A dental implant is the closest resemblance you’ll get to a natural tooth, if you need to replace one. The dental implant procedure is painless and is usually carried out in the dental rooms. The treatment has three stages; during stage one we place a small titanium dental implant in the area where the tooth is missing and we allow it to heal for three months. During stage two, the dental implant is exposed and we place a cover that will allow the gum to form around the dental implant. Stage three is the final part where we place a porcelain crown on the dental implant that resembles a normal tooth – so in essence, we build you a new tooth.
Dental implantology is a wonderful treatment choice when it comes to replacing missing teeth; it gives you complete functionality with balanced occlusion. At Tzaneen Dental Studio we can replace single teeth, multiple teeth and even place dental implants to support full dentures for better function and retention. In the edentulous patient, an option is to place dental implants in the affected jaw with a hybrid denture – a non-removable type denture.
The Procedure
The key to a great dental implant is accurate planning. The dental implant process starts with a thorough dental examination. Many medical problems can interfere with the placement and integration of a dental implant. Please inform us of any medical problems and medication you are taking. We do not guarantee dental implants in smokers – as explained previously, smoking interferes with wound healing and bone integration of a dental implant, and can lead to loss of an implant.
The examination for dental implantology is very similar to that of a normal dental examination and we need to treat any other dental problems before we can start with the dental implant process. As explained, caries and gum disease can spread through the mouth and may affect the integration of our dental implant.
The additional examination for dental implantology is what we call a periodontal examination and age plays a very important role. We cannot place a dental implant if the patient has not completed his growth pattern. In women, we do not treat before the age of 18, and in men not before the age of 19. We also need to look at the mouth opening and whether there is sufficient space to place a dental implant. We also look at bone quantity and quality on the x-ray.
Your first appointment is the examination and consultation appointment. During a periodontal examination, we measure the level of the bone surrounding each tooth with Williams’ perio probe. The levels are charted on our system. If there is bone loss with active periodontal disease, we need to clear up the disease before we start with the treatment. Our aim is to discuss problems with regard to loss of function, and the long and short term benefits of having a dental implant. We will make a second appointment for you where we will provide you with a treatment plan and a quotation.
Our Treatment
Our treatment sequence is as follows:
- Emergency Treatment (Main complaint)
- Periodontal and oral hygiene procedures
- Routine dental therapy
- Restoration of neighbouring teeth
- Dental implant surgery
During your second appointment, you will be provided with a treatment plan and quotation. We also need you to sign an informed consent form, where we explain all possible complications, duration of treatment and cost. Once you have agreed to the treatment plan and signed the consent form, we can start with the planning phase. I will discuss the complete planning, treatment and possible complications in this section.
During the third appointment, we will start with the planning of the dental implant procedure and educate you to improve your dental IQ. It is very important for every patient to understand that the mouth is a very hostile environment. Although we aim to provide you with the best dental implant possible, we cannot guarantee that it will last forever.
We start the planning process by taking impressions of both arches for study models. These will be used to measure the amount of bone, the size of the dental implant used, the position of the implant, and for making a stent for the placement of the dental implant. Positioning is very important; we need two millimetres of space between the dental implant and the tooth on both sides of the implant and two millimetres buccal and lingual bone. This is called 3D positioning. Next we look at the interocclusal space. This will determine whether we can use a screw retained or a cement retained crown on the dental implant. For screw-retained crowns, we need five millimetres of space and for cement-retained crowns at least 7.5 mm.
At Tzaneen Dental Studio we like to perform the surgery on the model before we do it in the mouth. Our motto is to use a dental implant that is as narrow as possible and as wide as necessary. We need 8-12 mm height of bone, since this will determine the length of our dental implant. We need to determine the type of bone we’re dealing with. We classify bone as type one to type four. Type one bone has a very thick cortex and dense medulla. It is difficult to penetrate and needs more preparation. Type four bone is very soft with a thin cortex and low density. Primary stability is a big issue in type four bone.
Dental Implant Abutment Selection
Although both cement and screw retained abutments are available, we prefer screw retained abutments, as the crowns are easier to remove and recover with screw retained abutments. Unfortunately, during placement of cement retained abutments, cement can enter the space surrounding the dental implant causing inflammation. In anterior areas we use zirconium abutments for aesthetics, but posterior we prefer titanium abutments.
