I have a tooth that is going to be removed! How do I find out if I can have an implant?

What do I do and when?

You’ve are going to lose a tooth! It’s a shock and upsetting but now you need to have a consultation and discussion with your dentist about how you will replace that tooth. If you chose to have an implant then the you can start taking appropriate actions to help retain the bone at the site to get the very best result and obtain the most natural appearance with your future implant and crown.

Immediate implants

Sometimes it is possible to delay tooth loss until having analysed the site using a 3D cone beam volumetric tomography scan as it can sometimes be possible to remove a tooth and insert an implant at the same time.  This is referred to an immediate implant.  Your implant surgeon will explain the pros and cons of this method of placing an implant to you during your consultation.

Who should remove the tooth; my dentist or the implant surgeon?

Generally, if you have a tooth that must be removed and you are choosing to replace it with an implant, then the implant surgeon usually prefers to remove the tooth.  This allows them to make a number of decisions at the time the tooth is extracted to save you facing problems later, and it may enable the surgeon to maintain as much bone as possible at the extraction site, or even supplement the amount of bone by using a grafting material to maintain bone volume that would otherwise resorb and shrink during the healing period after extraction.

Post-extraction healing:

Assuming you have had a tooth removed, firstly the site where the tooth was lost, must be encouraged to heal.  This takes place naturally and the blood clot that forms in the extraction socket will be converted to bone over the 8-10 weeks after extraction.  The gum will also heal and cover the extraction site.

Undisturbed healing is necessary:

It is always important that the tissues around the extraction site are not moved or interfered with in any way during the healing period.  Any movement of the healing wound may result in a failure to produce new bone at the extraction site.  The implant surgeon will advise you on whether you should have a false tooth or not during the healing period.  This is a personal decision and depends on many factors including the site of the missing tooth, the need for replacement to satisfy appearance requirements, or the need to modify diet to avoid trauma to the site while healing takes places.  It is always best not to replace the tooth during healing with a denture as this will often rest on the tissues and may move during chewing causing movement of the healing wound.

Delayed implant placement after extraction:

Leaving an extraction site to heal for longer is not ideal as once the 10 week point is reached, it is usual that bone will begin to disappear from the outside of the extraction site, leading to a loss of bone height and reduced bone volume to support the future implant.  This is why the 8-10 week point is the best time to obtain 3D scans and initiate treatment.

The cone beam volumetric tomography scan (CBVT):

At the 8-10 week point after extraction, it is advised that a 3D cone beam volumetric scan is taken of the area of the extraction and the opposing jaw in the area.  This will allow the implant surgeon to assess the site using 3D data to choose the most suitable implant for the site.

It is always best that the implant surgeon obtain their own scan as it is easier for the 3D planning process and the surgeon will have software that allows the 3D scans taken in their practice to be used within his or her practice planning system to choose the exact size of implant, angulation of implant and the best length of implant to ensure that no other anatomical structures are damaged when the implant is inserted.

How will surgery be performed?

Once the detailed implant plan has been formulated, the decision on how your surgery is to be performed must be made; in a day surgery unit under general anaesthetic or in the surgeon’s practice under either local anaesthetic alone or with intravenous sedation.

Implant consultations with scans:

Some practices will offer a free implant consultation but you should find out exactly what this includes.  A consultation is meaningless unless you have a 3D scan and this must be carefully analysed by the implant surgeon, ideally in the presence of the patient, allowing them to see the process and ask any questions they may have.   This is unlikely to be free and so find out what the costs are that you will face for the complete implant planning consultation and scans.

Here at NQ Surgical Dentistry we will have a consultation that will address all the issues relevant to your treatment, including the taking of the 3D scan and the analysis of that scan with you present.  A choice of implant will be made and then after you have decided to proceed, you will need to have a surgical discussion with the surgeon so that you can provide your informed consent for the procedure to insert the implant.

You will also be provided with leaflets covering every aspect of your care.  You will receive an implant leaflet that gives you a very detailed understanding of the treatment process and the pros and cons of implant therapy.  You will also receive post-operative instructions explaining how to care for your mouth and the site of surgery immediately following the procedure.  You will receive a prescription for suitable post-operative medications and a leaflet addressing the need for antibiotics, and analgesics (pain-killers).

Your consultation is an opportunity to ask questions.  Use the time to get the information you want.  Ask any questions you may have.  It is important that you have a good understanding of the treatment and the process before you agree to accept the treatment.