A natural tooth has two main components: the crown, which is the visible part of the tooth, and the root, which is the part of the tooth lodged in the jaw bone under the gum.

When inserted into the jaw bone, either the jawbone or the mandible, the dental implant acts as an artificial root.

A dental implant alone cannot replace a missing natural tooth. An abutment must be placed on the implant once it has been inserted into the jaw bone. Depending on the number of teeth to be replaced, an artificial crown (CEREC or laboratory), a prosthesis (removable or fixed) or a bridge will be made and installed on the abutment.

Many dental health professionals are qualified to install dental implants: dentists, oral and maxillofacial surgeons and periodontists. These professionals must have extensive training in dental implant placement to qualify as implantology specialists.

Dental implants have many advantages over other treatments involving removable prostheses:

• Implants allow the placement of fixed (that the patient cannot remove) or removable (that the patient can remove) prostheses;
• They are more comfortable and discreet than removable prostheses not fixed by implants because they do not cause unpleasant friction or movement on the gums. Some prostheses attached to implants may not even cover the palate at all;
• No unpleasant adhesives (glue) are required to hold implants in place;
• Implants offer better stability of artificial teeth, which facilitates chewing and digestion, improves comfort and facilitates patient speech;
• The patient is not forced to adapt his diet;
• Implants distribute the masticatory forces evenly between the implants and adjacent structures (gum, bone and remaining teeth) in the mouth, which helps to reduce stress on these structures. In the event that healthy teeth are still in the mouth, the patient can expect to be able to keep these remaining teeth longer than if no implants were installed and the space created by the missing teeth remained vacant;
• Implants help maintain the volume of the alveolar bone (the bone around the teeth) by preventing its resorption where the teeth are missing. Indeed, when a tooth is no longer in the mouth, the part of the alveolar bone that held it back is no longer stimulated and it gradually deteriorates;
• Implants do not require a change in the shape of adjacent teeth or the loss of part of the enamel of these same teeth to support them as in the case of a traditional bridge;
• Implants give the impression of having natural teeth, both aesthetically and functionally. The patient can therefore regain the natural features of his face that had been affected by the loss of several teeth;
• The two main components of an implant, the artificial crown and the implant itself, cannot be affected by dental caries;
• Once osseointegration is complete, implants rarely need to be replaced and therefore offer a reliable long-term solution. Despite its high initial cost, the dental implant is a good investment given its lifetime;
• The success rate of an implant procedure, over a period exceeding fifteen years, is 90% for implants placed in the maxilla and 95% for implants placed in the mandible. The difference between the success rate of the two jaws is explained by the fact that the jaw has a lower density than the mandible, which makes osseointegration a little more difficult to achieve;
• The average life span of an implant is at least ten years, and it can theoretically remain in place throughout the patient’s life. However, the life span of the crown, prosthesis or bridge installed on the implant is shorter, as is that of any other prosthesis.

The advantages of ceramic implants over titanium implants are many:

• Biocompatible and in harmony with the body;
• Do not conduct heat;
• Corrosion resistant;
• Studies conducted to date on ceramic implants have not identified any incompatibility or allergy;
• Very low risk of peri-implantitis;
• Resistant to fractures and bacterial plaque;
• Very good osseointegration quality;
• More aesthetic than titanium implants due to their white coloring.

Some disadvantages of implants:

• A certain amount of bone material is required for implant placement, which may require prior grafting;
• Additional surgery, called sinus lift, may be required before implant placement;
• Certain medical conditions may represent contraindications to implant placement;
• Dental implants require a significant monetary investment. However, it is a durable solution with many advantages as listed above.

The only disadvantage of ceramic implants, if any, is related to its relative novelty: we do not have data on the long-term effects of ceramic implants. However, due to the high biocompatibility of this material and its hypoallergenic nature, scientific studies conducted by professionals in this field suggest that ceramic (or zircon) implants could gradually replace titanium implants.

