Dental Implant Process in Malaysia

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Upper picture shows implant with a titanium healing abutment, lower pic shows a PFM Crown installed on the dental implant
Upper picture shows implant with a titanium healing abutment, lower pic shows a PFM Crown installed on the dental implant

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You have completed your clinical evaluation and made the decision to have dental implants . The day of your surgery is approaching. You will probably be enthusiastic about getting new teeth, but also a little nervous about the surgery. These feelings are normal. Most patients have some anxiety about the surgery. As previously stated in the overview of dental implants, the three stages for a standard procedure are: the implant surgery, abutment connection, and the final restoration, or receiving your permanent crowns. This process can vary depending on whether all your appointments are with one doctor at one dental center, or whether you will be seeing more than one specialist in different offices.

Stage 1: Implant Surgery

Preparing for dental implant Surgery

It is recommended that you wear loose clothing so that you will be comfortable during the procedure. If you are having intravenous (IV) sedation or general anesthesia, plan to have a responsible adult drive you to and from the doctor’s office. You are not permitted to drive a car or operate power equipment for a period of at l least 24 hours following sedation or general anesthesia. You and your surgeon should have discussed any medications you take daily. In some cases, you may have been advised to discontinue a medication prior to surgery. Just prior to your surgery, you will be given a long-acting local anesthetic, sedation or anesthesia.


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Undergoing dental implant Surgery

The surgical procedure may take from one to several hours, depending on the number of implants being inserted. In most cases, you will be seated in a dental chair. It is important that the surgery be done under sterile conditions. The surgical equipment l used during your procedure is sterile, and the implant is provided to your surgeon in a sterile container. The surgical assistants will have a special sterile drape which they will use to cover you. You can expect your hair to be covered and a sterile drape placed over your clothes. The implant team will also be wearing sterile gowns and gloves, as well as hats and masks.

The surgery begins with the surgeon making small incisions at the top of the gum line. The gum tissue is lifted, exposing the jawbone. The surgeon uses a series of tiny drills to make small holes in the bone.

With the holes in place, the surgeon inserts the implants. At this time the surgeon will decide whether to submerge the implant under the gum or to leave it protruding through the gum with an attached healing cap. If the surgeon chooses to not use the healing caps, he or she will place a tiny protective cap atop each implant. These are referred to as cover screws. The gums are then closed with sutures, submerging the implant in gum tissue.

After dental implant Surgery

After your surgery, ice will be applied to the outside of your jaw to help reduce swelling. The surgical staff may take x-rays of the surgical site so the doctor can examine the placement of your implants. This will allow the doctor to evaluate the position of the implants and will be helpful in planning the next stage of treatment. 

Most patients are ready to go home about thirty minutes after the surgery. Before leaving the doctor’s office, you will be given a list of instructions to follow for taking medications, eating, and applying ice to the treated area. The numbness in the gums usually lasts from two to four hours.

If you’re having multiple teeth replaced, you may be without teeth for the next seven to ten days. Why can’t you wear a temporary denture? A denture could place pressure on the gums, causing the sutures to break open. The implants must not be disturbed during the early stages of bone healing. If they move during this healing phase, osseointegration will not occur and the implants may be lost.

In some cases the surgeon may have been able to close the incisions tightly enough to permit the patient to wear a removable denture with a soft liner. If a denture is used it is for cosmetic rather than functional or chewing purposes. No pressure should be placed on the healing incisions. You’ll be asked to return to the clinic in seven to ten days to have your sutures removed

Recovering at Home

Once home, you will need to rest. You may be sleepy from the medications you received. If you were sedated, you should have someone stay with you until you are fully alert. While groggy, you may be prone to falling. You should not drive a car or operate any machinery immediately after your surgery.

During the first day or two at home, if you should have symptoms such as high fever, excessive bleeding, increased swelling, or excessive pain, call your doctor immediately. High fever, for example, could be a sign of infection in the bone, although infection is rare if antibiotics are being taken as directed.

Medications for dental implant Surgery

After surgery, your gums and mouth may be numb for several hours. However, as the numbness of the anesthetic wears off, you may need medication for discomfort. Prior to your surgery your doctor will have given you a prescription, to be taken as you need it. The medication may be a codeine-based tablet or other type of narcotic. Some individuals find they can manage with a milder non-aspirin, over-the-counter analgesic.

You will also be given antibiotics as a precaution to minimize post-operative infections. And you may also be given a prescription mouthwash. These mouthwashes, which are referred to as antimicrobials, help kill bacteria. Gargle with the mouthwash as directed. Antimicrobials often have an unpleasant taste, but they help keep the tissues healthy.

