Dentistry has undergone tremendous change in the past few decades. The entire focus has shifted from removing the tooth to saving it. In spite of these developments, many a times we have to extract a tooth. A tooth  may be lost for various reasons which include accident, infection or loss of bone around the tooth. Dental implants have been in the market for at least 30 years. Prior to implants, the only option people had were complete dentures or fixed bridges or removable bridges. Today, let us try to understand what dental implants are and how they work.

Q1) What are dental Implants?

Dental implants are a way of replacing missing teeth. Dental implants are "screws" placed inside the jaw bone. These screws are then fixed with a connection (called as abutment) on to which the cap (called as prosthesis) is fixed. Depending on the patient's requirement, dental implants can be used to replace either one single tooth or multiple teeth. Dental implants work on the principle of "Osseointegration." Following the placement of dental implant our body will naturally react with a process called osseointegration. Derived from the Greek and Latin terms for “bone” and “to make whole”, osseointegration is the process that allows dental implants to become a permanent part of our jaw. 


Q2) Why do patients need dental implants?

Have you seen a hand that has been removed from a plaster after 5 weeks? The hand is considerably thinner than the other hand. This is called "disuse atrophy" in medical terminology. It is a general physiologic process of resorbtion and breakdown of tissues. Same process happens when a tooth is removed. The native bone in which the tooth was in place starts to reduce in size over a period of time. Thus you require an object to hold the bone in place so that it doesn't reduce in size. This job is done by the implant. 

This also has advantage over other treatment modalities such as crown/ bridges where there are 2 fold problems:

1. Normal teeth (in back and front of missing teeth) which are unnecessarily cut so that a bridge can be placed.

2. Over a period of time due to disuse atrophy a gap is created between bone and the bridge where starts to food accumulate.


Q3) When do you place dental implants?

There are various clinical situations that determine when the implant has to be placed, though pre-surgical work-up is required for the same. Broadly speaking, implants have to be placed as early as 3 months after extraction of the tooth for ideal results. In some clinical scenarios, it can also be placed immediately after tooth extraction. The fixing of prosthesis to the implant(loading) can happen 3 months later.  

Q4) Where do you place a dental implant?

Implants are placed in the bone where natural tooth is missing. The bone is assessed with help of CBCT (Cone-beam computed tomography systems, which is a type of x-ray) for the available width and height. Accordingly, the length and breadth of the implant are selected. If there is insufficient height or width, certain procedures need to performed to augment it.  

Q5) How is a dental implant placed?

The patient is first made to sit comfortably on the dental chair. A small local anesthetic injection is given to numb the area. The gum area is cut and the gums are reflected to expose the bone underneath. 

The implant kit contains various drills. The drills are used to drill the bone sequentially. After adequate drilling, the implant is placed in the bone and the reflected gum is sutured back. The patient is given some medications for pain relief. Sutures are removed after a week. The next procedure begins 3 months when implant is exposed with a minor surgery. 

This is called as stage 2 surgery. After 7-10 days, impressions are made for placement of crown.

A standard appointment timeline for dental implants is as follows:

1) Implant placement surgery appointment 

2) Suture removal (after 7 days 3 months of waiting period appointment)

3) Stage 2 procedure appointment 

4) Impressions making of implants (after 10 days of prior appointment)

5) Lab trialappointment 

6) Placement of the final crown