• Tilt of the neighboring teeth;
• Extrusion of the antagonistic teeth;
• Bone resorption;
• Sinus hyperpneumatization, risks and consequences of not treating

• Replacement of one or more missing teeth;
• Support for a fixed or removable complete prosthesis.

The costs to be paid for dental implants are divided into two categories:

• cost of surgery during which dental implants and abutments are inserted into the patient’s jaw;
• cost of prosthetic restoration, i.e. the fabrication of the crown (CEREC or laboratory), bridge or prosthesis that will be attached to the implant abutment.

The cost varies depending on the type of implant used and the number of implants to be implanted. The price of dental implants also differs depending on your health condition. Each patient’s situation is unique and only your dentist and/or a specialist can provide a specific cost for a treatment plan, but you can expect to pay up to several thousand dollars for dental implants. Dental plan beneficiaries may be reimbursed for some or all of these expenses based on their insurance coverage.

If necessary, surgery in preparation for implant placement (bone grafting, sinus lift) may also result in additional costs.

Some patient conditions are contraindications to implantology surgery, as the complications that may occur can be serious or even fatal. Contraindications are classified into three categories:

• absolute contraindications: dental implants cannot be considered;
• relative contraindications: dental implants can only be considered after a specific problem has been solved;
• local contraindications: dental implants can be considered with additional precautions for mouth or jaw problems.

The following blocks present a non-exhaustive list of the most frequent absolute, relative and local contraindications. It includes information about the risks of placing dental implants in these conditions, as well as possible solutions. It should be noted that only a specialist can accurately assess a patient’s eligibility for implantology, based on information gathered during the initial consultation with the patient and known contraindications.

Absolute contraindications:

• Major allergies (more specifically to anaesthetics used during surgery)
  -Risks: Increased postoperative swelling, anaphylactic shock, death.
  -Solutions: Find an anesthetic tolerated by the patient, find an alternative to conventional dental implants.
• Patient’s early age
  -Risks: Insufficient space to insert the implant into the alveolar bone, insufficient space in the mouth for the artificial crown of the implant, resumption of the procedure when growth ends.
  -Solutions: Wait until the jaws have stopped growing, which may be at 17 or 18 years of age, and find an alternative to conventional dental implants.
• Patients with a condition requiring organ transplantation
  -Risks: Post-operative infection due to long-term treatment with anti-rejection drugs that suppress or slow down the immune system, failure of osseointegration.
  -Solutions: Find an alternative to conventional dental implants.
• Immunocompromising diseases such as AIDS or patients with weakened or suppressed immune systems
  -Risks: Failure of osseointegration, postoperative infection.
  -Solutions: Find an alternative to conventional dental implants.
• Osteoporosis and other bone diseases
  -Risks: Failure of osseointegration, premature loss of the implant, jaw fracture.
  -Solutions: Find an alternative to conventional dental implants.
• Evolving cancers
  Note: This refers to cancers that are not in remission. Cancers that have been treated with biphosphonates or that have required radiotherapy treatments in the jaw area also have a contraindication.
  -Risks: Failure of osteointegration, postoperative infection, osteoradionecrosis, slower or altered healing.
  -Solutions: Cancers with radiotherapy: use rigorous asepsis during the procedure, under general anesthesia, and work with the radiotherapy team to find an alternative to conventional dental implants.
• Cardiovascular diseases (e. g. recent heart attack, valvulopathy, severe heart failure)
  -Risks: Death.
  -Solutions: Find an alternative to conventional dental implants.

