Implants are placed into the bone of the jaw during a minor surgical procedure. Sometimes the implant can be placed at the same time as a doomed tooth is extracted (immediate implants).
When an immediate implant is not possible or the tooth has already been removed there are generally two surgical methods used - single stage and 2 stage techniques.
2 Stage Surgery
During a small surgical procedure a gum flap is raised. A small hole of exact length and width is prepared in the bone. This is done either with a surgical bur or by hand instruments (ostotomes). The orientation of the implant must be very precise and this will have been planned prior to the surgery.
The implant is either tapped in or screwed in and the flap sutured, completely covering the implant. After a healing period of up to 6 months a second minor procedure is carried out to expose the implant. By now the implant should have become firmly fixed into the bone and a strong biological bond should have formed between the bone and the implant surface. A provisional crown, bridge or denture is made for the implant and impressions taken at a time when the soft tissues have healed fully for the final permanent restoration.
The image on the far left shows the implant at the end of the first surgical procedure with the gum closed over the top of it. The image to the right of this one shows the implant during the construction of the provisional crown after the second surgical stage of uncovering the implant, up to 6 months later. The provisional crown will be fixed to the blue coloured abutment which has already been screwed into the implant.
Single Stage Implants
In some cases modern implants can now be completed with only one single surgical stage. When the implant is placed into the jaw bone, as described above, a small healing collar is fitted. The gum is sutured back over the implant but this healing collar protrudes a few millimetres through the flap. Over a period of a few weeks the soft tissue heals around the collar. When the implant has become firmly fixed into the bone the healing collar is simply clicked off without the need for a second surgical stage to expose the implant head, as above.
A temporary crown, bridge or denture is constructed as soon as the healing collar is removed and the permanent restoration subsequently constructed. The image on the right shows the first stage (left implant) with the healing collar protruding through the soft tissues when the implant has first been placed. The second image shows the abutment fixed into the implant onto which the crown will be placed.