Implant dentistry is a branch of dentistry that has undergone significant technological developments over the past few years. Today it offers advanced solutions to replace missing teeth and restore oral health. The time required for these therapies can be relatively short (a few weeks) or last many months, sometimes fitting within a course of treatment that can last for years. No wonder, then, that in the face of such variability in duration many patients feel bewildered and wonder why an acquaintance of theirs underwent a dental extraction and put in a new tooth immediately, while they were presented with significantly longer times. This short article aims to illustrate the different aspects that influence the timing of implant dentistry, while also answering the most common questions about the concept of “fixed teeth in a day.”

The most conservative solution to replacing a missing tooth is to place a dental implant. This is a screw, (usually made of titanium), that replaces the root of the lost tooth, onto which the prosthesis (the new tooth) is installed after healing is complete. The implant becomes fixed in the bone through a delicate healing process called osseointegration. This begins from the moment the implant is placed and continues for several months. Traditional protocols call for healing times of about six months; the development of new implant shapes and highly biocompatible surfaces that promote osseointegration have reduced these times in many cases to about 12 weeks.

Immediate Loading:

Immediate loading is an approach that allows the new tooth or teeth to be connected to the implant on the same day or days immediately following placement. This protocol is adopted when the dental implant has sufficient stability and there is certainty of its immobility during the healing process. However, this is not always possible because of the patient’s oral health condition and variations in the quality of the bone and surrounding tissues.

Factors Affecting Immediate Loading:

• Quantity and Quality of Bone: There must be an adequate amount of bone to stabilize the implant. The bone must be healthy, dense, and free of infection.
• Gingival conditions: The health of the gums and surrounding soft tissues is critical. If gingival inflammation is present this must be brought under control before any implant therapy.
• Case complexity: Situations with bone defects may require additional procedures, such as bone reconstruction before implant placement.
• Degree of cooperation and chewing habits of the patient: In cases where it is possible to place a tooth immediately, the patient should take care not to chew on it at least in the initial stages of healing. If there is any doubt that the patient is unable to provide masticatory stress-free healing to the new implant, it may be more appropriate to adopt a traditional approach.

In light of these observations, it follows that not all clinical situations and not all patients can receive fixed teeth immediately after placement of a dental implant. The decision depends on the patient’s general health condition, periodontal health (of the gums and bone), and the amount and quality of bone tissue in the area that will receive the new tooth.

In conclusion, the timing of implant dentistry is subject to multiple variables. Significant advances in the field of implant dentistry now make it possible to perform minimally invasive procedures and in some cases replace missing teeth with a new tooth immediately. This is a source of great satisfaction for the clinician and especially for patients who are able to restore aesthetics in a short period of time. For this to occur, a number of conditions must exist to ensure that the treatment is successful in the best possible way and without taking any risks. Some clinical situations make it impossible to install a new tooth immediately or even require waiting a long time before implant placement because periodontal disease will need to be brought under control first to ensure lasting results.

A tooth lost due to decay, trauma, or gum disease can be replaced with either a removable option or a fixed new tooth. The solution of choice, the least invasive one, to give you back a fixed tooth, is the placement of a dental implant. In fact, in this way, the missing tooth can be replaced with an esthetic outcome that is very similar to that of the natural tooth without touching the adjacent teeth, which would be necessary in case of opting for a traditional bridge.

Technically, the term “dental implant” refers to the artificial tooth root that is placed in the maxillary or mandibular bone to support a new prosthetic tooth or bridge. However, very often when lay people talk about “implant,” they are referring to the combination of the implant proper (the artificial root) and the prosthetic crown (the new tooth).

There are different types of dental implants, let’s try to provide some clarity:

First, it is good to distinguish between two main types:

1. Endosseous (implants placed in bone): the most common dental implants. They can have various shapes: cylindrical, conical, or bladed. They are surgically placed inside the bone. Through a healing process called osseointegration over the course of a few weeks the adjacent bone “attaches to the implant” and is thus ready to support the chewing loads of the new tooth. Each implant supports one or more prosthetic teeth.
2. Sub-periosteal (above-bone implants): this type of implant is placed under the gum but above the bone (not within it) with a metal skeleton that has portions protruding from the gum to allow placement of the new tooth or fixed prosthesis. Sub-periosteal implants are used in patients who are unable to wear conventional dentures and do not have enough bone for an endobony implant.

The most commonly used implants are endosseous implants because they are the ones supported by the strongest scientific evidence and for this reason they are the only type of implant we use at Anestident Specialized Dentistry.

A new tooth on an implant consists of three components: the implant proper (the screw in the bone), the abutment (usually made of metal, it connects the implant to the oral environment by passing through the gum), and the crown (the prosthetic tooth that restores function and aesthetics).

Implants differ from each other in macroscopic anatomy (the shape of the screw), microscopic anatomy (the roughness of the surface), size (there are different lengths and diameters), the shape of the connection between implant and abutment, and the material from which they are made. Most are made of titanium or titanium-zirconium alloys but there are also ceramic implants.

There are dozens of companies on the Italian market that produce dental implants and hundreds of different types of implants. While for one patient one implant may be equivalent to another, in reality there are also important differences in terms of the quality of the scientific research behind the product.

