How is a dental implant made? Step-by-step treatment process

How is the Preliminary Examination and Planning Stage of Dental Implants Conducted?

The preliminary examination stage is realized by the clinician evaluating the mouth clinically and examining the anatomical structure of the jawbone through three-dimensional radiological scans. The diameter and length of the titanium material to be used in this process are calculated with millimetric values, creating an individualized surgical map and medical schedule for the person.

The clinical evaluation process begins with a detailed inquiry into the individual’s history of systemic diseases. Blood pressure values, the current diabetes status, use of anticoagulant medications, and other medical data affecting bone metabolism are recorded. During the oral examination, the current condition of the gums is assessed. If active infection signs such as gingivitis or periodontitis are detected, the periodontal treatment for this area is prioritized according to medical protocols. It is a fundamental rule of medical standards not to proceed with surgical intervention without establishing a healthy foundation.

In the imaging phase, digital sections obtained from Dental Volumetric Tomography (CBCT) devices are of great importance. These scans clearly reveal the degree of sagging of the maxillary sinus cavities located in the upper jaw and the position of the mandibular nerve pathway running through the lower jawbone. The physician plans an appropriate positioning scheme in digital form by obtaining measurements of the thickness and density of the jawbone to avoid damaging the anatomical neighbors.

What Steps Are Followed During Surgical Application?

The surgical procedure consists of the steps involving the local anesthesia of the relevant jaw area, the millimetric separation of the gum, and the placement of a titanium screw into the jawbone. After the procedure, the gum is returned to its original position and closed with sutures, allowing the wound tissue to rest biologically under clinical guidelines.

The clinical operation is performed in an environment where asepsis and antisepsis (sterilization) rules are strictly followed. After local anesthesia is injected into the surgical area, nerve transmission is blocked. Once the area is numbed, the physician elevates the gum tissue with a medical scalpel to expose the cortical (outer) surface of the jawbone. Once the bone surface is reached, specialized drills (perforating medical instruments) are used in succession to open a cavity at the designated width and depth.

During the preparation of the cavity, sterilized cooling fluids (saline solution) are dripped onto the area throughout the procedure to prevent thermal damage (necrosis) to the bone tissue. Once the planned depth is reached, the dental implant is taken from its sterile package and fixed to the cavity prepared with special guides. After the upper part of the screw is covered with a small cap, the gum tissue is repositioned over or around the screw and stitched with fine sutures. The surgical phase takes an average of half an hour for a single area, depending on the number of teeth involved.

How Long Does the Healing and Bone Integration (Osseointegration) Phase Take?

The healing and osseointegration phase takes about two to three months on the lower jaw and approximately three to four months on the upper jaw. During this time, the osteoblast cells in the jawbone adhere to the titanium surface, forming a cellular network at a micro level and creating a stable foundation for the prosthetic crown.

Osseointegration is a biological adaptation phase that forms the basis of medical implantology. The body’s repair mechanisms are activated from the moment the screw is placed into the jawbone. Bone cells migrate to the specially treated surface of titanium, creating new bone islands here. Due to the anatomical structure, the mandible, being harder and more cortical, may undergo the cellular integration process more quickly compared to the maxilla. The spongy (cancellous) structure of the maxilla requires extra time for biological maturation.

In this period, the course of the process is monitored with X-rays taken according to the physiological structure of the clinic and the patient. For example, in Avrupadent process management and general clinical protocols, it is requested from the patient that no physiological load (bite pressure) is placed on the screw during this waiting period. Otherwise, pressures applied before the cell structures have solidified may cause micro-movements, leading to titanium being surrounded by soft tissue (fibrous binding) instead of bone. To prevent this situation, it is quite important for the region to rest.

How is the Prosthetic Tooth Placement Process Progressed?

The placement of prosthetic teeth progresses after confirming the biological integration of the screw with the jawbone, by sending measurements taken from the mouth to the laboratory. The prepared porcelain or zirconium superstructures are fixed to the titanium root via intermediate pieces (abutment), thereby medically supporting the patient’s biting function.

When the standard level of soft tissue regeneration is completed, the stage of shaping the gum form is reached. If the implant is covered, a small local intervention is made to open the gum and metallic pieces called “healing abutment” (gingiva former) are placed over the screw. These abutments stay in the mouth for about 7-10 days, allowing the gum to contour naturally according to a normal tooth form and creating an aesthetic emergence profile.

