The implant represents a titanium screw (similar to the tooth’s root) with either smooth or furrowed surface, which is surgically applied and driven into the bone. It is expected to integrate with the bone and allow for the application of a crown over the screw in 3 to 4 months’ time. The crown will from then on perform the same chewing and esthetic functions as a natural tooth would do. The implant is driven into the bone through a precisely made slit where it is screwed down. The procedure covers the following phases: initially a drill is used to make a small hole in the bone. Usually this small tunnel in the bone is by 1 mm deeper than the size of the implant. The implant is either screwed down or riveted to the tunnel made to accommodate it. The riveted implant is covered with a cap and the gum is stitched to it and left in peace to knit to neighboring bone tissue.

After a few months the implant is opened with a new surgical intervention which however is much simpler and takes place under local anesthesia only. It is the time to cover the implant with a temporary crown expected to aid the gum in growing around the artificial tooth (the implant) into the typical festoon shape as with natural teeth. Once the gum has acquired the right shape, the permanent crown can be made.

Implantology is performed by general dentists, periodontal dentists and oral surgeons under general or local anesthesia. There is a growing tendency of cosmetic dentists applying implants in relatively simple cases.
The period of recovery and integration of the implant with the bone usually takes from 3 to 6 months. After that time a crown can be applied or a larger construction in the case of multiple tooth replacement.

Supplementary procedures

Sinus lifting - This is a routine surgical intervention. The dentist thickens the unfit part of the atrophic jaw bone towards the sinus by way of a bone transplant or by adding extra bone tissue. The result is an increased volume of the bone that can easily become a comfortable lodge for the implant.

Augmenting the bone - When the extraction of one or more teeth has not been followed by rapid implantation within a matter of 6 months or one year, the toothless section of the bone gets atrophic meaning it lacks the necessary height and width to be able to take the bone in effectively. This requires thickening and grafting of the bone. The method is surgical: some bone-replacement grainy substance will be placed under the gum (either artificial or own, taken from the patient). It is expected to knit to the bone and thus augment it in both thickness and width. Just like sinus lifting, the augmenting of the bone precedes the application of implants by 6 to 8 months. This is the time necessary for the integration of the new bone-like substance with the bone.

 Panoramic X-ray is a must, and where greater precision is needed, 3D technologies such as computer tomography (scanner) of the bone are employed. Obtained data are used for making a computer-generated guide in applying implants so as to eliminate mistakes in accommodating the implant in the 3D space of the bone.

Methods of implant application after tooth extraction

• Placing the implant immediately after tooth extraction.
• Placing the implant from two weeks till three months following tooth extraction.
• Placing the implant more than three months after tooth extraction.

There are three options for the procedure of loading implants.

1. Loading immediately after the procedure, i.e. placing the crown 4 to 5 days after implant application.
2. Loading from 1 to 12 weeks after the procedure
3. Loading three months after the implanting procedure.

WHAT PATIENTS SHOULD KNOW

1. The implant is an excellent solution for the replacement of missing or extracted teeth, but it can never replace the natural tooth fully. Therefore, a course of endodontic treatment, even with a 50 to 90% rate of success, is always preferable, because it saves natural tooth tissue, and the natural bone too. So, even if the life of a tooth, whose root canals have been treated, is extended by only 5 to 10 years, the same extension is valid for the irreversible process of bone atrophy – inevitable after tooth extraction.
   BUT: once the tooth has been extracted or lost, application of the implant should start immediately – up to 6 months after extraction.
2. Although the success of implantology today is more than 90%, a possible failure is most often linked to the inability of the implant to knit to the bone. Implantation is deemed unsuccessful when the implant falls out, loses stability or displays loss of bone of 1 mm in the first year or more than 0.2 mm in the following years. Implants are not affected by cavities, but they could be troubled by peri-imlantitis caused by surgical infection, by poor oral hygiene or by failure to stick to post-surgical instructions. Smoking is another risk. Smokers are expected to give up the habit or else, they run the risk of several abortive surgeries. Is it worth the risks? In many cases smokers are advised to receive a bridge or another construction alternative to implants.

COUNTER-INDICATIONS

1. Non-compensated diabetes 2nd degree or other non-compensated conditions.
2. Bruxism (teeth grinding).
3. Use of certain medicines such as bisphosphonates (Actonel, Fosamax and Boniva, received during breast cancer and osteoporosis treatments) should stop six months prior to the procedure. Intravenous application of those medicines considerably ups the risk of implant failure, while oral application downsizes that same risk tangibly.