Variations on the type of implant to be used
There are many different kinds of root-form endosseous implants. They vary in length, diameter, degree of taper, surface treatments, method of attaching the crowns, bridges, or dentures, and anti-rotation features. Some have threads, and some do not. There are many different manufacturers, each with slight variations on these features. Your dentist will select the most appropriate type and size of implant for your needs. ToothIQ discusses only endosseous root-form implants, but other designs you may want to investigate include blade-form implants and subperiosteal implants, especially if you are missing all of your natural teeth.
Variations on the timing of placement of dental implants
There are several options for timing the placement of dental implants, as well as the restorations that attach to them. A few are discussed here.
“Traditional” (delayed) placement
The traditional timing of placement of a dental implant is four to six months after a tooth has been removed. This allows time for the tooth socket to fill in with new bone, and for the new bone to mature. Frequently, patients wait longer than six months to replace a tooth (sometimes much longer). However, as a general rule, the longer a person waits to replace a tooth, the less bone there will be to place an implant into. Sometimes it is necessary to graft additional bone into the site where the implant(s) will go and wait for that bone to integrate and mature (generally four to six months) before an implant can be placed.
The bone graft material can be autogenous (i.e. your own bone), allogenic (same species—i.e. donated human tissue), alloplastic (synthetic or inorganic), or xenoplastic (from another species, e.g. cow bone). Autogenous grafts can be taken from various places in the jaw bones, from the leg or hip, or even from the skull. Not everyone who desires an implant will require bone grafting. Your dentist(s) will determine whether you might need it.
Traditionally, an implant is placed into the bone, covered with gum tissue, and allowed to “osseointegrate” into the bone for four to six months. At that time, following traditional protocols, the implant is uncovered, and a “healing cap” that extends through the gums is inserted into the implant. Again, following traditional protocols, the implant is then restored with a crown, bridge, etc., a couple of weeks later. Your dentist can tell you whether your edentulous condition indicates traditional protocols for implant placement and restoration, or whether the timeline can be shortened at all.
“Delayed-immediate” placement
Following this protocol, a tooth is removed and the gums are allowed to heal over the tooth socket for about six weeks. This is enough time for the “hole” to be covered with soft tissue, but not enough for the bony tooth socket to fill with new bone. The idea here is that there will be gum tissue available to close the implant placement site completely. If good soft tissue closure is obtained over an implant, there is less likelihood of infection (one of the main reasons an implant can fail to integrate into the bone).
Another advantage to the delayed-immediate protocol is that the number of bone forming cells (“osteoblasts”) will be greatest about six weeks after the tooth is removed. Ask your dentist whether your situation might indicate the delayed-immediate implant placement protocol, and how long it will be until the implant can be restored.
“Immediate” placement
This protocol is becoming more popular, especially for replacing front teeth that require extraction, because people generally don’t want to be without a tooth or teeth in the visible “esthetic” zone any longer than necessary. Under this protocol, the tooth is removed and an implant is immediately placed into the extraction site. It may be necessary to graft bone around the implant, and in most cases, there is no ability to close the gum tissue over the implant. If certain conditions are present, it may also be possible to place an immediate temporary crown on the immediate implant.
In those cases, the patient never goes without a tooth, and doesn’t require a temporary denture of any kind. Ask your dentist whether your situation might favor this technique, with the understanding that it may come with some additional risk of not integrating into the bone properly. Many dentists charge more for immediate restoration of immediate implants due to the greater risk.
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