What you can expect

Dental implant surgery is usually an outpatient surgery performed in stages, with healing time between procedures. The process of placing a dental implant involves multiple steps, including:

• Damaged tooth removal
• Jawbone preparation (grafting), when needed
• Dental implant placement
• Bone growth and healing
• Abutment placement
• Artificial tooth placement

The entire process can take many months from start to finish. Much of that time is devoted to healing and waiting for the growth of new bone in your jaw. Depending on your situation, the specific procedure done or the materials used, certain steps can sometimes be combined.

When bone grafting is required

If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can have dental implant surgery. That's because the powerful chewing action of your mouth exerts great pressure on your bone, and if it can't support the implant, the surgery likely would fail. A bone graft can create a more solid base for the implant.

There are several bone graft materials that can be used to rebuild a jawbone. Options may include a natural bone graft, such as from another location in your body, or a synthetic bone graft, such as bone-substitute material that can provide support structures for new bone growth. Talk to your doctor about options that will work best for you.

It may take several months for the transplanted bone to grow enough new bone to support a dental implant. In some cases, you may need only minor bone grafting, which can be done at the same time as the implant surgery. The condition of your jawbone determines how you proceed.

Placing the dental implant

During surgery to place the dental implant, your oral surgeon makes a cut to open your gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed. Since the post will serve as the tooth root, it's implanted deep into the bone.

At this point, you'll still have a gap where your tooth is missing. A type of partial, temporary denture can be placed for appearance, if needed. You can remove this denture for cleaning and while you sleep.

Waiting for bone growth

Once the metal implant post is placed in your jawbone, osseointegration (oss-ee-oh-in-tuh-GRAY-shun) begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process, which can take several months, helps provide a solid base for your new artificial tooth — just as roots do for your natural teeth.

Placing the abutment

When osseointegration is complete, you may need additional surgery to place the abutment — the piece where the crown will eventually attach. This minor surgery is typically done with local anesthesia in an outpatient setting.

To place the abutment:

• Your oral surgeon reopens your gum to expose the dental implant
• The abutment is attached to the dental implant
• The gum tissue is then closed around, but not over, the abutment

In some cases, the abutment is attached to the dental implant metal post when the post is implanted. That means you won't need an extra surgical step. Because the abutment juts past the gumline, however, it's visible when you open your mouth — and it will be that way until your dentist completes the tooth prosthesis. Some people don't like that appearance and prefer to have the abutment placed in a separate procedure.

After the abutment is placed, your gums must heal for about two weeks before the artificial tooth can be attached.

Choosing your new artificial teeth

Once your gums heal, you'll have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth. The crown can't be placed until your jawbone is strong enough to support use of the new tooth.

You and your dental specialist can choose artificial teeth that are removable, fixed or a combination of both:

• Removable. This type is similar to a conventional removable denture and can be a partial or full denture. It contains artificial white teeth surrounded by pink plastic gum. It's mounted on a metal frame that's attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning.
• Fixed. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can't remove the tooth for cleaning or during sleep. Most of the time, each crown is attached to its own dental implant. However, because implants are exceptionally strong, several teeth can be replaced by one implant if they're bridged together.

After the procedure

Whether you have dental implant surgery in one stage or multiple stages, you may experience some of the typical discomforts associated with any type of dental surgery, such as:

• Swelling of your gums and face
• Bruising of your skin and gums
• Pain at the implant site
• Minor bleeding

You may need pain medications or antibiotics after dental implant surgery. If swelling, discomfort or any other problem gets worse in the days after surgery, contact your oral surgeon.

After each stage of surgery, you may need to eat soft foods while the surgical site heals. Typically, your surgeon will use stitches that dissolve on their own. If your stitches aren't self-dissolving, your doctor removes them.