Prepare for a Visit

Tooth loss is a serious condition that should be addressed as soon as possible. It can have profound effects on your ability to chew, your ability to speak clearly, and your appearance. It can also contribute to changes in your nutrition, obesity, diabetes, and heart disease. It is even associated with some forms of cancer.¹

Dental implants are one of the more significant advancements in oral healthcare. They are often viable options for replacing natural teeth. Dental implants are artificial tooth roots placed into your jawbone. They bond with your natural jawbone over time, becoming a strong anchor point to support one or more replacement teeth. They are most often made of titanium which is extremely strong. Metal-ceramic implants are now used in some situations. Titanium has a property that allows the bone to adhere directly to it in a process known as osseointegration.

Implants are available in many shapes, sizes, and textures. Your dentist will select the appropriate type of implant for your needs. The most common type of implant is the "root-form" (endosteal) implant. Root-form implants are generally cylindrical, and many have screw-like threads.

You may be a good candidate for a dental implant if:

• Your jawbone has fully grown. For most people, the shape and size of their jawbone is finished developing between the ages of 16 and 18, although it may occur as late as age 25 in males.
• You have healthy oral tissue without active periodontal disease.
• There is adequate quality and quantity of bone to support an implant, or if a bone graft can be used to create sufficient bone support.
• You have good overall health with no conditions that may interfere with bone healing.
• You do not have poorly-controlled diabetes, which increases the risk of infection and poor healing.

Some advantages of dental implants include:

• Ensuring the tooth-supporting bone can continue to bear the force of chewing. Implants help to preserve the amount of the underlying tooth-supporting bone.
• Avoiding the removal of healthy tooth structure from adjacent teeth which occurs when choosing to insert a bridge.
• Maintaining the shape and integrity of the dental arch, which supports your lips and cheeks.
• Helping to restore normal chewing function.
• Preventing adjacent teeth from drifting, which helps maintain your normal bite.
• Providing excellent cosmetic results.
• Lasting for many years with proper maintenance and good oral hygiene.

Once you have made a decision to get an implant, you and your dentist will develop a treatment plan to achieve your long-term goals. There are many ways a dental implant can be used in conjunction with other dental restorations to replace one or more teeth.

• Implant and crown: Dental implants enable your dentist to replace a missing tooth with a crown without reducing any natural tooth structure from the teeth on either side of the crown. Implant and crown
• Implant-stabilized removable denture: Poorly adjusted or loose-fitting complete dentures can cause denture sores. To address this problem and provide a better denture fit, your dentist can place as few as two dental implants.
• Implant-stabilized removable denture

• Implant, crown, and cantilevered replacement tooth
• Implant-supported bridges
• Implant-stabilized removable denture
• Implant-supported fixed dentures
• Temporary mini implants for dentures

Not all dentists place dental implants. Your dentist may refer you to an oral surgeon or periodontist.

The traditional method to place a root-form dental implant is a multi-step process that may take several months. The steps below describe the process to replace a single tooth with an implant. You should expect at least two office visits to complete the treatment necessary to make your implant fully functional after it has healed into the bone. You will have additional appointments If other treatments are required or if you are having multiple implants. The general steps include:

• Tooth removal of the damaged tooth (unless the tooth is already missing). If your dentist needs to remove the tooth, an impression will be taken in order to make the crown look similar to your original tooth.
• A bone graft, if needed.
• Placement of the dental implant.
• A healing phase to allow your jawbone to bond with the implant (osseointegration).
• Final restoration of the replacement tooth.

In some cases, your dentist may be able to provide an immediate dental implant or delayed-immediate dental implant. These techniques can reduce the time needed for an implant to become functional and may eliminate or combine some of the previous steps. There are some risks and concerns related to these procedures. Be sure to discuss these with your dentist.

Before recommending these options, your dentist will consider several factors such as the:

• Location of the implant.
• Density of the bone.
• Expected bite force on the implant.
• Anticipated healing time.

