Every so often, I have a patient who is about to lose a tooth from decay, accident or gum disease. They have heard of dental implants and know that dental implants can replace teeth, but they really don’t know what implants are or what to expect from the procedure. They also don’t know anything about functioning with dental implants.

So I thought that I would take the opportunity to write a set of  blogs explaining dental implant surgery.

First, when a tooth is lost, through either accident or extraction, the bone holding that tooth into your jawbone (the alveolar bone) starts to shrink and “melt away.” It’s sort of the “use it, or lose it” principle in action. If too much time elapses, in this case longer than 3-6 months, the ridge of bone where the tooth was often shrinks to half of its original width. This “shrinkage” can make it difficult for the surgeon to place the implant because there is insufficient bone to secure the implant to.

What does this mean to you?

Well, it means that if you are about to lose a tooth, one of two things should happen to prevent the alveolar bone from shrinking too much:

1. The surgeon should fill the empty socket with a bone graft to help reduce the shrinkage of bone, or
2. The surgeon should place the implant the day of the extraction of the tooth.

If the surgeon decides at the time of extraction that there is insufficient bone to hold the implant, then she should place bone graft into the socket (the hole that remains after the tooth has been removed)  to help reduce some of the future bone shrinkage. If this is necessary, then the implant placement will have to be delayed about 6 months to allow for the socket /graft to fully heal.  The there will be sufficient bone to place the implant.

Why would the surgeon choose one of these procedures over the other? Well it depends on the location of the tooth,  the amount of bone present and if there is the presence of infection.  (I will discuss what treatment choices if infection is present in my next blog)

If the tooth to be removed is a front tooth, and it is being removed because of an accident, breakage, or decay, there may be sufficient bone to hold the implant firmly. The implant being held firmly is crucial to the success of the implant placement. Think of a telephone pole. If you are trying to place one in the ground, you don’t want to place it in an open swimming pool. You’d want to dig a very tight fitting hole in the ground to hold the pole so it doesn’t fall over.

The same idea applies with implants. If the socket of the extracted tooth is too large for the implant to be stable, either the hole must be prepared deeper than the original socket to get stability, or the socket must be filled in with bone, and the site allowed to heal, like filling in the swimming pool with concrete. After the socket has healed, a new hole is prepared for the implant.

Sometimes, when the tooth is being removed, the surgeon can prepare an area deeper into the bone in order to get stability. When this is the case, the implant can often be placed the same day the tooth is removed. However, sometimes the surgeon can’t prepare deeper into the bone, because there may be vital structures in the way, such as nerves or sinuses, or there is not enough bone. In these cases, the surgeon needs to place a bone graft in place, allowing the socket to heal. When this happens, it can be several months before the implant can be placed.

All this sounds like it might be painful. But in fact, it rarely is. My patients are always prescribed antibiotics to prevent post surgical infection, anti-inflammatory medication, and pain medication to be taken if they need it. The anti-inflammatory medication is to prevent inflammation which can result in additional pain. Most of the time, however, my patients are so comfortable that they forget to take their pain medication.

Next week, I will write more about what is involved with implant placement and what you can expect from this simple procedure. I will also be writing about what can be done if your tooth was removed more than one year ago and now there isn’t enough bone to place the implant.

Stay tuned!