The dental implant procedure.

This page illustrates and outlines the series of steps that a dentist follows when placing a dental implant.

In most cases, a person's procedure can be performed right in their dentist's office.

If you'd like to skip ahead and access information about a specific step, use the blue tabs to the right.

What types of anesthesia are used for dental implant surgery?

a) Local Anesthetics.

A local anesthetic is usually all that's needed for a person's implant procedure.

"Locals" are administered by way of giving an injection (a "shot"). This is the same technique that's used to numb teeth for tooth extractions and fillings.

Related page: Will my dental injection hurt?

Sedation is an option.

For patients that have anxiety about their proposed surgery, a decision might be made to use conscious sedation technique during their procedure so they are more relaxed. (The use of a local anesthetic is still required.) Here's more information: Conscious Sedation.

b) General Anesthesia.

Some implant cases may benefit from the use of general anesthesia. With this technique, a medication is used that places the patient in a state of deep sleep. (One where the patient is unable to react to stimuli.)

What type of anesthesia should be used for your surgery?

A decision regarding which type of anesthesia should be used will usually hinge on factors such has case difficulty and expected treatment time. Here are some examples:

  • For simple dental implant surgeries, such as the placement of one or two implants, the use of a local anesthetic, alone, is probably all that's needed.
  • For more complex cases, and those requiring longer surgical times, both the patient and the surgeon may benefit from the use of conscious sedation or general anesthesia technique.

The dental implant procedure. -

When placing an implant, the gum tissue is first flapped back to expose the jawbone.

Step 1 - Accessing the jawbone.

As an initial step, the dentist will need to access the bone in the region where the implant will be placed.

To do so:

  • They will first use a scalpel and score incisions in the patient's gums that outline two separate flaps of gum tissue.
  • The dentist will then use a hand instrument to push and peel each flap back, so the bone underneath is exposed.

Evaluating the placement site.

Once the gum tissue flaps have been raised, the dentist will evaluate the shape of the bone that has been revealed.

Ideally this portion of the jaw should to be relatively flat and smooth on top. If the dentist feels that the bone does not meet these conditions, they will use their dental drill and reshape it.

Treatment variation - A less invasive way to access the jaw bone.

In those instances where:

  • There is no question about the suitability of the gum tissue and bone in the region where the tooth implant will be placed.
  • And no concerns about being able to suitably position the implant itself.

There is a chance that the surgeon can access the jawbone through a small circular incision rather than by raising tissue flaps.

This technique involves the use of a round punch that scores and removes a small circular section of gum tissue (one slightly larger in diameter than the planned implant). The implant drilling and placement process is then performed through this hole.

Step 2 - Identifying the exact position for the implant.

Now that the bone has been accessed, the dentist will use a series of drills, each of increasing diameter, to prepare a hole into which the dental implant will ultimately be placed.

As a starting point for this process, the dentist will first use a small round bur (a dental drill bit) to make a divot in the bone.

This divot, which penetrates the bone's hard, outermost layer, helps to insure that the positioning of the pilot drill (the first drill bit used deep inside the jawbone) is easily centered in the implant site.

Creating the initial portion of the dental implant pilot hole.

Step 3 - Creating the pilot hole for the implant.

The initial drill that's used when making the hole for a dental implant is called a pilot drill.

A drill used for dental implants.

This is simply a small diameter drill bit which, as its name implies, is used to create a hole that serves as a guide for other drills used later on.

When using the pilot drill, the dentist may make use of a plastic jig (that they have created ahead of time on plaster casts of the patient's mouth) that is positioned over the implant site so to help guide the pilot drill's orientation.

During this initial phase, the pilot drill is just used to create a hole about one third to one half the total length needed for the dental implant.

An alignment pin is used to evaluate the initial alignment of the dental implant pilot hole.

Step 4 - Evaluating the initial orientation of the implant's pilot hole.

Once the initial portion of the pilot hole has been created, the dentist will insert an alignment pin into it.

The idea is that the alignment pin allows the dentist a chance to check the orientation of the hole being created.

If its alignment seems to be off target (such as tipped too far in one direction), since this hole is only half as deep as it will need to be, its orientation can still be corrected.

The dentist will complete the drilling of the implant pilot hole.

Step 5 - Completing the pilot hole.

After making any needed adjustments, the dentist will resume their drilling.

They will now extend the pilot hole far enough to accommodate the full length of the dental implant. Measurement markings located on the drill itself help the dentist to gauge this depth.

The dentist will perform a final check of the implant pilot hole.

The bone must be treated with care.

It's essential that the dentist does not overheat the bone during the drilling process.

Overheating can result in bone cell death which, in turn, will prevent the successful osseointegration of the dental implant.

So to avoid this complication, the dentist must insure that the drills they are using are sharp and that they are not used with excessive drilling speed or pressure.

During the drilling process, the dentist will continuously flush the tooth implant site with water or saline solution as a way of minimizing the amount of heat being generated.

Step 6 - The dentist will perform a final check of the dental implant's pilot hole.

The dentist will now reinsert the alignment pin into the completed pilot hole. This allows them an opportunity to confirm that the overall alignment and positioning of the hole is suitable.

The measurement markings on the pin also allow the dentist to confirm that the depth of the hole is sufficient to accommodate the length of the planned implant.

An x-ray may be needed.

In some cases, the positioning of a dental implant may be close to important anatomical structures (nerves, blood vessels, neighboring teeth). If so, the dentist may need to take an x-ray of the implant site while the alignment pin is in position so they can evaluate its relationship to them.

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