Control of Minor Bleeding

Slight bleeding is not unusual after removal of teeth or following implant surgery. If you should have light bleeding, bite gently on gauze packs for thirty minutes. Remove the gauze, wait a few seconds, and see if any bleeding continues. If bleeding stops, place water-dampened gauze at the surgery site for another thirty minutes. If bleeding has stopped, no further gauze is necessary. If application of gauze does not stop bleeding on a second try, double wrap a tea bag with slightly dampened gauze and gently bite on it for forty-five minutes. Tea contains tannic acid, which can help blood clot.

X-ray shows implants in lower jaw.
X-ray shows implants in lower jaw.

Eating after dental implant surgery

Drink only liquids until the anesthetic have worn off. Proper nutrition after surgery is vital. The result of not eating correctly is fatigue, headache, dehydration, and delayed wound healing. However, you must eat only soft foods during the first several days after surgery. Avoid foods that must be broken with your teeth-hard foods such as nuts, raw vegetables, and meats that require more chewing. Many patients are comfortable with such foods as well-cooked chicken, fish, or pasta. Some individuals prefer to chop food in a blender during the first several days. Others prefer cold foods and tepid soups. Drink at least four glasses of fluid daily.

Swelling and Bruising

After surgery, some patients experience bruising and swelling. However, the tendency to do so varies with each individual and is difficult to predict. Black and blue marks on the jaw and cheek may occur. These will fade in seven to ten days.

To control swelling, apply an ice pack to the outside of your jaw for the first twenty-four to thirty-six hours. Apply the ice pack for twenty minutes, then remove it for ten minutes to avoid injury to the skin. In place of an ice pack, a bag of frozen peas or other small vegetables may be used.

You may eat ice cream, sherbet, or any very cold liquid to aid in reduction of swelling. It’s recommended you sleep on your back, with your head elevated. This helps minimize swelling by preventing lymph fluids from collecting around your jaw.

Hygiene after Implant Surgery

On the third day following surgery, gentle salt water rinses or the rinses prescribed by your doctor are permitted up to four times daily. Crushed ice or ice water may be held in your mouth. Do not vigorously rinse or spit out the ice. Either swallow the water or let it gently run out of the mouth. Do not brush areas with sutures. Use of a water jet, set to a low pressure, is helpful. Use the water jet to clean around your natural teeth, avoiding the surgical site.


Post-Surgical Guidelines

Avoid heavy rinsing for 48 hours following surgery.

Do not drink from a straw.

Do not smoke until the implants are uncovered.

Do not apply heat to the surgical area.

Do not drink very hot beverages for 48 hours after surgery.

Do not brush the areas adjacent to sutures.

Do not drink carbonated beverages for 48 hours after surgery.

Do not blow your nose hard for 48 hours, if surgery was in the upper jaw and sinuses.

Do not skip any meals.

Do not wear removable appliances until the sutures are removed or unless instructed to do so by your doctor.


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Postoperative Visits

Patients are generally asked to return to the doctor’s office in seven to ten days after surgery. Depending on how you are healing, your sutures may be removed at this time; or, you may be asked to return in a few days for suture removal.

Stage II: Abutments and Crown Preparation

Three to six months after implant insertion, the implants are firmly rooted in jawbone. It’s time to attach the abutments, the devices that are placed on top of the implants to hold the crowns. 

Surgery to Connect Abutments

The surgeon who inserted your implants may also perform your abutment connection surgery. For this procedure, you will receive a local anesthetic to the gum area over the implants. If the healing caps have not been used, a small incision is made in the gums to expose the implants and the cover screws. Once the implants are clearly visible, the surgeon will remove the cover screws and then place the abutments into the implants. To ensure that the abutments are attached properly, the surgeon uses both manual pressure and an electronically controlled device to tighten them. The abutments are now ready to serve as the foundation for your new teeth, whether it is a bridge, denture, or even a single crown.

In some cases, the incision to expose the implants may require several sutures. This can be accomplished either before the temporary teeth are fastened to the abutments or immediately after.

Abutments, which will hold the crowns, have been attached to the tops of this patient’s implants
Abutments, which will hold the crowns, have been attached to the tops of this patient’s implants

After Abutment Surgery

Immediately after the abutments are connected, ×-rays will be taken assure that the abutment cylinders are properly placed. These x-rays are important to document the status of the implants and surrounding bone. These x-rays also serve as a basis for comparison of the bone structure in the years ahead.

After the abutment surgery, most patients report little discomfort. However, your gums may be tender to the touch for five to ten days. You should have very little swelling; some individuals have slight swelling of the lips or cheeks, but this is usually short in duration. In a standard procedure, you will probably be given a denture with a soft lining to wear until your final teeth are ready.

You May See Another Doctor

In some cases, the doctor who performed your surgery will also be responsible for the fabrication of your crowns. However, if your surgeon does not make your restoration he or she will refer you to another restorative dentist or prosthodontist, who will fabricate your new teeth. 