There are implants supported by excellent scientific research and others that although legally available commercially do not have the same solid research behind them.

Interesting in this regard are the data collected in a Gotheborg University study a few years ago (Derks 2015) in which analyzing nearly 600 patients with dental implants it was noted that the risk of the implants becoming diseased over time was also correlated with the presence of periodontal disease, the number of implants placed, whether they were made by a general dentist or a specialist, and finally also with the brand name.

It is for this reason, that based on scientific knowledge, we select the most suitable implant for the individual patient based on the specific clinical situation and use only implants that meet the highest quality standards and supported by validated scientific studies of the highest standard.

The loss of a tooth due to trauma, caries or excessive mobility constitutes an unpleasant event that confronts us with the dilemma of how to replace it. For several years now, we are no longer forced to file down the two adjacent teeth to receive a bridge; in fact, dental implants are now the less invasive solution of choice to predictably and effectively restore function and aesthetics of a lost tooth.

A patient who is a candidate to receive a dental implant often comes to our attention with a number of doubts and uncertainties. One wonders, among other things, what the duration of the surgery will be, whether it will be painful, whether stitches will be used, whether a fixed tooth can be placed immediately, or whether there is a risk of “rejection.”

The increased availability of information has helped, even in the dental field, on the one hand to make the population more aware of treatment options, but on the other hand it might create even more confusion, especially where one is unable to distinguish the authority of sources. One may find oneself reasoning with terms that are not easily understood by the layman such as “immediate loading,” “all on four,” “guided surgery,” “flapless implants,” and “bone regeneration.”

Actually when losing a tooth one should dwell on the causes that led to its loss and what are the pros and cons in the long and in the short term. Sometimes there is a notion that replacing a lost tooth with a dental implant is a solution for life, however, implants just like natural teeth can also become diseased over time. This is why it is very important that every patient with implants is then placed within a course of maintenance therapy.

Dental implants have very high success rates, recent studies show that osseointegration, the process by which an implant “anchors” into the bone, occurs without complications in more than 95 percent of cases. However, there are factors such as untreated periodontitis, poor oral hygiene, uncontrolled diabetes or smoking, which we know negatively affect the health of the gums both around the teeth and around the implants.

For this reason, it is important to assess the general health status, health of the oral cavity, gums, and bone volume (through two- or three-dimensional radiographs), and to determine accordingly the most appropriate time and manner for each patient’s rehabilitation. There is no one-size-fits-all solution. In some cases, for some patients, it will be possible to place a dental implant with a fixed tooth on the same day as the extraction; in others, in patients with periodontitis or limited availability of bone, it may be necessary to defer implant placement only after treating periodontitis or regenerating the bone with therapies that can take up to several months.

Replacing a missing tooth with a dental implant is a highly predictable process that must, however, be experienced as a step in the journey of taking care of the health of one’s oral cavity and thus one’s body and cannot be thought of as the purchase of an item such as a car or a new smartphone.

To regain and maintain a healthy smile over the years, the replacement of a tooth with a new tooth on an implant must be part of a journey of care that begins with the first visit and continues well beyond the placement of the new tooth, through maintenance therapy and prevention.

At Anestident Specialized Dentistry, implantology is performed by highly qualified dentists who have completed advanced training programs. The timeline for placing dental implants varies depending on several factors, including the need for preparatory procedures and the number of teeth to be replaced. Typical steps in the treatment are outlined below:

Initial evaluation

During the initial consultation, a detailed examination of the teeth, gums, and jawbone is performed, making use of the latest technology such as 3D intraoral scanners and CBCT three-dimensional radiography. This evaluation allows for the determination of whether preliminary procedures, such as tooth extractions, are necessary and the creation of an individualized treatment plan. CBCT also facilitates guided surgery planning, ensuring precise and safe implant placement. We will provide detailed explanations of the procedure and answer any questions.

Preparatory Procedures

For patients who require preparatory procedures, a follow-up visit will be scheduled. During this phase, we will perform any dental extractions and bone grafting if necessary. Post-extraction healing generally takes two to three weeks. If bone grafting is required, recovery may take three to six months.

Implant Placement Surgery

The implant placement phase is completely painless because it is performed under local anesthesia (the same anesthetic used for a filling or root canal therapy) and varies in duration depending on the number of implants to be placed, which can range from just over half an hour to about 3 to 4 hours.

Osseointegration

After surgery, the implants begin a process of integration with the jawbone, known as osseointegration. This phase, which is crucial to the success of the treatment, usually lasts two to six months. During this period, we will monitor progress through follow-up visits to ensure there are no complications. In some situations, immediate loading can also be performed, which allows the crown or provisional prosthesis to be placed on the same day of surgery.

Placement of the Restoration

Upon completion of the osseointegration process, we will proceed to take digital impressions of the smile, which will be used by the dental laboratory to fabricate the customized restoration. Once the crown, bridge or implant prosthesis is completed, we will secure the restoration and verify that it fits properly. At this point you will once again be able to chew and smile comfortably having restored a functional and aesthetically pleasing smile.