Implants are the most optimal method of replacing one or more missing teeth.

It avoids damaging adjacent teeth to provide fixed bridges, however, a suitable bone foundation is necessary.

Patients need to be in good health, the following poses high or higher risk for successful implant placement;

• Long term Biophosphonate use (osteoporosis)
• Immunocompromised persons
• Diabetics
• Smokers
• Some infection diseases e.g. Lyme’s disease

Step 1: Extract the Tooth and possible graft the socket

The tooth should be removed atraumatically, taking care to preserve as much of the surrounding bone as possible.

In some instances, they will extract part of the tooth and leave part behind. This is called a socket shield and is a technique used to preserve the bone.

If the bone has been damaged by infection, it may be necessary to graft the socket first, to allow the eventual placement of the implant.

Step 2: Allow to heal for 8-16 weeks

It takes approximately two to four months for the extraction site to heal and the graft to mature. During this time, the graft serves as an extracellular scaffold that allows the patient’s native bone cells to replace the grafting material with live bone, creating an ideal site for implant placement.

Step 3: Scan for an implant placement guide

At this appointment, a CBCT (Cone Beam Computed Tomography) and a digital impression is taken of the extraction site.

A placement guide is digitally manufactured to assist in the accurate placement of the implant.

Step 4: Place the Implant

In some instances, it is possible to place the implant at the same time that the tooth is extracted. This is called an immediate implant placement. If not, it will be done after the extraction site has healed. This is called delayed placement.

During surgery to place the dental implant, your oral surgeon makes a cut to open your gum and expose the bone. A hole is drilled into the bone, using the placement guide, where the implant will be inserted. Since the implant will serve as the tooth root, it’s implanted into the bone, below gum level.

At this point, you’ll still have a gap where your tooth is missing. A partial, temporary denture can be placed for appearance, if needed, you can remove this denture for cleaning and while you sleep.

A measurement is then taken to assess the stability of the implant – implant stability quotient (ISQ) value. If there is good implant stability, a healing abutment is fitted which will be flush with the gum. If there is inadequate implant stability, the implant will be covered by the gum and exposed approximately three months later.

Step 5: Review and exposure the implant

The process of the bone integrating with the implant is called osseointegration.

Approximately three months post insertion, implant stability (ISQ) will be measured again.

If the implant was covered by gum, exposure of the implant will take place and a healing abutment placed.

To place the healing 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

After the abutment is placed, your gums must heal for at least a week before the artificial tooth can be attached.

In certain cases, a provisional implant supported crown may be placed to ensure optimal soft tissue healing.

Step 6: Permanent implant restoration

Once your gums have healed satisfactorily, you’ll have impressions taken. These impressions are used to make the crown — your realistic-looking artificial tooth. The final crown can’t be placed until your jawbone is strong enough to support use of the new tooth.

Implant care after the procedure

You can help your dental work — and remaining natural teeth — last longer if you:

• Practice excellent oral hygiene.Just as with your natural teeth, keep implants, artificial teeth and gum tissue clean. Specially designed brushes, such as an interdental brush that slides between teeth, can help clean difficult to reach areas around teeth, gums and implant abutments.
• See your dentist regularly.Schedule dental check-ups to ensure the health and proper functioning of your implants and follow the advice for professional cleanings.
• Avoid damaging habits.Don’t chew hard items, such as ice and hard candy, which can break your crowns — or your natural teeth. Avoid tooth-staining tobacco and caffeine products. Get treatment if you grind your teeth.