Taking dental implant Impressions

After the abutments are in place, it’s time to prepare for your final crowns by having impressions made of your teeth and gums. As you’ll recall, you also had a set of impressions made during your clinical evaluation; however, those impressions were mostly for diagnostic purposes. This time the dental staff will take master impressions from which your final set of teeth will be made. Taking these impressions had to wait until they could include the shape and location of the abutments.

The impression is used to create the master cast on which the implant prosthesis is constructed. This impression records the precise position of the implants as they appear in the mouth.
The impression is used to create the master cast on which the implant prosthesis is constructed. This impression records the precise position of the implants as they appear in the mouth.

How are the dental implant impressions made?

First, a U-shaped mouth tray filled with a putty-like impression material is placed over the implants and any remaining teeth. Once the impression material has set, the tray is removed from the mouth. Now that the dental lab technicians have an exact impression of your teeth and jaws, they can pour a master stone cast. This cast precisely replicates the position of the implants in the mouth. 

With the master cast made, the dental technician will make the metal framework that will hold the new teeth. The framework should be ready in about two weeks. You will be asked to schedule an appointment with your dental specialist to verify that the framework fits well. It will be screwed into place and x-rays will be taken to make sure the framework fits the abutments correctly. New computerized technology allows the frame to fit the abutments with extremely high precision.

Temporary acrylic teeth fabricated in the dental lab are ready for the patient.
Temporary acrylic teeth fabricated in the dental lab are ready for the patient.

Hygiene after Abutment Surgery

Gentle brushing around your prosthesis and abutments  is recommended if you have sutures. Cleaning between the implants may begin after the sutures are removed. You may be prescribed an antimicrobial mouthwash to use in the morning and at night.

Stage III: The Restoration

In the restoration phase, the new teeth are fabricated and fitted to the abutments. The time required by the dental lab to complete the construction of the new teeth will depend on whether a single tooth or bridge is being fabricated. This time may vary from one to two weeks or as long as six to eight weeks. Once the teeth are ready, the dental specialist will attach them to either an implant- supported bridge or denture.

Once your new custom- made teeth are attached to the abutments, they will be examined for shape, size, color, and fit. Your bite will be evaluated to make sure your upper and lower teeth are aligned. If necessary, your teeth will be adjusted.

Dental professionals create a natural look with prosthetic teeth by carefully selecting the right shade of white for the crowns.
Dental professionals create a natural look with prosthetic teeth by carefully selecting the right shade of white for the crowns.

Follow-up Visits for dental implant

You’ll be asked to return to the clinic in about a month, at which time the doctor will check the tightness of the prosthetic screws-the small screws that hold the teeth onto the abutment. In addition, several visits may be required to analyze and adjust your bite.

Using Night Guards

Many people clench or grind their teeth while sleeping. For those with implant-supported teeth, a night guard (mouthpiece) commonly called an occlusal guard, helps prevent fracture and wear of the teeth that may occur from grinding teeth during sleep. The guard is worn over your prosthesis. Similarly, a removable denture should not be worn during the healing phase; clenching the dentures could injure the implants.

Your doctor will probably take photographs and x-rays to use as a reference for checking for any future damage to your prosthetic (or natural) teeth from night grinding.

Post-Treatment Instructions for dental implants

To ensure long-term success of your treatment, it is imperative that you keep your follow-up appointments and establish a daily hygiene maintenance routine. At your follow-up appointments, your doctor will reassess your bite, determine the stability of the prosthetic teeth, assess the condition of the gums, and evaluate bone tissue around the supporting structures. If you have an occlusal guard, be sure to take it with you to your follow-up visits.

If you detect any pain or loosening of your implant teeth, contact your dentist immediately, Eating with a loosened bridge will lead to screw fracturing and may destroy your implant-supported teeth. This may actually lead to loss of your implants.


Summary for dental implants in Malaysia

Standard Implant Process

Before having dental implants, you will need a thorough evaluation by a dentist. The evaluation should include an oral examination, full-mouth x-rays, diagnostic casts, and photographs. This evaluation should be done less than six months prior to surgery.

Stage I Surgery

• Implants are placed in jaw

• Swelling disappears 4 to 7 days after surgery

• Sutures are removed 7 to 10 days following surgery

• Soft diet is recommended during the first 4 to 6 weeks

• Osseointegration occurs in 3 to 6 months

Stage II Surgery

• Implants are uncovered 3 to 6 months later

• Implants are checked for osseointegration

• Abutments are placed; gum tissue is sutured closed

X-rays are taken

• Impression of mouth is done for final prosthesis

o Temporary prosthesis is made

o Sutures are removed 7 to 10 days later

o Metal framework is tested for fit

Stage III The Restoration

• Final prosthesis is completed and placed onto the implants

• Adjustments are made

o X-rays are taken

Follow-up Care for dental implant

Oral hygiene maintenance is performed at three to six month intervals following placement of the final prosthesis. Regular and fastidious oral hygiene maintenance is the key to the long-term success of dental implants.


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