Before the procedure

• Antibiotics: Some dentists will prescribe antibiotics to prevent infection. These are generally taken for a couple of days before and after the procedure.
• Review your health status: You will share information that will help ensure that your dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Treatment review: Your dentist will review the procedure with you, including its risks, benefits, and options. Understanding the process will lead to the best treatment outcome. Ask any questions you have before the procedure is started.
• Oral exam: Your dentist will give you a comprehensive dental exam.
• X-ray images: Your dentist may take X-ray images or use other imaging methods like a Cone Beam CT scan to help plan for placing the implant.
• Treatment plan: Your dentist will create a treatment plan based on how many implants you will need. They will also consider the condition of your remaining teeth and the state of your jawbone in the implant area. The implant procedure may include several underlying procedures. To avoid surprises, be sure that the treatment plan includes all of the estimated costs before you commit to the procedure.
• Anti-anxiety medication: If you are anxious about dental procedures, your dentist may recommend sedation.

During the procedure

• Antiseptic: You will rinse your mouth thoroughly with an antiseptic rinse and wash your face with an antibacterial scrub.
• Anesthetic: Your dentist will numb the surgical area with a local anesthetic. This also helps reduce the normally minimal amount of bleeding that will occur during the procedure.
• Gum and jaw preparation: Your dentist will make an incision in your gums to expose the underlying jawbone. A hole is then drilled in the bone and gradually enlarged until it is the proper size. A threaded hole may be created in the bone for some types of implants.
• Placing the implant:
  • Your dentist will place the implant in the prepared jawbone hole (osteotomy). After the implant has been placed, additional X-ray images may be taken so your dentist can see the implant's depth and angle.
  • Your dentist will insert a thin cover screw into the implant and then close the gums with sutures. The cover screw will keep the gums from growing into the center of the implant during the healing phase.
  • Your dentist may take another impression to assist in preparing the final crown or other appliance.

After the procedure

• Pain management:
  • Implant placement, like any surgical procedure, has general post-treatment risks such as swelling, bruising, bleeding, and infection. Your dentist will typically recommend or prescribe pain relievers following the procedure to help reduce discomfort and swelling. The specific medication(s) will depend on your age and health history. Some prescribed medications are opioids, which require special consideration and dialog with your dentist before taking them.
  • Check with your physician or dentist before taking any unprescribed medications or using alternative treatments for your symptoms.
• Infections: Infections generally don't occur in the first few days after dental implant surgery. If you begin to experience pain, swelling, fever, or tooth sensitivity to hot or cold, call your dentist as these symptoms may indicate the beginning of an infection. Your dentist will evaluate your condition and respond appropriately. If your dentist feels an infection is present, an antibiotic may be prescribed.
• Follow-up care:
  • Your dentist will give you instructions for post-treatment home care following the procedure. Any unique medical or dental situations you have will be taken into account. It is essential to follow the instructions to increase your chances of a successful outcome.
  • You should request a copy of the instructions. Although they may seem straightforward at the time, you may need to refer to them later at home.
• Healing and bone regrowth: The healing and bone regrowth phase takes approximately three to six months, depending on your bone density and other factors. If a bone graft procedure was conducted as part of your implant, the healing time might be even longer so that new, mature bone can form.

Final restoration

After proper healing, the implant is ready to be finalized. The implant requires an attached prosthetic device to be fully functional. If a cover screw was inserted, your dentist will uncover the implant and then install the final appliance.

• Implant and crown
• Implant, crown, and cantilevered replacement tooth
• Implant-supported bridges
• Implant-stabilized removable dentures
• Implant-supported fixed dentures
• Temporary mini implants for dentures

Additional treatments you may need

There are other procedures you may require if you elect to have dental implants. These procedures are separate from the dental implant itself.

• Tooth removal.
• Bone grafts.
• Cone Beam CT scans.
• Crowns.
• Bridges.
• Partial dentures.
• Complete dentures.
• Sedation.
• If you are currently grinding or clenching your teeth, you may require an occlusal guard to protect the appliance connected to the implant.

