Introduction to Implant Dentistry

Introduction to Implant Dentistry

Timing of Implant Placement
Once a tooth has been removed, dynamic physiological and dimensional changes take place during the healing phase that may influence the choice of the best time to place an implant. There are several time points following tooth extraction that may be considered for the placement of dental implants. Each time point has advantages and disadvantages.
This Learning Pathway defines the different time points and explains advantages and disadvantages of each. The Pathway outlines the factors that are important in determining the timing of implant placement and offers clinical examples to demonstrate application in practice. The Pathway also discusses the timing of placement in combination with guided bone regeneration (GBR).
The goal of an implant supported reconstruction is to obtain optimal aesthetics and function. In order to achieve this, visualisation of the final restorative reconstruction is necessary prior to beginning treatment. The term 'restorative-driven' treatment planning has been used to identify this process.1 It requires a team approach of specialists, who can develop a multi-disciplinary treatment plan. It starts with an accurate diagnosis, which will lead to a prognosis of each individual tooth and the overall dentition. This information will help the clinician develop the treatment options suitable for tooth replacement. Only when the goals have been defined can the sequence of therapy be established. Working backwards from the wax-up of the final diagnostic model of the proposed treatment assists not only with the management of the complex case, but will help avoid mishaps.2 Effective communication between the team and the patient is extremely important. Understanding the patient's expectations is key to a successful outcome. Deciding that these expectations are realistic requires a correct diagnosis and an inter-disciplinary treatment plan that is logical. This approach takes time and requires a comprehensive treatment discussion between the team members, and then a thorough case presentation to the patient.3 Only then will the patient begin to understand the extent of their problem and the options available to reconstruct their mouth.
Diagnosis
The restorative dentist will develop and direct the plan after gathering data, which includes a complete medical and dental history, clinical findings, photographs, mounted diagnostic casts and radiographs. Consultation with other specialists (periodontist, oral surgeon, orthodontist, endodontist) regarding the periodontal and endodontic health, and any occlusal, skeletal and space problems will be required.
A correct diagnosis with long-term prognostic information is mandatory, in order to develop an interdisciplinary treatment plan. All the treating specialists on the team need to collaborate their findings, which includes the following examinations.
Dental Implant Treatment Timeline
The road to dental implant placement and restoration can be a time commitment. Depending on each individual case, whether there is enough bone present or if a tooth needs to be extracted, it may take anywhere from five months to one year or more to complete the process. Unfortunately, these time periods are dictated by the time it takes for the body to heal. We understand that the process can be confusing. That’s why we have summarized the steps involved in the implant process below. Keep in mind that your particular treatment timeline may differ based on your anatomy, overall health, and treatment goals. Should you undergo the implant process, we will keep you informed every step of the way!
PRE-SURGICAL APPOINTMENT: Impressions of the jaw and teeth may be taken. We recommend you follow a soft diet the first few days after surgery so you don’t put undue stress on your new implants, so you may want to go shopping pre-surgery for soft foods like mashed potatoes, mac-n-cheese, soups, cottage cheese, yogurt etc.
IN SOME CASES THE EXTRACTION OF A TOOTH is indicated. If the bone is healthy, the implant may be placed the same day as the extraction. However, if there is severe bone loss or presence of a large infection, it may not be possible to place the implant at the same visit as the extraction. In such cases, it may be necessary to bone graft the area (See “socket preservation” in the above menu.) Bone grafts usually have to heal 4 months before implants can be placed. IN OTHER CASES, BONE GRAFTING in the site of the missing tooth may need to be done (especially if the tooth has been missing for a while). Bone grafting procedures, such as sinus lift and ridge augmentation, at times need to be performed prior to implant placement so that a solid bone foundation is present for the implant. Again, bone grafts usually need 4 months of healing prior to implant placement.
IMPLANT SURGERY APPOINTMENT: The implant fixture is surgically placed in the bone at this stage. If necessary, bone graft and membrane will be added to augment any areas of deficient bone and to maximize the success of the implant. Depending on many factors, Dr. Farbod may decided to submerge the implant(s) under the gum and allow it to heal or may have it non-submerged and place the healing cap right away. Typical time for bone integration of a dental implant is 4-6 months, depending on the bone quality.
FOLLOW UP APPOINTMENTS: Dr. Farbod will monitor the healing at 1 week, 2 weeks, 1 month and 4-6 months after surgery (times may vary with each individual case
UNCOVERY APPOINTMENT: If the implant was “buried” under the gum tissue, and after the 4-6 month healing period, the implant can be uncovered and a “healing cap” placed. A healing cap is a small, round component that is attached to the implant. This component contours and shapes the gum tissue so it is ready for the final step. You must wait 2 weeks after the uncovery and healing cap placement appointment before seeing your general dentist for the final impressions. At this point, the rest of these steps are completed by your dentist at their office!!
APPOINTMENT TO TAKE IMPRESSIONS: After the implants have integrated into your bone in the jaw, and the gum tissue has healed around the healing cap adequately, an impression of the upper and lower jaws will be taken by your general dentist. Your general dentist will also choose a tooth color with you as well as take a record of your bite. These materials are used by laboratory to fabricate the final tooth.
ABUTMENT & CROWN PLACEMENT APPOINTMENT: After a period of 10-14 business days, the lab will complete your abutment and the final crown and send it to your general dentist. When you see your dentist, the abutment (part that fits over the portion of the implant that protrudes from the gum line) will be placed, followed by cementing and adjustment of the final crown. All that waiting has paid off and now you have a wonderful new smile!