During the Procedure

1. An ice pack will be given to you to hold to the outside of your face, reducing swelling.

2. You will be given gauze to bite on, to minimize gum swelling and bleeding.

3. You will be given instructions to go over carefully on how to care for yourself.

4. It is MOST important not to have any pressure on the implant surgical site.

Immediately following surgery you may be asked to bite on some gauze to stop any bleeding, and an ice pack may be used during the first 24 hours to help reduce swelling. Expect some swelling in the area of the implant surgery for up to 72 hours following the procedure, as well as some discoloration of the skin and gums for a few days. Prescribed pain medication will help alleviate any discomfort, and you should be able to resume normal activities within 3-5 days. Expect some minor bleeding on the day of surgery (up to 24-48 hours following surgery), but report excessive bleeding to your surgeon immediately.

During this time, a no-chew diet is recommended to avoid placing stress on the new implants, and you will be given instructions on how to clean your mouth. If you have been wearing a denture, the surgeon or your dentist may ream out the appliance and eventually place a soft lining in it so you can wear it comfortably during the healing period. It may be necessary to leave it out for a short period of time. If spaces due to missing teeth must be filled in while healing takes place, temporary teeth that appear natural can be made. Sutures that were placed after surgery will either dissolve or you will return to have them removed.

The second procedure takes place after the jaw has fully healed from the Stage I surgery, and involves placing titanium posts on top of implants, called abutments.

1. Pre-operatively:
a. We will have followed your case carefully throughout the months following Stage I surgery. At appropriate intervals, we will take an x-ray to check for integration.
b. Usually local anesthesia is sufficient for this stage. It usually takes less time than the first, however each case is different. IV Sedation/General Anesthesia is required for more extensive cases.
c. Call your restorative dentist to inform them of your appointment. It is advisable to make an appointment immediately following the surgery to adjust the prosthesis for a comfortable fit. They will let you know when they want to see you in their office to take the impression for the final prosthesis.

2. During the procedure:
a. When the local anesthetic takes effect, the surgeon makes an incision to expose the tops of the implants.
b. All the excess tissue and bone are cleaned away from the fixtures.
c. The surgeon confirms that all implants have successfully osseointegrated (become solid with your jaw bone).
d. Titanium posts, called temporary abutments or healing caps, are screwed into the implants, and stitches are placed.

3. After the procedure:
a. Sometimes your old denture can be fitted with a soft liner to fit over your abutments, or your prosthesis can be hollowed out to fit over the abutments. This is usually done by your dentist.
b. After the gums have healed (usually 2-3 weeks), your dentist will be able to commence fabrication of your prosthesis. In some cases, more time is given for soft tissue healing. Temporary abutments or healing caps are eventually replaced by permanent abutments and the final implant prosthesis. In anterior anesthetic cases, a temporary crown may be worn over the implant up to 8-12 months for soft tissue sculpting to take place before fabrication of the final prosthesis. Please inquire about the Atlantis system.

When your gum tissues have completely healed following Stage II surgery, you are ready to visit your restorative dentist and begin fabrication of your new artificial teeth.

1. How your new teeth are created:
a. Your restorative dentist takes impressions (molds of your mouth) and bite registrations (imprints of the way your jaws fit together). These are used to fabricate a model of your jaw and any remaining teeth as well as the final abutments themselves. Abutments are the metal posts that screw into the implant and are exposed above the level of blue. First, temporary abutments or healing caps are placed at Stage I for one-stage implants and at stage II for two-stage implants. Following soft tissue healing, permanent abutments are fabricated to act as the base for the permanent implant prosthesis.
b. From this model, your dentist has a dental lab create your prosthesis (artificial replacement tooth or teeth).
c. To ensure the best fit, your dentist will need to see you several times. This fitting process can take a few months. During this time you can continue to wear your old denture, partial, or false tooth.
d. To ensure the best fit, a trial set of teeth is carefully set in wax for a fitting or “try-in.” Then your final prosthesis is made and fitted onto a cast metal framework.

2. Different types of prostheses that are available:
a. An individual crown or bridge can be constructed from porcelain or composite plastic and screwed or cemented onto the final abutment(s).
b. A bar can be made to connect two or more implants, with a clip within the denture providing retention. This is called an implant overdonture.
c. Prostheses can be removable or fixed, or you can use a combination of both. You, your surgeon, and your dentist can discuss these and decided which is best for you. It will depend on the placement and affordability.