Relative contraindications:

• Smoking, drug and alcohol abuse
  -Risks: Post-operative infection, much longer healing and healing time, more complex healing process, decreased effectiveness of the immune system required to fight gum and bone disease, failure of osseointegration.
  -Solutions: Stop smoking, drinking alcohol or consuming before the intervention, at least one week after the intervention and ideally throughout the recovery and even beyond.
• Pregnancy
  -Risks (for the fetus): use of local or general anesthesia, taking x-rays.
  -Solutions: Wait until after delivery to perform implant surgery.
• Poorly controlled or uncontrolled diabetes
  -Risks: Post-operative infection, development of periodontal or dental diseases, much longer healing and healing times.
  -Solutions: Control diabetes, use strict asepsis during surgery, take antibiotics before the procedure to minimize the risk of infection.
• Disease requiring anticoagulants to thin the blood
  -Risks: More heavy and uncontrollable bleeding (during and after surgery).
  -Solutions: Consult the doctor who prescribed the anticoagulants to find out if they can be stopped or modified before and during surgery, take extra precautions during the procedure to avoid bleeding.
• Autoimmune diseases (e. g. lupus, rheumatoid arthritis, etc.)
  -Risks: Post-operative infection, much longer healing and healing time.
  -Solutions: Take antibiotics before the procedure to minimize the risk of infection, use strict asepsis during the procedure.
• Some untreated psychiatric or psychological problems
  -Risks: Danger to the safety of the surgeon or patient during the procedure, patient dissatisfaction with the final result due to unrealistic expectations.
  -Solutions: Evaluate the psychiatric or psychological problem to determine if it can be controlled by medication (in consultation with the patient’s treating physician), find an alternative to conventional dental implants.
• Other diseases (e.g., severe sinusitis, seropositivity)
  -Risks: Post-operative infection, much longer healing and healing time.
  -Solutions: Wait for the disease to heal, as in the case of sinusitis, find an alternative to conventional dental implants.
• Lack of motivation of the patient to respect the treatment plan and post-operative follow-up
  -Risks: Failure of osseointegration, postoperative infection, much longer healing and healing time.
  -Solutions: Make the patient aware of the strict discipline necessary for successful dental implant placement, find an alternative to conventional dental implants.

Local contraindications:

• Insufficient density or volume of alveolar bone
  -Risks: Fracture of the jaw, perforation of the maxillary sinuses, failure of osseointegration.
  -Solutions: Do a bone graft or sinus lift before the procedure (healing time varies from a few weeks to a few months), find an alternative to conventional dental implants.
• Insufficient gum quality and/or quantity (e.g., loosening or other periodontal or gum disease)
  -Risks: postoperative infection, failure of osseointegration, premature loss of the implant.
  -Solutions: Do a gum graft (healing time varies from a few days to several weeks), treat periodontal or gum disease to stabilize or eradicate it, find an alternative to conventional dental implants.
• Bruxism (clenching or grinding of teeth)
  -Risks: Premature wear of the artificial crown on the implant or of the implant itself, failure of osseointegration.
  -Solutions: Wear braces to prevent damage to teeth and implants at night, find an alternative to conventional dental implants.
• Unfavourable position of the lower alveolar nerve and other anatomical structures of the mandible
  -Risks: Loss of sensation (paresthesia or numbness) in various parts of the face, such as the lower lip and chin, if the lower alveolar nerve is affected during the procedure.
  -Solutions: Take extra precautions before installing an implant in the mandible with 3D X-rays and other measuring tools, find an alternative to conventional dental implants in the mandible.
• Unfavourable anatomy of the maxillary sinuses
  -Risks: Perforation of the maxillary sinuses when the implant is placed.
  -Solutions: Properly evaluate the position of the maxillary sinuses and take the necessary precautions for the placement of dental implants in the maxilla, perform sinus elevation, find an alternative to conventional dental implants in the maxilla.
• Poor oral hygiene or infection of teeth adjacent to the implant site
  -Risks: Post-operative infection, much longer healing and healing time, more complex healing process, failure of osseointegration.
  -Solutions: Treat affected teeth before the procedure, treat existing dental infections, improve oral hygiene habits before the procedure.
• Lesions in the mouth (oral dermatosis)
  -Risks: Post-operative infection, much longer healing and healing time, more complex healing process.
  -Solutions: Treat the lesion before the procedure, use strict asepsis during the procedure.
• Dental malocclusion
  -Risks: Insufficient space to insert the implant into the alveolar bone, insufficient space in the mouth for the artificial crown of the implant due to teeth that have fallen into the edentulous space or an excessive eruption of antagonistic teeth in the edentulous space, premature wear of the artificial crown on the implant or the implant itself, damage to the roots of healthy teeth adjacent the implant.
  -Solutions: Do an orthodontic treatment before placing the implant.