• Medical conditions: Dental implant surgery, like any surgical procedure, comes with risks. Those risks may be greater for some people. While people with the following conditions may be able to safely receive implant surgery, your doctor will need to either take precautions or consider alternatives:
  • A history of bleeding, bruising, or taking blood thinning medication.
  • Planned or existing prosthetic joints within six months of the implant surgery.
  • Organ transplants.
  • Diabetes.
  • Reduced immune function.
  • Prosthetic heart valves.
  • Rheumatic fever.
  • Osteoporosis.
• Bisphosphonates: You may be required to stop taking bisphosphonate medications before undergoing dental implant surgery. Bisphosphonates decrease the blood circulation in the head and neck bones, which could impair healing and invite infection. This risk is especially true if you receive the medication intravenously or take immunosuppressive drugs. Taking bisphosphonates may also put you at a higher risk for osteonecrosis. Always consult your physician before changing dosage or stopping medications.
• Radiation treatment: Be sure to alert your dentist and physician before getting an implant if you have had any past or present treatments involving radiation. You may be at an increased risk for developing osteoradionecrosis following dental implant surgery.
• Anesthesia: Dental implant surgery requires the use of local anesthetic and/or sedation. Talk to your dentist about the risks associated with these services.
• Pain management: Dental implant surgery has post-surgical risks such as swelling, bruising, bleeding, and infection. In most cases, your dentist will recommend or prescribe pain relievers or anti-inflammatory medications following implant surgery to manage your symptoms. Some medications are opioids, which requires special consideration and thoughtful dialog with your dentist before taking them.
• Infections: Infections generally don't occur in the first few days after surgery. If you begin to experience pain, swelling, fever, or tooth sensitivity to hot or cold, call your dentist. These symptoms may indicate the presence of an infection. An antibiotic may be prescribed if your dentist thinks you have an infection.
• Additional risks: Depending on where the implants are being placed, other risks may include:
  • Nerve injury.
  • Sensory changes in the lip, chin, or tongue.
  • Temporary inability to open your mouth fully.
  • Jaw joint pain (normally temporary).
  • Poor healing, which may result in loss of the implant.
• Treatment planning: While dental implants can be an excellent long-term tooth replacement option, they are generally more costly than other solutions. To avoid surprises, have your dentist discuss the entire process, including implant components or additional treatments you may need, the number of appointments and time involved, and the costs.
  • In some cases, an immediate implant may be an option. Discuss this possibility with your dentist, along with the pros and cons of this procedure.
• Patient responsibility: With proper maintenance and good oral hygiene, your implant should last many years, even decades. Continue to see your dentist regularly so they can monitor your implant and the surrounding gums and bone.

Implant failure

The failure rate of a dental implant is low, but it can occur. In general, two things cause implants to fail — heavy bite stress on the implant or infection. Either of these may require your dentist to remove the implant at a later date.

• Tobacco use: Smoking, vaping or chewing tobacco can dramatically reduce the success of implants. This is because tobacco impairs blood circulation, which is essential to good healing and immune response. It also has effects on bone loss. Some studies have indicated that tobacco users are up to 20% more likely to experience an implant failure than non-tobacco users.²
• Stress damage: Grinding or clenching reduces the success rate of dental implants. If you are currently grinding or clenching, you may require an occlusal guard to protect your implant.
• Bone integration:
  • The implant may integrate into the bone in a position where it may be more difficult to properly place or support the final appliance (crown, bridge, denture, etc.).
  • The implant may also integrate into the bone in a position that would not provide an ideal function or cosmetic appearance.
  • Occasionally, the implant fails to integrate into the bone. When this happens, it is not typically complicated to fix. In most cases, the implant can be removed, the site grafted with bone, and another implant inserted. This can happen either at the time the original implant is removed or two to four months later, depending on the bone's status.
• Breakage: While uncommon, the implant itself may break.

Your dentist can often replace a missing tooth with a bridge. Multiple missing teeth may be replaced with a partial denture.

If you are missing all the teeth in the upper or lower jaw (or both), your dentist can create traditional dentures. If the dentures are not supported by implants, they may be less stable, particularly in the lower arch.

Quickly replacing a tooth lowers your risk for complications associated with missing teeth. These complications can include bone loss, shifting teeth, chewing problems, jaw pain or dysfunction, and changes in your appearance. If you need to delay treatment, ask your dentist about filling the gap in your mouth with a dental flipper or a clear vinyl tray with a temporary tooth.

• Am I a good candidate for a dental implant?
• Are there alternative treatments I should consider? What are the pros and cons in terms of longevity, oral health, and bone health?
• Is there anything in my health history or the medications I am taking that may cause concern or reduce my implant's success rate?
• What are the timing options for placing and restoring implants with a crown, bridge, or other components? Does shortening the timeline add any additional risks for failure?
• What additional treatments or procedures may I need, and is there an extra cost?
• What oral hygiene recommendations do you have to help maintain my implant and the teeth around it?
• You recommended an occlusal guard to protect my implant from my grinding or clenching habit. Do I have to wear it all the time?
• What is your office policy if an implant fails?