Dental implant surgery is usually an outpatient surgery performed in stages:
- Your damaged tooth is removed.
- Your jawbone is prepared for surgery, a process that may involve bone grafting.
- After your jawbone heals, your oral surgeon places the dental implant metal post in your jawbone.
- You go through a healing period that may last several months.
- Your oral surgeon places the abutment, which is an extension of the implant metal post. (In some cases, when the implant is very stable, this can be done at the same time that the implant is placed.)
- After the soft tissue heals, your dentist will make molds of your teeth and jawbone and later place the final tooth or teeth.
The entire process can take many months from start to finish. Much of that time is devoted to healing and waiting for the growth of new bone in your jaw.
When bone grafting is required
If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can have dental implant surgery. That's because the powerful chewing action of your mouth exerts great pressure on your bone, and if it can't support the implant, the surgery likely would fail. A bone graft can create a more solid base for the implant.
In bone grafting, a piece of bone is removed from another part of your jaw or your body — your hip, for example — and transplanted to your jawbone. Another option is to use artificial bone (bone commercially available) to place in these areas. It may take several months for the transplanted bone to grow enough new bone to support a dental implant.
In some cases, you may need only minor bone grafting, which can be done at the same time as the implant surgery. The condition of your jawbone determines how you proceed.
Placing the dental implant
During surgery to place the dental implant, your oral surgeon makes a cut to open your gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed. Since the post will serve as the tooth root, it's implanted deep into the bone.
At this point, you'll still have a gap where your tooth is missing. A type of partial, temporary denture can be placed for appearance, if needed. You can remove this denture for cleaning and while you sleep.
Waiting for bone growth
Once the metal implant post is placed in your jawbone, osseointegration (os-e-o-in-tuh-GRAY-shun) begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process, which can take several months, helps provide a solid base for your new artificial tooth — just as roots do for your natural teeth.
Placing the abutment
When osseointegration is complete, you may need additional surgery to place the abutment — the piece where the crown will eventually attach. This minor surgery is typically done with local anesthesia in an outpatient setting.
To place the abutment:
- Your oral surgeon reopens your gum to expose the dental implant
- The abutment is attached to the dental implant
- The gum tissue is then closed around, but not over, the abutment
In some cases, the abutment is attached to the dental implant metal post when the post is implanted. That means you won't need an extra surgical step. Because the abutment juts past the gumline, however, it's visible when you open your mouth — and it will be that way until your dentist completes the tooth prosthesis. Some people don't like that appearance and prefer to have the abutment placed in a separate procedure.
Choosing your new artificial teeth
After the abutment is placed, your gums must heal for one or two weeks before the artificial tooth can be attached. Once your gums heal, you'll have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth. The crown can't be placed until your jawbone is strong enough to support use of the new tooth.
You and your dental specialist can choose artificial teeth that are either removable, fixed or a combination of both.
- Removable. This type is similar to a conventional removable denture. It contains artificial white teeth surrounded by pink plastic gum. It's mounted on a metal frame that's attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning.
- Fixed. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can't remove the tooth for cleaning or during sleep. If affordability isn't a concern, you can opt to replace several missing teeth this way. Most of the time, each crown is attached to its own dental implant. However, because implants are exceptionally strong, several teeth can be replaced by one implant if they’re bridged together.
After the procedure
Whether you have dental implant surgery in one stage or multiple stages, you may experience some of the typical discomforts associated with any type of dental surgery, such as:
- Swelling of your gums and face
- Bruising of your skin and gums
- Pain at the implant site
- Minor bleeding
If swelling, discomfort or any other problem gets worse in the days after surgery, contact your oral surgeon. You may need pain medications or antibiotics.
After each stage of surgery, you may need to eat soft foods while the surgical site heals. Typically, your surgeon will use stitches that dissolve on their own. If your stitches aren't self-dissolving, your doctor removes them.