We also need to consider the occlusion of the patient. Bruxism patients that grind their teeth need wider dental implants and we need to increase the surface area of the crown. We also suggest that these patients make use of biteplates.
Now that we have completed our planning we can start with the treatment. The first appointment is the surgical placement of the dental Implant. We make use of a surgical unit and use ice cold saline to cool the drill. We anaesthetise the area with a local anaesthetic, and we can provide conscious sedation to patients with high levels of anxiety.
Placing the Dental Implant
Using a scalpel, we make a small incision through the epithelium and periosteum and lift a mucoperiostel flap. We make use of sutures to pull the flap away from the surgical site to increase access and visibility. Using our stent, we can start with the drilling process and we follow a predetermined drill system.
The first drill is called a lance and is used at high speed (600 rpm), high torque (50 ncm) to perforate the bone cortex. We make sure the drill is kept cool to prevent necrosis, and we follow the same procedure with the second drill. We place our guide pin inside the prepared site and take an x-ray to confirm our position and depth. If correct, we can start drilling with our final drill, which is the width of the chosen dental implant. This is used at 400 rpm with 50 ncm torque. We clean and rinse the prepared site and check for any perforations. In the unlikely event that we perforate the buccal bone plate, we will stop the procedure and do bone augmentation in the area before placing the dental implant.
Now we can place the dental implant in the prepared site with the surgical unit. We use low speed and the maximum torque as prescribed by the manufacturer, and stop short of length with the surgical unit. The last few turns are made using the hand wrench. The dental implant is placed subcrestally; then we have to determine if this is going to be a two-step procedure (transgingival healing) or three-step procedure (subgingival healing).
The indications for sub-gingival healing:
- Poor primary stability
- Any bone augmentation necessary
- Below a full or partial denture with high overload
In this case, a cover screw is placed and the implant site is closed using non-absorbable nylon sutures. The dental implant is then left to heal for the prescribed period of time. On the second appointment, the dental implant will be surgically exposed and a healing abutment placed. Once the area is properly healed, we can continue with the third appointment, which is the impression for the crown.
Indications for Trans-Gingival Healing:
- Good Primary Stability(>20ncm torque or ISQ >60)
- No bone augmentation necessary
- No Initial overload necessary
In this case, we will place a healing abutment close the soft tissues using non-absorbable nylon sutures and leave the dental implant to heal and integrate for the prescribed time.
Possible Complications During Surgical Placement Of The Dental Implant:
- Poor primary stability, in which case we will make use of Sub-Gingival Healing
- Intra-op pain, which we will treat by giving more local anaesthetic in the surgical site
- Intra-op bleeding, which we control using a local anaesthetic containing adrenalin
Possible Complications after Surgical Placement Of The Implant:
- Pain
- Bruising
- Swelling
- Paraesthesia – if your lip feels numb after the surgery you need to contact and inform us immediately, aswe then need to remove the Implant.
- Bleeding
Late Complications of Dental Implant Placement:
- Draining Sinus – inform the Dentist, the screw is loose or fractured
- Fractured screws
- Fractured implants
- Fractured abutments
The Duration for Integration Depends Largely on the Type of Bone in the Implant Site:
- Type 1 bone – 2 months
- Type 2 bone – 2 months
- Type 3 bone – 3 months
- Type 4 bone – 4-6 months
Post-Operative Instructions that the Patient Needs to Follow:
- Maintain a soft diet for the first 7-10 days
- Do not chew on the dental implant until complete integration
- Clean all the areas of the mouth except around the implant site
Medications Prescribed Before and After Surgical Placement of the Dental Implant:
- 3gram Amoxil 1 hour before procedure and 1.5 grams 6 hours after the procedure
- Antibiotics for 7 days
- Please inform us if you have a Penicillin allergy, so we can prescribe an alternative
- Myprodol or Mypaid for pain
Maintenance and Follow-Up of Dental Implants:
- 1 Month follow-up after placement
- 3 Month follow up after placement
- 6 Month follow-up after placement
- Oral hygiene maintenance every 3 to 6 months
For more information about dental implants, please get in touch.