10-14 days after surgery.....................
  4-6 weeks after surgery .....................
  3-6 months after surgery.....................

Impressions 
Molds of the teeth and jaws are also necessary.  Using these impressions, the dentist will then make plaster-like models so he or she can plan the treatment and make surgical guides.  Such surgical guides help the surgeon to properly place the implants.

In addition, a psychological test may be given.  This provides the dentist with insight into particular personality problems a person may have that could cause the treatment to be less successful than expected.

Surgery
Once you and your dentist have that implant therapy is right for you, the examination has been done, and you dentist has chosen the appropriate implant system, surgery will be scheduled.  The surgical treatment is usually performed in one or two stages depending on the implant system chosen by your dentist.

The surgery may be performed in an office setting with local anesthesia and perhaps mild sedation.  Or, it can be performed in a hospital setting with general anesthesia.  A sterile environment and gentle and cautious surgical procedure are essential to success.  If the surgery is performed in a hospital, a one-night stay in the hospital after the procedures may be required.

Stage 1 surgery 
During the first operation, implants will be placed into the jawbone, underneath the gum tissues.  They will stay "buried" under the gums for a healing time - from 3 to 6 months. ( In the upper jaw and back part of the lower jaw, complete healing usually takes longer.)

Some implants are not buried; they are left uncovered during the healing period.  With these implants a second surgery is not required, but a healing period of 3 to 4 months is still necessary. 

The day after surgery, you can expect some swelling of the gums in the area of implant placement.  You may also be able to feel the sutures (Stitches) that were used to close the incision.  The gums may be discolored as they start to heal.  When you had teeth removed before, you probably remember the pain experienced; the immediate discomfort at this time will likely be similar or less pronounced.  Medication can be used to lessen the pain.


Within 4 to 5 days, the initial swelling will be gone and the surgical area will be less painful.  The denture that you may have been wearing can be lined with a soft material and placed back in your mouth to improve your speech and appearance.  You should be able to return to work or resume normal daily activities comfortably by this time.

If the stitches closing the wound have not come out on their own by this time, you dentist or surgeon may remove them after 10 to 14 days.

You must not use your denture to chew solid foods until your dentist says you can do so.  The ability of your mouth to successfully accept implants depends on their not being disturbed during the first 4 to 6 weeks after surgery.   A soft diet must be continued during this period.

  Stage 2 surgery   (For those implant types requiring a second surgery)
.
The second stage of surgical treatment can usually be done on an outpatient basis in a dental office setting 3 to 6 months after the implants have been placed.  The surgeon will numb the area of previous surgery with a local anesthetic to make you more comfortable.  The gum tissue is then opened in the area of the implants to expose them. Extension posts called abutments, are attached to the implants. (Eventually your new teeth will be attached to these abutments.)  At this time, the implants are examined to be certain of their firmness and integration with the bone.  The gums are then put back in place around the abutments and suture (stitched) closed.  Protective caps are screwed onto the abutments, and a surgical packing or your old denture with a soft lining is then placed over the abutments to help the gum tissues heal and to lessen discomfort.

At this phase of treatment, the dentist will want to determine that osseointegration has been achieved and that the abutments are firmly and accurately attached to the implants.  This requires and X-ray

Several days after the abutments are attached, the surgical pack can be removed.  If you are wearing a denture with a temporary lining, your dentist will continue to refit the lining to keep your mouth comfortable. 

As with the stitches place in your first surgery, those used to close the soft tissues during abutment connection will usually come out by themselves within 10 to 14 days.  If not, or if a non-dissolving type of material is used, your dentist or surgeon will remove them.

At least several days after the abutments have been attached to the integrated implants, impressions are again make of your mouth.  Plaster-like models of the jaws and any teeth that you may still have can then be made from the impressions.  The new replacement teeth (bridge or denture, also called a prosthesis) will eventually be made on these models.

If no natural teeth are present, bite records are made on temporary denture bases with wax rims. Artificial teeth are arranged on the bases so that the correct position of the teeth can be determined in your mouth.

A metal frame work is then made, and the artificial teeth are attached to this framework in the previously determined positions.

This whole assembly of framework and teeth will be tried in your mouth to see how it fits and looks.  When the teeth look satisfactory and function properly, the prosthesis is completed.

At last, the final prosthesis is secured on the abutments with small screws ( or in situations where natural teeth also remain, with dental cement).  This is called a fixed prosthesis

The final fixed prosthesis (bridge) is shown above in place in the mouth.  Note that abutment posts are not visible when you smile.

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