*Orthodontic treatment is not a contraindication to dental implants. However, if a patient is considering the installation of dental implants in the presence of dental malocclusions, it is important to consult an orthodontist first. The orthodontist will be able to determine the best time to do the implantology treatment so as not to interfere with the orthodontic treatment, as a dental implant cannot be moved by any orthodontic movement. In addition, orthodontic treatment may, in some cases, prevent the need for dental implants. The patient will therefore benefit from consulting an orthodontist in the first place!

• In order to ensure that the dental implant is the best solution, a complete examination of the mouth with X-rays (in two or three dimensions) is performed;
• If necessary, a bone graft or sinus lift is performed;
• Under local anesthesia, a dental implant is inserted under the gum tissue. A healing process that generally takes 6 months will allow the implant to integrate into the bone and firmly attach itself to the gum;
• Then, an abutment to connect the replacement tooth to the implant is attached to the implant and an impression of the final crown is also taken;
• Finally, the replacement tooth (CEREC crown or laboratory crown, bridge or dental prosthesis) is fixed to the abutment;
• If several teeth need to be replaced, you have two options: you can use a single implant with several crowns welded by a bridge or prosthesis or you can use several implants with separate crowns.

A few sessions are sometimes necessary for an ideal fit of the final prosthesis on the abutment. When the replacement involves an anterior tooth, the placement of a temporary crown is combined with the installation of the implant to avoid leaving a free space in the front.

Please note that these recommendations are provided for information purposes only and that the best recommendations are those of your dentist or specialist who performed the surgery.

The following is a list of the most common recommendations from practitioners:

• Take prescribed or recommended analgesics;
• Take the prescribed antibiotics;
• Do not eat or drink during the first 2 hours after surgery;
• Wear the prosthesis for the first 24 hours (including at night). If it is a removable prosthesis, it can be removed after 24 hours to be rinsed. Put it back for another 24 hours. After 48 hours, it is recommended to wear it as little as possible;
• Avoid drinking straw, spitting and smoking;
• Avoid touching the intervention site (with fingers or tongue);
• Apply ice in 20-minute periods every hour for 24 to 48 hours;
• Avoid brushing teeth near the wound for a few days;
• Avoid intense sporting activities as recommended;
• Avoid foods that are too acidic, very hot, salty or vinegar;
• In case of bleeding, apply a sterile compress to the wound or a moist tea bag and maintain pressure for 15 minutes. When lying down, keep your head elevated by adding an extra pillow;
• If they have been used, the stitches are fragile. Some are melting, some are not. It is necessary to be informed of the specific care according to each case. It should be noted that sutures often fall off by themselves. Do not pull on the wires, do not cut them;
• The recovery period following surgery varies from person to person depending on the complexity of the surgery and how the patient complies with post-operative advice;
• Allow about two days of rest following surgery. The swelling will usually peak during this period;
• The discomfort associated with surgery often occurs within the first five days.

Dental implants require regular brushing and flossing just like natural teeth. Good dental hygiene practices will remove plaque to prevent the integration and longevity of implants from being compromised by inflammatory reactions. Regular cleaning of the implants in the clinic combined with the use of an interdental brush at home is also strongly recommended.

• Titanium implants;
• Fixed partial prosthesis (bridge);
• Removable partial prosthesis with metal or acrylic structure;
• Removable complete prosthesis.