What Happens During the Dental Implant Process, Start to Finish?

What is a dental implant, actually?

It's three separate parts, and that's where a lot of the confusion starts. There's the implant itself, a post that sits in your jawbone where the tooth root used to be, made of titanium or other materials. On top of that sits the abutment, which is a connector. And on top of that is the crown, the part you can actually see. That's worth knowing, because the post can be in and finished while you're still months away from having a tooth.

What happens at the first visit?

Nothing gets done to your teeth. You're examined, you have x-rays taken, and we have a conversation. We start with regular x-rays, and when we need a closer look, a three-dimensional scan shows us the bone, where your sinus sits, and where the nerve runs. Almost everything I tell you afterward comes off that information.

Does anything have to happen before the implant goes in?

Sometimes, and this is where timelines stretch. If the tooth is still there, it comes out. If there isn't enough bone to hold an implant, we may need to add some first, and that can add months before the implant goes in. Not everybody needs it. But if you do, you're counting in months, not appointments.

What happens on the day of implant surgery?

The area is numbed, and if you're nervous, talk with us about comfort options beforehand. That's a conversation rather than a default. The implant goes into the bone, and then one of two things happens, which is the part almost nobody explains. Sometimes the gum is closed over the implant while it heals, and it's uncovered later with a small second step. Other times the implant sits through the gum from day one, so no second step is needed.

What are the first few days like?

Some swelling, bruising and soreness is normal. What surprises people is the timing. Swelling usually peaks around the second day, not the first, so there's a stretch where it can feel like you're going backward when you aren't. In studies, most people describe the pain as mild to moderate. Soft food for a while. And if your pain is getting worse instead of better after the first few days, call us.

How long does an implant take to fuse to the bone?

This is the long part, and nobody warns you how quiet it is. The American Dental Association, the American Association of Oral and Maxillofacial Surgeons, and the FDA all describe the bone bonding to the implant as taking up to several months, and sometimes longer. It just sits there, knitting into your jaw, and you wait. It's the longest stage of the whole thing and the least eventful, and it's where most people lose track of where they are.

Is a full arch different from a single tooth?

The stages are the same. If it's one tooth, what I've described is basically it: one implant, one abutment, one crown. A whole arch is a different animal. The International Team for Implantology recommends a minimum of four well-distributed implants to support a one-piece full-arch bridge, and a large review found similar survival with fewer than five implants compared with five or more.

The bigger difference is what goes on top, because there are two kinds, and they aren't the same thing to live with. One is fixed, meaning you can't take it out yourself. The other is an overdenture, which you do take out to clean. Both sit on implants, both get called implant teeth, and which one you're being offered is something to settle before anybody starts.

On timing, with the conventional approach, the implants heal for more than two months before the final teeth go on them.

How does the final tooth get made?

Once the implant has fused, the tooth gets made. We take a scan or an impression, place the abutment, and then the crown. If yours was one of those cases where the gum was closed over the implant, the uncovering happens just before this. For a lot of people, this last part is an anticlimax, and I think that's worth saying out loud. After all those months, the finishing is a couple of short appointments. The hard part was the waiting.

Do dental implants need maintenance?

Yes. Implants aren't fit and forget. Large research reviews estimate that roughly one in five implant patients develops peri-implantitis, which is inflammation with bone loss around an implant. An international workshop of gum and implant researchers found strong evidence that the risk goes up with a history of severe gum disease, poor cleaning around the implant, and no regular maintenance care. For full-arch implant teeth, the American College of Prosthodontists advises maintenance visits every two to six months based on your risk, with x-rays every year or two.

So that's the real deal you're making. Not a procedure with a finish line, but a tooth that needs looking after, the same as the one you lost did. If you're somewhere in the middle of this and nobody has laid it out for you like that, here at our Manalapan office, that's what the consultation is for.