Same Day Dental Implants

There are two main differences between traditional and same day implants:

• there is no time without tooth for same day treatments, with traditional implants there is a 3-6 months period with missing tooth / teeth
• implant failure rate is higher for same day teeth implants

While people really don't like to spend several months with their missing teeth visible, you also have to consider the lower success rate of one day implants. Please make sure you discuss this with your dentist.

Here is a more detailed list about the differences between the two types of implants:

The procedure

Traditional implants: After implant placement in the jawbone, the overlying gums (mucosa) is sutured or a healing cap is placed. After the healing is completed - which means that the bone is fused with the implant surface - the abutment is attached and the crown is placed.

Same day implants: When we talk about same day implant, basically it means that it is loaded immediately with a crown or a bridge. The process of implant placement is same. but after its placement temporary crown is placed immediately.

The crown

Traditional implants: A permanent crown is placed directly after a 3-6 months healing period. No temporary crown is used.

Same day implants: Initially temporary crown is placed in the same day of the implant placement. Later this is replaced with a permanent crown, after the implant has integrated with the bone and achieved its final stability.

The healing period

Traditional implants: Sufficient amount of time is given to the implants to heal and to get anchored firmly in the bone.

Same day implants: As they are loaded immediately there is almost no time given for healing and osseointegration. Healing period is considered from the time of temporary crown placement to permanent crown replacement.

Bone formation, osseointegration

Traditional implants: Healing period does not disturb the bone formation at all as the forces of mastication (chewing / swallowing) have only minimal effect on the implant, since the gums protect the implant.

Same day implants: There may be disrupted healing as the temporary crown serves its function. This means the forces caused while eating are transferred to the implant through the temporary crown. This might interfere with the bone integration and lead to loose (failed) implants.

The time factor

Traditional implants: The entire procedure takes approximately 5- 6 months and may exceed even more if bone grafting or any procedure required.

Same day implants: This procedure is almost done in a day except for permanent crown placement.

Number of appointments

Traditional implants: More number of subsequent visits required.

Same day implants: Fewer number of visits.

After the surgery

Traditional implants: After the implant placement, the patient usually feels bit under confident due to missing tooth / teeth.

Same day implants: No such problem is seen as the patient leaves the chair with new tooth / set of teeth.

Success rate

Traditional implants: Success rate is higher. (around 95% - 98%)

Same day implants: Success rate is lower. Ask your dentist how often he or she does immediate load implants, experience matters a lot. You also have to follow your dentist's instructions (e.g. stick to a soft diet for 3-6 months), otherwise your implant might fail.

Same day implants are recommended when the jawbone is healthy enough with a very sound bone quality as well quantity and there is no need for additional procedures like bone grafting or sinus lifting. Because reduced bone height results in deficient bone support, resulting in failure.

The overall health and hygiene of the mouth is also an important factor determining the probability of success.

Other factors like general health, systemic diseases also plays a vital role. Healthy individual with no systemic problems are the candidates as the bone healing is relatively fast.

There are some health problems when same day implants are not recommended. These are the most common ones:

• Diabetes: Bone resorption is very commonly seen in diabetics.
• Osteoprosis: Patients with Osteoporosis. the low quality porous bones makes osseointegration slow and risky.
• Paget's disease: In Paget's disease, there is abnormal bone formation as the body tries to repair the resorbed bone. This attempt to repair massively changes the bone dimension. Usually there is unevenly increased size of upper jaw bone.

The common factor in the various bone diseases and diabetes is that they make integration of the implant with the jaw-bone slower, which increases the risk of implant failure, especially if the implants are immediately loaded.

Smoking is another major cause of impaired healing. It is strongly recommended to stop smoking before having an implant treatment.

Healthy habits fastens the healing and the success rate of implants.

For implants or root replacement, the material mostly used is the titanium and its alloys, mainly Ti-6Al-4V. This has an excellent biocompatibility (friendly with the biologic tissues, negligible chance of allergic reactions).

Nowadays, surface treated implants are available to increase the bonding and help or stimulate new bone formation in the adjacent areas.

Other materials include cobalt chromium alloys, nickel chromium alloys, stainless steel etc.

The abutment, which attaches implants and the crown, is available in titanium, stainless steel etc.

Crowns are available in zirconia, porcelain and various other types of dental ceramics. Most commonly used is zirconia as it has an excellent flexural strength 1200 Mpa, which can easily resist the heavy forces while chewing.

Zirconia is also highly esthetic. It is a tooth colored material available in various colours to match the existing dentition in the mouth.

The implants are same for both the traditional and the same day treatment. Only the procedure varies.

Some of the ommonly used implants with good results are:

• Straumann.
• Nobel Biocare (Danaher)
• Dentsply Sirona (Previously called as Astra Tech)
• Zimmer Biomet
• BioHorizons

For one day teeth implants it is recommended to choose a higher quality (i.e. usually more expensive) implant brand, as these products can make osseointegration faster, the risk of failure smaller. Don't forget that when discussing implant brands and prices with your dentist!

The procedure varies from patient to patient, depending on the number of teeth missing, the bone quality and quantity, the oral health and the general health of the patient.

Single same day implant replacing single tooth

This treatment is most often used for replacing a missing front tooth. This procedure has the highest success rate compared to other replacement treatments amongst the same day implants.

Patients with missing front tooth prefer this treatment instead of traditional implants, so that they don't have to wait 3-6 months with a missing front tooth until their implant heals.

With an experienced dentist, a quality implant and proper oral health of the patient, this treatment might be a good choice.

