The best way to describe how a typical dental implant is placed and restored for a singly tooth scenario is through illustration of a simple case scenario.
The following page goes through a complete case. There are some mildly graphic surgical images ahead, however the emphasis is more on the reconstruction.
The patient in this case is a teenager with two congenitally missing lateral incisors, as you can see in the pictures below:
His restorative options were a Removable Partial Denture, a fixed Bridge or two dental implants. The patient chose the implant option.
Below you can see the patient during surgery. Two Root Form Implants (screw-type) are placed in the edentulous sites. The two x-rays show before (left) and after (right) images.
After the implants were placed, the tissues were sutured back together again. The sutures were removed approximately ten days after the surgery. Four weeks after the surgery the patient presented for a post-operative check-up. Below, you can see images of the surgical sites four weeks after surgery.
The implants were left undisturbed for approximately six months, after which they were uncovered. The Uncovery procedure involves a small exposure of the head of the implant and placement of either a Healing Abutment or a Temporary Crown. Both are designed to “train” your gum tissues to grow around the future prosthesis in a collar-like fashion. The temporary crowns are usually the better choice in an esthetic area, such as in this case, since they are able to shape the gum tissues into the nice, scalloped appearance, which makes the entire restoration look more natural. The healing abutments are designed to stick out of our gums after they are placed, which would make them esthetically not so pleasing in this case.
In this case temporary crowns were chosen for the patient an the images below show the temporaries in place right after uncovery of the implants (left image) and approximately 4 weeks after uncovery of the implants (right image).
Once the tissues are in satisfactory condition, a final impression is taken with the help of specialized transfer impression pins, as you can see below to the left (the transfer pins connect to implant analogs, which will record the position of the implants in the stone cast. The impression is then poured into stone with the appropriate implant analogs in place (below to the right). The analogs (arrows) are metal components duplicating the exact position and “neck morphology” of the implant fixture as it is in the patient’s mouth.
The laboratory technician will then make custom abutments (red arrow in the left image below), which are attached to the implant fixtures in the mouth via screws (green arrow in the left image below). The crowns (blue arrow in the same picture) are then cemented over the custom abutments. Below to the right you can see the custom abutments inserted. At this point, the screws, connecting them to the implants will be torqued to a pre-determined torque value, in order to achieve the correct pre-load value of the screw. This step is very important, because it will prevent future loosening of the screws.
Once the abutments are torqued in, the screw access is sealed off and the porcelain crowns are cemented onto the abutments, much like crowns are cemented onto natural teeth. Below you can see two views of the restored lateral incisors.
