried out using either a one-stage or two-stage procedure, depending on your particular clinical circumstances. In either case, the surgery involves making a small incision in the gum to expose the bone and using a special drill to shape the implant site.
In the one-stage procedure, the implant is fitted into the prepared bone and then an attachment called a healing cap, which protrudes through the gum, is placed over it. This healing cap is removed after a 3-6 month period and replaced with a permanent attachment called the abutment, which takes the form of a post and core. The replacement tooth, or crown, is cemented in place over the abutment.
In the two-stage procedure, a cover screw is placed flush over the top of the implant and the gum is sewn up over it for the period of healing. A second procedure is needed to uncover the implant via a small incision in the gum and attach the healing cap. Then, after the gums have healed, the healing cap is removed and replaced by the abutment, in readiness for the new crown.
Two-stage surgery may be necessary if there is a need to increase the quantity of bone at the site with a bone graft or a bone regenerative technique. There are a number of reasons why there might be a lack of bone at the implant site, including long-term missing teeth, denture wear, and bone loss from periodontal disease, ageing or injury. When teeth are missing, the surrounding gum and underlying bone shrink away over time. This is because, in health, the presence of our teeth stimulates the natural turnover, or renewal process, within the bone.
Preparation of teeth and impression When your gums have fully healed (after about 6 weeks), your dentist will take a new impression of your mouth. This will be used to make a model of your teeth on which the dental technician will construct your crown or bridge, paying special attention to achieve a natural finish that matches the rest of your teeth.
When your new crowns and bridges have been prepared, your dentist will cement them on to the abutments over the dental implants, assess the appearance and fit, and check that your upper and lower teeth work together comfortably when you bite. You will usually need to return for several review appointments to make sure that the implants are stable and functioning well, and that you are completely happy with the finished result.
Bone grafts are carried out to increase the width and height of the jawbone at the implant site. The best results are seen when bone from another part of your own body is used and this is known as autogenous grafting. Typically, bone is harvested from the hip, as it is a good source of marrow which contains many bone cells. Allografts are grafts that use donated human bone taken from a ‘bone bank’ and work in the same way as autogenous grafts. Xenografts are procedures that use bone from an animal donor, with cows acting as the main source (bovine bone). The bovine bone in the graft is replaced by your own bone tissue over time. Alloplasts are grafts that use synthetic bone substitutes that are chemically similar to human bone. These grafts act as a sort of framework for new natural bone formation and may be replaced by natural bone (resorbable alloplast) or retained (non-resorbable alloplast).
An autogenous graft is the preferred option because there is no risk of your body rejecting it. After the procedure, you will need to wait for at least 3 months before having implants placed, so that healing can take place. The exact waiting time will depend how much bone has been grafted.
This is a special technique that helps to give bone cells an advantage over other types of cell to multiply and fill an area where bone loss has occurred. Usually, cells from the gum surface and the connective tissues are much faster at filling the gaps created by periodontal destruction compared with the bone cells and so bone may not have an opportunity to regenerate even when inflammation has been eliminated. In this procedure, the barrier membrane covers the area of bone loss and blocks access to it for the other cell types, giving the bone cells a chance to fill in the defect. The barrier may disintegrate and disappear over time (resorbable) or may need to be removed in a later procedure (non-resorbable).
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