According to the American Academy of Implant Dentistry, over 5 million dental implants are placed in the United States each year. Although dental implants have become the preferred method for replacing missing teeth, the majority of patients do not understand the process of dental implant treatment.
The first and most important step with implants is an examination and a 3-D radiograph called a Cone Beam Computed Topograph (CBCT) which allows the dentist to examine the patient’s bone and surrounding structures (nerves, blood vessels, nasal sinuses, etc). This information is critical in treatment planning the implant surgery because the dentist is able to take measurements and determine the appropriate implant size and location in relation to the adjacent teeth and/or other important structures.
If there is not enough bone, a bone grafting procedure will need to be done prior to or in conjunction with implant placement. In the maxilla (upper jaw) a sinus augmentation may be required to add bone and make space for an implant. In most cases, the implant will be placed 4-6 months after the graft has healed properly.
Once the treatment planning has been done and the foundation (bone) has been established, the implant surgery is performed, at which time the implant is completely embedded in bone, and is left to heal for about 4-6 months before the crown is made. This time allows the bone around the implant to remodel and form a union to the implant through a process called osseointegration. In some cases, especially for anterior teeth, it is possible to attach a temporary or permanent crown to the implant the same day as the implant placement, but this usually depends on the initial stability of the implant on the day of surgery.
When it comes time to make the crown, the process is similar to a traditional crown procedure. An impression must be taken, and the crown can either be cement-retained or screw-retained. Posterior teeth are primarily screw-retained, which is advantageous because it decreases risk of tissue irritation from excess cement and it also allows the dentist to remove the crown, if necessary, without potential damage to the implant. In anterior teeth, a custom abutment is made and attached to the implant, and the crown is cemented to this abutment.
The advantage of implants for replacing missing teeth is that they closely resemble natural teeth when comes to function, esthetics, and preservation of tissues. That being said, it’s important to realize that implants and implant crowns can develop plaque and periodontitis (periimplantitis) the same way as natural teeth. Flossing and brushing around implants is just as, if not more important than around natural teeth.