How do dental implants stay in place?

        I am not sure if you may know, but when you lose one of your permanent teeth, you can replace it in various ways, one of which is inserting a dental implant. In order to place a dental implant into either your maxilla or mandible, there are two methods. First, and more commonly used, the gingiva/gum is cut where the implant will be placed, the flaps are pulled back and a hole is drilled to place the implant in. Then, the oral surgeon places the implant into the hole and stitch the gum tissue back together. The second way is via a surgical guide--one of newer technologies of dental implants that is often used for precision and quicker healing time. If this method is used prior to the implant placements, the patient will have a 3-D scan of their skull so that the prosthodontist can visualize the maxilla and mandible on a specialized program that allows the prosthodontist to select the angle/degree and location that the implant will be put into the bone. Once all necessary parameters are met, a surgical guide is created. A surgical guide is similar to a dental retainer, however, thicker and with holes where the implants will go. Before having the implants placed, the patients will have to remove the ailing teeth if necessary. The patient then puts on the surgical guide, and two nails are used to hold the guide into place. Rather than cutting the gums, as was necessary in the first technique, the oral surgeon can drill directly into the holes that are established on the surgical guide. The implants are then placed and the healing time is cut in half. Pretty neat stuff!

I was curious, however, as to how the implants remain in place. From the drilling, the implants do not fit perfectly in all the grooves, so why don’t they fall out? The answer is osseointegration--the ability for the bone in our jaw to fuse around the implant, securing it in place. Since most implants are made of titanium, a bio-compatible metal, it allows the bone to fuse directly with it.  Osteoblast cells migrate to the location of the implant to begin building bone that was lost to drilling. The actual bonding of bone to the implant happens on the most outer surface of the implant since this is there titanium is oxidized. The oxidized layer attaches strongly to the bone. This strong bond allows for the it to be secure into place and function as would a normal tooth.

Alexander H, Ricci JL, Hrico GJ. 2009. Mechanical basis for bone retention around dental implants. Journal of Biomedical Material Research: Applied Biomaterials. 88:306-311.