Background Information:

What are the other Names for the Procedure?

• Dental Implant Placement
• Dental Implant Procedure

What is Dental Implant Surgery?

• Dental Implant Surgeries are procedures to permanently replace missing teeth using artificial dental implants that typically consists of metal posts, abutments, and crowns
• Such procedures are generally undertaken in adults and the implants can serve as substitutes for dental bridges or to replace partial or full dentures

What part of the Body does the Procedure involve?

A Dental Implant Surgery involves the broken or missing tooth, gums, and jawbone.

Why is the Dental Implant Surgery Performed?

A Dental Implant Surgery may be recommended by dental specialists/professional dental experts for the following reasons:

• To improve one’s look, smile, and confidence by addressing issues of missing tooth/teeth
• To help or restore normal biting, chewing, and speaking ability
• The shape of one’s face (cheek, chin, and lips) is affected by missing teeth
• When tooth is severely damaged and the roots are affected such that it is not possible to perform a root canal treatment; also other alternatives are unavailable
• As an alternative to dentures (that are removable) or dental bridges
• For cosmetic purposes
• Blunt trauma, damage from explosions, motor vehicle or industrial accidents, after removal of bone tumors of the jaw

What are some Alternative Choices for the Procedure?

In many cases, there are no suitable alternatives to a Dental Implant Surgery.

What are the Recent Advances in the Procedure?

The advances in the field of Dental Implant Surgery are more to do with newer procedural techniques and the use of better materials for making the implant.

What is the Cost of performing the Dental Implant Surgery?

The cost of Dental Implant Surgery depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Dental Implant Surgery and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.mayoclinic.org/tests-procedures/dental-implant-surgery/about/pac-20384622 (accessed on 01/05/2018)

https://www.animated-teeth.com/tooth-implants/b1-dental-implants-procedure.htm (accessed on 01/04/2018)

Prior to Dental Implant Surgery:

How is the Dental Implant Surgery Performed?

Dental Implant Surgery may be undertaken by oral surgeons or dentists in the following manner: (usually the procedure may be carried out over several months and numerous sittings)

• A visual examination of the tooth in concern is made and X-rays are taken to view the site
• Depending on the procedure, local or general anesthesia  with sedation may be administered, since the underlying jawbone is to be accessed for surgery
• Using a scalpel, the gum tissue over the missing tooth is accessed (incised). The gum flaps are then pushed aside to expose the bone. In some cases, a small round section of gum tissue is punched out and the bone exposed
• The bone is then reshaped to make it appear flat, to receive the implant, using a hand-held instrument. Following this, a hole is carefully drilled into the jawbone using specialized dental drills of increasing sizes
• A continuous flush of saline water is provided to the drill site to prevent overheating of the drill bit and bone. It has to be noted that heating the bone to high temperatures may damage it permanently
• The exact size, location, and orientation of the hole (called a pilot hole) is checked and a pin inserted to verify its alignment for receiving the implant
• Based on this assessment, corrections/adjustments are made to the hole. Also, if necessary, an X-ray may be taken to evaluate the pilot hole
• The pilot hole is threaded using a thread-forming electric tool. This threading is needed to receive the metal screw post (or cylinder), which is screwed into place. In some cases, no threading is necessary, since the grooves on the metal post create the required threading
• The exposed portion of the metal post is then capped, in order to seal the metal post that is partly into the bone. The gum flaps are then cut and shaped around the cap and held in place by sutures, which may be removed after 7-10 days
• In some cases, the gum flaps are sutured over the cap to heal. The cap may be recovered by performing a simple surgery (by trimming gum tissue)
• The material of the post is such that it fuses into the jawbone over a period of 3-6 months. This is known as osseointegration and it makes the implant post very firm and sturdy. In some cases, a temporary dental implant may be placed over the cap (for retaining the profile of teeth/jaw and aid in chewing)
• Following the time period recommended by the dental professional, the cap is removed to be replaced with an abutment, which extends above the post to receive the synthetic crown. After this, the fabricated dental crown (or replacement tooth) is placed over the abutment and secured using specialized cement

Note: If the jawbone is not thick or strong enough to receive the dental implant, the individual may need bone grafting (taken from the hipbone or a synthetic bone is used) to reinforce the existing bone. This may necessitate additional surgical procedures.

Where is the Procedure Performed?

A Dental Implant Surgery is usually performed in an out-patient surgery center facility, a dentist or an oral surgeon’s clinic or office.

Who Performs the Procedure?

A dental specialist or an oral surgeon typically performs the Dental Implant Surgery.

How long will the Procedure take?

Usually a Dental Implant Surgery may take anywhere from 1-2 hours (per session), over several sessions, based on the assessment of the dental professional. The entire duration of the procedure, from start to completion, may take many months (even over 6 months).

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Dental Implant Surgery and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication, food items, or the filling material used in the procedure
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Dental Implant Surgery using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Dental Implant Surgery?

Before a Dental Implant Surgery, the patient may have to undergo certain tests such as:

• Visual examination of teeth
• Complete physical examination for overall health
• Assessment of the bone
• Routine blood and urine analysis, as required
• X-rays of the mouth

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Dental Implant Surgery?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Dental Implant Surgery:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia or general anesthesia with sedation may be administered for the procedure, as ascertained by the dental professional.

How much Blood will you lose, during the Procedure?

There may be some blood loss involved while trimming or cutting the gums as part of the Dental Implant Surgery.

What are the possible Risks and Complications during the Dental Implant Surgery?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Dental Implant Surgery include:

• Anesthetic complications
• Damage of adjacent tooth, gums, or even the sinus cavity, during the procedure
• Jawbone injury and injury to the nerves, resulting in numbness and tingling
• Risk of infection
• Misalignment of the screw-like post, abutment or synthetic crown
• Allergic reaction to the material used

What Post-Operative Care is needed at the Healthcare Facility after the Dental Implant Surgery?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Dental Implant Surgery:

What are the possible Risks and Complications after the Dental Implant Surgery?

The possible risks and complications that may arise after a Dental Implant Surgery are:

• Bleeding from the gums
• Infection at the site
• Misalignment of the implant
• Swollen face
• Jaw pain

What is the Prognosis after the Surgery?

The prognosis after a Dental Implant Surgery is usually good, in a majority of individuals.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain or swelling around the gums and teeth
• Bleeding or fluid drainage from region
• The implant feels loose or does not fit properly
• Signs of an infection
• Headache
• Fever, feeling sick
• Dizziness

What Post-Operative Care is needed at Home after the Dental Implant Surgery?

At home, the following post-operative care is recommended after a Dental Implant Surgery:

• Avoid very hot or cold food items for a few days following the procedure
• Avoid hard food items for a few days after the procedure; take a meal of soft foods for a few days
• Avoid smoking or chewing tobacco
• Brush and floss regularly after taking food, or twice daily

How long does it normally take to fully recover, from the Procedure?

The recovery time usually depends on the extensiveness of the surgery. Simple dental implants have shorter recovery periods and the individuals are able to carry on normal function after recovery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

• If any tissue is removed, it is taken for further examination and later disposed as per the standard medical procedure
• Majority of the times, the tissue that is removed is not sent for examination. But if the dental professional determines it should be, then it is sent

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

If a specimen (tissue) is submitted for exam, then the following steps are involved:

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Dental Implant Surgery?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue is sent for analysis)
• A dental professional or an oral surgeon

The patient is advised to inquire and confirm the type of billing, before the Dental Implant Surgery is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA