There are several approaches. My most common way is to have my patient lightly sedated, so they are relaxed. After thorough numbing, I open the gumline so I can see the bone clearly. This helps me choose the precise orientation and height of my implant. A pilot hole is gently drilled in the bone, double checked and enlarged. The implant is then carefully rotated into place. In complex cases, I will use a CT scan and a digitally designed guide system to aid in precise implant placement.

I have seen too many poor results because implants were not carefully planned and placed. I generally prefer to close the gums completely while the patient’s bone fuses (integrates) to the implant over a period of 2 to 6 months. In the mean time, patients have a temporary tooth or teeth so they always have teeth in aesthetic areas. Back teeth are often left as just the natural gums during the integration period. The advantage to this approach is highest success rates ( high 90’s) and the best gums later.

I do some clever things to make the gums look very natural on most front teeth. This happens when we uncover the implant and make a beautiful temporary that promotes a natural looking gumline. It is one of the “art parts.”

In special carefully selected situations, we may remove a tooth, place the implant and build the temporary tooth all in one step. Placing implants and teeth all at the same time is becoming more common, but some of the precision and success rates can drop. It is a decision that is important to make with plenty of information.

Once the implants have integrated, the patient is ready to have their new teeth made. We are able to replace a single tooth or several; all the way to an entire arch. Many people do single individually flossable teeth. With two implants, we make lower dentures much more secure. With 4 – 8 implants we can make a whole arch of secure teeth that stay in place and are not removable.

Kirk Donaldson DDS MS

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I (Kirk Donaldson DDS MS) have participated in implant dentistry since the current styles were first introduced to North America in 1982. As a graduate student at the University of Michigan, I listened to the Swiss research team present their material to U of M. They wanted Ann Arbor to become THE implant center in North America. U of M was apprehensive because implants had a bad history. Toronto took up the Swiss on their offer and most of the patient studies came from there for years.

As implants became available to the general public, Brannemark’s system was considered the gold standard. They are now owned by Nobelpharma. For historical reasons many dentists still cling to this “godfather” company. I still use them when patients come to my practice from an oral surgeon that still uses the system. Personally, I prefer and use the Biohorizons Implant system. They have the highest level of bone healing and maintenance around the implants. Plus, I can get consistently nice looking gums around them; it’s a joy to use.

There are many good systems out there. I prefer to use a few systems very well and don’t experiment with every new variation until I see some good research that shows significant improvement.