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By Mayo Clinic staffPlacement of dental implants and artificial teeth involves surgical procedures usually done in several stages. The entire process takes three to nine months, or sometimes even longer. That may sound daunting, but a lot of that time is spent healing and waiting for the growth of new bone in your jaw.
Typically, the dental implant cylinder is first implanted in your jawbone. This is followed by a healing period that may last several months. After that, the abutment is placed, followed by your new artificial tooth (also called an implant prosthesis or crown).
When bone grafting is required
If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can proceed with 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 would likely fail. A bone graft can create a much more solid base for the implant.
With 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. The transplanted bone will grow, but it may take six to nine months to grow enough new bone to support a dental implant. In some cases, you may need only minor bone grafting that can be done at the same time as the implant surgery. The condition of your jawbone determines how you can proceed.
Placing the dental implant
Whether you have a bone graft or not, the dental implant must be surgically placed in your jawbone. This surgery is usually done on an outpatient basis, in either a dental office or a hospital. You don't need to stay in a hospital overnight.
You will be given some form of anesthesia for pain control during surgery. Anesthesia options include local anesthesia, sedation or general anesthesia. Talk to your dental specialist about which option is best for you. Your dental care team gives you specific instructions about eating and drinking before surgery, depending on what type of anesthesia you have. If you're having general anesthesia, plan to have someone take you home after surgery and expect to rest for the remainder of the day.
During the surgery, your gum is cut open to expose the bone. Holes are then drilled into the bone where the dental implant cylinder will be placed. Since the cylinder will serve as the tooth root, it's implanted deep into the bone. At this point, however, you still have a gap where your tooth is missing.
Usually, a type of partial, temporary denture can be placed to look more aesthetically pleasing. This denture is removable for cleaning and to sleep.
Waiting for bone growth
Once the metal dental implant cylinder is placed in your jawbone, osseointegration begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process usually takes two to six months. This is an important step because it 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, to which the crown will eventually be attached. To place the abutment, your gum is reopened to expose the dental implant. The abutment is attached to the dental implant. This minor surgery is typically done with local anesthesia in an outpatient setting. Once the abutment is placed, the gum tissue is then closed around, but not over, the abutment.
In many cases, the abutment is attached to the dental implant cylinder at the same time that the cylinder is implanted. That means you won't need an extra surgical step. Because the abutment juts past the gum line, however, it's visible when you open your mouth — and it may be that way for six months or so. 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 have healed, you have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth, or prosthesis. The crown can't be placed earlier in the process because your jawbone isn't yet strong enough to support use of the new tooth.
You and your dental specialist can choose from two main types of artificial teeth. They are:
- A removable implant prosthesis. 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. It's often a good choice when several teeth in the lower jaw are replaced, largely because it's more affordable than are multiple individual dental implants and yet more secure than a traditional denture.
- A fixed implant prosthesis. 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. Each crown is attached to its own dental implant.
After surgery
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. These may include:
- 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 implant surgeon. You may need pain medications or antibiotics.
After each stage of surgery, you may need to eat soft foods for five to seven days. Typically, stitches that dissolve on their own are used. If your stitches aren't self-dissolving, your doctor removes them in about 10 days.
