Dental implants planned by an oral and maxillofacial surgeon

An implant is a titanium root that fuses with the bone and holds a new tooth. My part is the surgery: measuring the bone on the CT scan, placing the implant where the tooth needs it, and protecting the bone and gum around it. Your dentist or prosthodontist makes the crown, working from the same plan.

Anesthesia

Local; sedation if needed

Imaging

Cone beam CT (CBCT)

Still in place at 10 years

93.2% to 96.4% in studies

Crown

Made by your dentist or prosthodontist

When it's indicated

• You're missing one or more teeth and want something fixed, without grinding down neighboring teeth.
• A tooth can't be saved: it makes sense to plan the implant before it comes out.
• Your removable denture moves, hurts or keeps you from chewing.
• The bone thinned after an old extraction and we need to measure if there's enough.
• The bone ridge was left uneven and needs smoothing before a prosthesis (alveoloplasty).

Before surgery

• If you already have a recent CT scan or panoramic X-ray, bring it: it sometimes saves a repeat scan.
• Bring a list of your medications and don't stop any on your own. If you take bisphosphonates or denosumab for osteoporosis, an international expert task force suggests they don't need to be stopped before an implant (a weak recommendation); we discuss the risk.
• If you have or might have diabetes, I'll ask for an HbA1c test: poorly controlled diabetes was linked to more bone loss around the implant, so it's worth adjusting it first.
• Gum disease and cavities are treated first. And if you smoke, now is the time to quit.
• If the plan includes sedation, I give you written fasting instructions and you'll need someone to take you home.

How I plan it

How I do it

1. 01Consultation and planI review your history, mouth and CT scan, explain the options — with and without an implant — and settle with your dentist the crown, the number of implants and whether a graft is needed.
2. 02Careful extractionIf the tooth is still there, I remove it while protecting the socket, the bone that will hold the implant. If conditions allow, the implant goes in that same day; if not, I fill the socket with graft to reduce bone shrinkage. I teach this: in 2018 I gave a talk on atraumatic extraction and socket preservation at the National Autonomous University of Honduras.
3. 03PlacementUnder local anesthesia, I place the implant in the planned position. It stays under the gum or with a healing cap.
4. 04IntegrationOver months the bone fuses with the implant. The timing depends on the bone and any graft; I check it before green-lighting the crown.
5. 05Crown and maintenanceYour dentist places the crown. After that, a programme of regular check-ups and cleanings, as the European Federation of Periodontology's guideline recommends.

Recovery

• First 72 hours: possibly when pain control matters most. Take the pain reliever I prescribe on schedule from the start, not once it hurts.
• First days: some swelling, bruising or light bleeding. Cold packs, soft food on the other side, gentle cleaning and no smoking.
• A follow-up visit to check the area and remove stitches if needed.
• Following months: the bone integrates. If you have a provisional tooth, don't bite hard on it.
• For life: regular check-ups were linked to less disease around the implant and, it appears, a lower risk of losing it.

Risks and how I prevent them

It doesn't integrate (early failure)

In smokers, the risk of early failure was double that of non-smokers, especially in the upper jaw. To lower that risk: a CT scan, no tobacco and, when indicated, a single antibiotic dose, which reduced failures in the Cochrane review. If it happens, I remove the implant and, once healed, we consider another.

Peri-implantitis

Inflammation with bone loss around the implant: between 21% and 25.0% of patients, depending on the review; in non-smokers, 5.2% of implants. It's linked to periodontitis, diabetes, smoking and alcohol. Healthy gums, controlled diabetes and maintenance help prevent it. Treatment: deep cleaning or, if it progresses, surgery.

Injury to a nerve, the sinus or a neighboring tooth

The CT scan and safety margin are there to reduce that risk. If your lip or chin stays numb after the anesthesia wears off, tell me right away.

Osteonecrosis with bone medications

In people with osteoporosis on antiresorptive drugs, it was reported in 0.5% after an implant. It's low but real: we discuss it and I watch for it. With cancer-treatment doses the evaluation is different.

Crown or screw problems

A screw can loosen or a part can fracture. Good design and check-ups help prevent it; it's adjusted or repaired.

Other options

Fixed bridge

It rests on the neighboring teeth, which have to be ground down. It makes sense if they already need crowns.

Removable denture

No surgery. It moves more than an implant and comes out for cleaning.

Not replacing the tooth

Sometimes valid, as with some back molars. The bone there tends to thin, though.

Short implant instead of a graft

In upper back teeth with little bone, eight randomized trials found no significant difference in failures between short implants (8 mm or less) and standard implants with a sinus lift; in a Cochrane review, the sinus lift had more complications.

Frequently asked questions