Dental Implant Surgery: Steps & Stages

A dental implant treatment is not a single procedure finished in one day — it is a process made up of several stages spread out over time. In general these stages are the consultation and planning, preparation when needed (a tooth extraction or a bone graft), the surgical placement of the implant, the healing period during which the implant fuses with the bone, and finally the making of the final prosthesis with an abutment. The number of stages, their order and the total length of the treatment differ from patient to patient and are decided by the dentist after an examination; this is not a guarantee of a particular result or of an exact timeframe. Below we explain the main stages of implant surgery step by step, in plain language, so that you know what to expect in the process.

How many stages does implant surgery have?

Implant treatment can be thought of as several stages in sequence. Each stage has its own purpose, and the next stage depends on the result of the previous one — for example, the final prosthesis is only made after the implant has fused firmly enough with the bone. Some stages (such as a tooth extraction or a bone graft) are carried out only when needed and do not apply to every patient. The diagram below shows the typical sequence in general terms; your individual plan may differ depending on the results of the examination.

• Consultation and planning — an examination of the mouth, an X-ray or 3D scan, and drawing up the treatment plan.
• Preparation (when needed) — extraction of a tooth that cannot be saved, or a bone graft when the bone volume is insufficient.
• Implant placement — the surgical placement of the implant into the bone under local anaesthesia.
• Healing (osseointegration) — the period during which the implant fuses with the bone, usually lasting several months.
• Abutment and final prosthesis — fitting the abutment after healing and making the visible tooth.

1–2. Consultation, planning and preparation

The first stage is the consultation and planning. The dentist examines the mouth, assesses the condition of the teeth and the jaw bone, and most often uses a three-dimensional (3D) scan to establish the volume of bone and the position of important anatomical structures. On the basis of this information an individual treatment plan is drawn up: how many implants, of what size and in which points they will be placed is planned in advance. Sometimes preparation steps are required before the implant — for example, extraction of a tooth that cannot be saved, or a bone graft (bone augmentation) when the bone volume is insufficient. These steps do not apply to every patient; they are carried out only according to the individual need.

• Examination and imaging: a clinical examination and assessment of the bone with an X-ray or a 3D scan.
• Planning: the number, size and position of the implants are determined in advance.
• Preparation (not always): a tooth extraction or a bone graft only when needed.

3. Implant placement (the surgical stage)

The placement of the implant is usually a surgical stage carried out under local anaesthesia, meaning you do not feel pain during the procedure. The dentist opens the gum, prepares a site in the bone at the planned point and places the titanium implant into it. In many cases the implant sits firmly enough from the very first moment (this is called primary stability), but this is not always guaranteed and cannot be promised in advance at the examination. The gum is then closed with sutures, or a small healing cap (healing abutment) is fitted on top. After the procedure some swelling or discomfort is normal and is usually temporary. The surgical stage for a single implant often takes a relatively short time; the exact length depends on the number of implants and the complexity of the case.

4. Healing and osseointegration

The healing period is the stage during which the implant fuses with the jaw bone, and this fusion is called osseointegration. It is the most important, but also the most patience-demanding, part of the process, because it cannot be rushed — the bone gradually grows onto the surface of the implant and holds it firmly. Osseointegration usually takes several months, but the exact time depends on the quality of the bone, the position of the implant and individual healing characteristics; for this reason it would be wrong to give a single, universal time for everyone. In some cases, when certain conditions are met, a temporary tooth may be fitted earlier (immediate loading), but this is a separate clinical decision and does not apply to every case. Throughout the healing the dentist checks the condition of the implant.

5. The abutment and making the final prosthesis

Once the implant has fused firmly enough with the bone, the final stage begins. In this stage an abutment is fitted onto the implant — this is the connecting part between the implant and the visible prosthesis. A digital or conventional impression of the mouth is then taken, and on the basis of that impression the final prosthesis — a crown, a bridge or a removable prosthesis — is made. Finally, the finished prosthesis is fixed onto the abutment and the visible tooth is restored. So the placement of the implant and the fitting of the permanent tooth most often do not happen on the same day; the final prosthesis is usually made after healing is complete.

• Fitting the abutment: attaching the support between the implant and the prosthesis.
• Taking the impression: a digital scan or a conventional impression to make the prosthesis.
• Fixing the final prosthesis: seating the crown, bridge or removable prosthesis onto the abutment.

How long does the treatment take, and is it painful?

The total length of an implant treatment differs from patient to patient depending on the number of stages, the condition of the bone and whether preparation steps (extraction, bone graft) are needed; the longest part is usually the healing (osseointegration) period. For this reason the exact time can only be given after an individual examination, and giving a universal duration in advance is not correct. Because the surgical stage is carried out under local anaesthesia, no pain is felt during the procedure; over the following few days mild swelling or discomfort is normal and is usually managed with simple measures. For the longevity of the implant, proper hygiene and regular check-ups with the dentist are important. It is perfectly normal to discuss with your dentist how many stages the treatment will involve in your case and its approximate length.

To learn about the stages of implant surgery and an individual treatment plan for your case, contact Dr. Bakhtiyar Aliyev in Baku.

This article is for general information only and does not replace individual medical advice or examination. Consultation with a dentist is recommended for an accurate diagnosis and treatment plan.