Single same day implant replacing 2 or 3 missing teeth

Single implant may also serve as pier abutment and cantilever bridge.

Pier abutment means that the implant placed, replaces 2 more missing teeth on either side along with the missing tooth associated with implant whereas cantilever bridge means it replaces one more missing tooth along with the missing tooth associated with the implant.

It is just like a balcony protruding from the building. Both types has higher chances of failure because there are undue stresses while chewing.

Moreover the stress imposed on all the replaced teeth are directed on the single implant directly, which multiplies the destructive forces that might make the implant unstable and loose.

Traditional bridges replacing 3 - 4 missing teeth

Three or four missing teeth in a row can be replaced with one day traditional bridge implants.

In this case two implants are placed and they can successfully replace one or two missing teeth in between.

This treatment has a higher success rate than pier abutments and cantilever bridges as they are relatively more stable. The bridge is supported by the implants on both the sides. It's also more expensive since you have to pay for two implants.

Full set of dental implants

They replace all the missing teeth in the mouth. Separate implants for placed for every tooth.

This is not used nowadays, neither in same day implant procedure nor in traditional implants procedure, because it significantly increases the treatment cost without much benefit.

There is a better option to treat such cases, see below.

All-on-4 implants

The entire dentition of one arch, upper or lower, is placed on 4 implants. Two implants are placed in each side of the arch over which the bridge is placed.

The All-on-4 technique is widely used for complete edentulous cases (no tooth in oral cavity / toothlessness).

Variation of this is all-on-6 implants, where three implants are placed on one each of the arch. All-on-6 technique is used when an additional support is required.

The most important advantage is that bone grafting can be avoided. Also the number of implants are less as compared to full set of dental implants, which makes the All-on-4 procedure cost effective.

The success of dental implants is much related to oral health maintenance and oral hygiene.

Maintaining proper oral hygiene is especially important for one day teeth implants as risk of failure is generally higher, compared to traditional implants.

On the day of implant placement

• It is advised to take a sound sleep and take proper rest.
• Avoid going at work on the same day. It is better if avoided next day too
• Avoid any kind of exercise, brisk walking or any type of intense activity.
• Food intake should be very light and healthy avoiding spicy food, carbonated drinks, hot beverages.
• Application of anypain relief spray or ointment should not be done. Proper antibiotics and pain relievers prescribed by the dentist is mandatory.
• Smoking cigarettes or cigars should be strictly avoided.

After 2-3 days of the implant placement

• Normal activities, office work and household chores can be done.
• Avoid intense work outs at the gym.
• Make sure to stick on a healthy diet plan.
• Brushing should be done very gently.

After a week

• It is advised to visit your dentist after a week even if everything is okay.
• You may even visit in between if anything makes you feel uncomfortable.
• The dentist will evaluate and tell you if everything is fine.

General care

• Proper teeth brushing: Brushing the teeth with soft bristles are recommended as they are kind enough to oral tissues and crowns and also flexible enough to adapt to the surfaces of the crowns as required which is necessary for thorough cleaning and plaque removal. It is advised to use fluoride containing toothpaste as it is prevents cavity formations and decaying.
• Mouth rinsing: Avoid alcohol based mouthwashes. Mouth rinsing helps in reducing the bacterial load and plaque in the mouth which ultimately improves the hygiene.
• Interdental cleaning: The area in between the teeth or the area of contact must be cleaned with floss, preferably unwaxed . Interdental brushes are also available for recessed gums. This improves the gingival health (health of the gums). In long term, it prevents interdental bone loss.
• General healthcare: Systemic problems and diseases like diabetes , hypertension must be controlled. Proper evaluation and treatment from time to time is important. Quitting deleterious habits : Habits like smoking, alcoholism, tobacco chewing must be stopped. This is beneficial in long term success of implants.
• Diet: During the 3-6 months healing period it is recommended to stick to a soft diet. Eating hard foods might put too large forces on the healing implant and can make it loose.

There is a lot you can do to make one day implants a success! Be sure to talk to your dentist about the things you need to do after the surgery.

For a single tooth in the United States expect to pay anywehere between $2000 and $5000. In the United Kingdom expect to pay around £1100 - £2000. So the cost of same day implants is similar to traditional implant costs.

All-on-4 with same day implants is also a common choice, that costs a lot more. In the United States costs are around $30,000, in the United Kingdom prices are around £20,000. In both cases the price is per arch.

Only the two stage surgeries, various investigations and additional procedures like bone grafting and sinus lift increase the final cost in traditional implants.

Other than this, the cost depends on the dentist's charges and location.

The cost of the entire procedure is calculated based on the number of implants and the number of crowns needed to replace the missing teeth. It is advised to get a written quotation from your dentist to know the exact cost.

Are same day implants safe?
They are safe if allowed to heal and proper care is taken as recommended by the dentist. Once the implant becomes stable, it functions just like a traditional implant.

Can implants be placed immediately after extraction?
Only if sufficient bone height is present and if it's healthy then implant can be placed immediately.

Immediate implant placement is not indicated if there is already existing inflammation which later on may cause peri-implantitis, resulting in failure.

How painful it is to get an implant placement in one day?
The procedure will be carried out under local anaesthesia and also sedation if required. This will block the pain pathways. After its effect wears off, slight discomfort may be present which will be masked by the pain relievers prescribed by the dentist.

How do I know if my implant has failed?

• The most important symptom of failed implant is mobility. The implant starts moving, loosing its stability.
• Bleeding may or may not be seen.
• Also pus discharge from the implant site is seen if associated with peri-implantitis.