How it happens: inserting a dental implant

Written by: Professor Andrew Sidebottom
Published:
Edited by: Sarah Sherlock

When there is a gap between your teeth, there are different options to fill the space. One option, and the most recommended option, is having a dental implant inserted. Professor Andrew Sidebottom, a highly-trained maxillofacial surgeon, provides information about what the procedure is, what is involved, and what to expect.

 

dental implant

 

What is a dental implant?

A dental implant is a replacement for the root of a tooth typically made of titanium. Eventually, the bone and the implant should fuse together.

 

Your surgeon will assess if this surgery is the best option for you. This assessment may include photos and x-rays for medical records, and they may ask questions about medical history. The amount of bone available to fuse with the implant will also be assessed, and a CT scan or a model of your jawbone may be made.

 

 

Are there any alternatives to inserting a dental implant?

It is possible to leave the gap in your teeth, however, it may cause strain on your other teeth, gum disease, and issues with talking and eating.

 

Dentures, which are artificial teeth in removable plastic or metal frames, can be used to replace some (partial dentures) or all of the teeth (full dentures). Although, these are not appropriate for all people. Dentures may cause gums to recede and bone loss over time, as well as problems with talking and eating. They need to be removed for cleaning, and in due time they will need to be replaced after your mouth has changed and they have been worn down.

 

For a single-tooth gap, a bridge may be possible. The teeth on either side of the gap are cut down and an artificial tooth is attached to them with either cemented wings (bonded bridge) or with a crown (fixed bridge). This process results in significant damage to the teeth that are cut down to attach the bridge. It is a more reliable option than dentures and they do not move while talking or eating; however, bridges fail more than implants. If it’s even possible, a bridge might need to be replaced with a newer one, or possibly replaced with dentures or an implant. Some still require dental implants to support bridges and dentures.

 

 

What will happen if I decide not to have the operation?

The gap in your teeth will remain. Your existing dentures will continue to be loose if your doctor has recommended an implant to support them. A bridge or dentures may be an option with doctor assessment.

 

 

What does the operation involve?

Under local anaesthetic, some single dental implants may be inserted easily. Your doctor may offer a sedative or give general anaesthetic if the procedure will be difficult.

 

The procedure for each implant usually takes 20 minutes up to an hour, depending on the difficulty of the insertion and if a bone graft is needed.

 

A cut on your gum will be made, and a special drill will be used to create a hole in the jawbone. Then the implant will be screwed or tapped into the bone. If there is not enough bone, then a bone graft will be done. The doctor will take bone from the hip or lower jaw, or artificial bone may be used.

 

Either your gum will be closed over the implant or a metal stud to push through out of the gum will be left. If closed, it will usually be done with stitches and they may be dissolvable. You may be asked to bite on a pack of gauze for about ten minutes to stop any bleeding.

 

dental implant

 

What can I do to help make the operation a success?

If you are a smoker, stopping smoking now reduces risk of complications, as well as improves your long-term health. Stopping smoking and keeping your mouth clean greatly cuts down the risk of infection and implant or bone graft failure.

 

Trying to maintain a healthy weight also reduces risk. If you are overweight, your risk of developing complications is higher.

 

Before the operation, regular exercise should help to prepare. It should also help to recover and improve long-term health.

 

 

What complications can happen?

General complications that may arise:

  • pain level related to difficulty of operation
  • bleeding after the operation
  • swelling and bruising; this is more common when a bone graft has been used
  • infection; wound may take longer to heal and there is a higher risk of implant failure

 

Specific dental implant complications:

  • Implant failure: 5 in 100 risk for non-smokers and 15 in 100 risk for smokers. Another implant or alternative may be assessed.
  • Sinus problems: an opening in the sinus and the mouth may happen from inserting an implant into the upper jaw. Secondary problems may be infection (sinusitis), pain, fluid draining between the mouth and nose, and implant failure.
  • Damage to neighbouring teeth: nearby teeth may become loosened and may need to be removed if they remain loose.
  • Damage to nerves connecting lip and tongue: loss of feeling in lip or tongue may happen from inserting implant into the lower jaw. It is typically temporary, but can take up to 18 months to recover.

 

 

What can be expected during recovery?

Once the bleeding has stopped, you should be able to return home the same day. Someone should take you home and stay for at least 24 hours if you have had a sedative.

 

If bleeding resumes at the site of the wound, press a pack of gauze or a clean handkerchief in a knot over the wound for 10 minutes.

 

Do not smoke and keep the mouth as clean as possible. Antibiotics may be given.

 

The wound should be left alone for one to two days. For the following two days, start gently rinsing mouth with salt water four times a day. During at least a week after, rinse mouth with chlorhexidine mouthwash twice a day until brushing is comfortable again.

 

Avoid drinking alcohol, exercise, or hot baths for one week to reduce risk of bleeding, swelling, and bruising. Over-the-counter painkillers should help any discomfort and should be commenced immediately following the procedure.

 

Only soft foods should be eaten for one to two days and gradually moving to solid food when chewing is comfortable. Try using the other side of your mouth when chewing.

 

Most people return to normal activities after two to three days following a single implant, but some people may need up to a week off work particularly if bone grafts are used.

 

If you are in need of a dental implant or would like a consultation to get more information, go to Professor Sidebottom's Top Doctors profile to schedule a visit. 

By Professor Andrew Sidebottom
Oral & maxillofacial surgery

Professor Andrew Sidebottom is a leading consultant oral and maxillofacial surgeon. He practices at BMI The Park Hospital, BMI The Lincoln Hospital and the Spire Nottingham Hospital. His primary clinical interests include temporomandibular joint disease, facial deformity surgery, facial cosmetic surgery, dental implant rehabilitation and oral surgery.

Professor Andrew Sidebottom is one of only eight surgeons in the UK who provides over ten TMJ Joint Replacement procedures yearly, and he has performed over 300 alloplastic joint replacements. His expertise covers all aspects of the management of TMJ pain and surgery. He is also an honorary assistant professor at the University of Nottingham. Professor Sidebottom has been a consultant in oral and maxillofacial surgery at Queens Medical Centre, Nottingham, since 2001. Professor Andrew Sidebottom qualified BDS with honours in Bristol 1986 and subsequently MBChB with honours in Birmingham 1993.

He attained the Fellowship in Dental Surgery of the Royal College of Surgeons of England (FDSRCS) in 1992 and the Fellowship of the Royal Colleges of Surgeons (FRCS) in 1995. Professor Sidebottom carried out oral surgery training in Birmingham and Liverpool from 1986 to 1989, as well as basic surgical training in Bristol from 1994 to 1996. He also completed higher surgical training in oral and maxillofacial Surgery in Liverpool from 1996 to 2001. Professor Sidebottom passed the exit FRCS in Oral and Maxillofacial Surgery {FRCS (OMFS)} with the Gold Medal in 2000.

Professor Sidebottom is in the top 10% providers of TMJ replacement in the world and he is also the lead author of the UK National Guidelines for TMJ Replacement. He is an associate editor in temporomandibular joint surgery for the British Journal of Oral and Maxillofacial Surgery. He referees articles for the European Journal of Craniomaxillofacial Surgery (EJCMFS) and the International Journal of Oral and Maxillofacial Surgery (IJOMS).

Professor Sidebottom has given over 150 international scientific presentations and over 70 international invited lectures. This includes keynote lectures at the British, European and International Association Annual Scientific conferences. He is an active researcher and has written 23 book chapters, including for Gray’s Anatomy on TMJ, as well as 78 peer-reviewed papers.

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