After the gum has been shaped, the measurement process begins. Three-dimensional records of the edentulous area and opposing arch are created using classic silicone materials or intraoral (in-mouth) digital scanners. Dental technicians produce porcelain or zirconium crowns based on the dentist’s prescription from these measurements. When the produced crowns are placed in the mouth, height trials are conducted. The occlusal contacts of the arches are checked with sensitive papers, and if appropriate, the prostheses are fixed with screw systems or dental cements (medical adhesives).

How Does the Process Work When the Jawbone Volume is Insufficient?

In cases where the jawbone volume is insufficient, additional surgical procedures such as adding medical bone powder (graft) or elevating the sinus floor in the upper jaw (sinus lifting) come into play. This allows for the biological depth and thickness necessary for placing the titanium root to be achieved in the area.

After many years have passed since the loss of teeth, the anatomical resorption known as “resorption” begins because the chewing pressure is not transmitted to the jawbone in that area. When the bone volume decreases in height and width, it mechanically becomes difficult to place a standard implant securely in that region. To overcome this obstacle, materials obtained from synthetic, rigid sources (bovine) or the patient’s autogenous (own) bone are surgically applied to the deficient area. To prevent the spread of this added powder structure, it is covered with barrier membranes.

Directly above the area where the upper jaw has the molar teeth, there are anatomical cavities known as “maxillary sinuses.” Due to resorption, when the sinus floor approaches toward the oral cavity, bone height can decrease to millimeters. In a sinus lifting operation, the thin membrane that reflects this cavity is pushed upward with special instruments to prevent damage, and the resulting cavity is filled with a bone graft. The integration of these added grafts into the patient’s own cellular structure, leading to the formation of new bone tissue, may require a waiting period of around 4 to 6 months, depending on the biological speed of the body.

How Do Digital Dentistry Tools Contribute to the Implantology Process?

Digital dentistry tools allow for virtual planning before the operation through three-dimensional scanners and software, contributing to the process. With the use of a surgical guide, incision sizes can be minimized, anatomical risk areas can be analyzed in advance, and the procedure can be managed within the planned limits.

In addition to traditional methods, digital workflows have become an integral part of today’s clinical processes. Intraoral optical scanners transfer precise digital copies of teeth and gums to the computer environment within seconds. This data is superimposed with the hospital’s tomography images in CAD/CAM (Computer-Aided Design/Manufacturing) software. Doctors virtually determine the location where the implant screw will be placed down to the millimeter on the computer screen.

Through this virtual planning, a transparent plate (surgical guide) that fits perfectly on the patient’s oral structure is produced using 3D printers. The openings and directions of the holes where the doctor will apply the drill are prepared on the plate. When this plate is placed in the mouth during the operation, the doctor can perform the procedure without straying from the planned opening and, in most cases, without the need to widely open the gums (flap lifting). This method helps to control swelling and tissue sensitivity situations after the procedure since it narrows the intervention area.

How Should Post-Treatment Oral Care and Controls Be Organized?

Post-treatment oral care should be organized based on the principle of brushing with fluoridated toothpaste at least twice a day, using interdental cleaners (dental floss, interdental brush), and minimizing plaque accumulation. Additionally, radiological and clinical tissue checks should continue with regular doctor visits every six months or annually.

Titanium and porcelain materials do not undergo tooth decay (cavitation) due to their structure; however, this does not mean that the area does not need to be cleaned. The gum tissue surrounding the screw and the underlying jawbone reacts to bacterial plaque just like natural teeth. Insufficient oral hygiene can lead to food residues and bacteria accumulating around the gum tissue, which can cause inflammation. If this situation progresses, a medical condition called ‘peri-implantitis’ may develop, leading to bone resorption in the jaw.

To move past tables like this, a mechanical cleaning routine is essential. The edges of crowns (covers) that the toothbrush cannot reach, specially designed interface brushes, and water flossers should be used for cleaning. During control appointments, the doctor examines whether there is bleeding in the gums or the formation of pockets with probes (measuring tools). In necessary cases, small dental stone cleaning sessions can be conducted to remove attachments from the area using professional methods, thereby medically supporting the health of surrounding tissues.

What are the Distinguishing Features of Implantology Applications Compared to Traditional Prosthetics?

Implantology applications differ from traditional prosthetics by deriving support directly from the jawbone without touching the adjacent healthy teeth. This approach transmits chewing forces directly to the bone, maintaining physiological stimulation in the area and eliminating the need for support tooth reduction seen in classic bridge systems.

In treatment planning, the method to be chosen is clarified based on the size of the existing edentulousness and the condition of the anatomy as a result of a clinical examination. The table below summarizes the biomechanical relationship of both systems with the tissues and the differences in their functioning: