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Dental implants. Basic surgical procedure

author icon By Dr. George Ghidrai

The surgical placement of dental implants is a painless procedure that can last a variable time (from 10 min to 2 hours) depending on how many implants are inserted.

Dental implant procedure is normally performed by the oral surgeon or another specialized physician under local anesthesia. However, in some cases, general anesthesia can also be used.

Timing of implants after extraction of teeth

There are different approaches to placement of dental implants after tooth extraction :

  • Immediate post-extraction implant placement

    An increasingly common strategy to preserve bone and reduce treatment time includes the placement of a dental implant into a recent extraction site. On the one hand, it shortens treatment time and can improve aesthetics because the soft tissue envelope is preserved.

    On the other hand, implants may have a slightly higher rate of initial failure. Conclusions on this topic are difficult to draw, however, because few studies have compared immediate and delayed implants in a scientifically rigorous manner.

  • Delayed immediate post-extraction implant placement

    The implant is placed two weeks to three months after extraction. The procedure requires some type of bone grafting to create a bony base for the implant.

  • Late implantation

    The surgery is performed three months or more after tooth extraction. It is the most prudent approach ; during this time, the body will grow new bone inside the alveolar socket (where the tooth was formerly held).

Surgery technique

Most implant systems have five basic steps for placement of each implant.

  1. Soft tissue reflection

    The aim of this step is to expose the bone in the area where the implant is placed. An incision is made over the crest of bone splitting the soft tissue. The edges of tissue, each referred to as a flap are pushed back to expose the bone.

    dental implant procedure : soft tissue reflection

    soft tissue reflection

    Flapless surgery is an alternate technique, where a small punch of tissue (the diameter of the implant) is removed for implant placement rather than raising flaps.

  2. Drilling

    For this operation, specific titanium burs are utilized. A cooling saline or water spray keeps the temperature low to prevent bone damage caused by overheating.

    • To guide optimal positioning of the implants, a guidance stent can be utilized

      guidance stent during implant surgery

      guidance stent

    • Pilot holes are placed with precision drills at highly regulated speed to prevent burning or pressure necrosis of the bone

    • The pilot holes are expanded by using progressively wider drills, typically between three and seven successive drilling steps, depending on implant width and length.

      dental implant surgery : drilling


    • The last drill used matches implant dimensions (width and length)

  3. Placement of the implants

    The implant is screwed into place at a precise torque so as not to overload the surrounding bone (which may cause osteonecrosis and the failure of the implant). A specific screw-key is utilized for the operation.

    dental implant procedure : placement of the implant phase 1

    placement of the implant phase 1

    dental implant procedure : placement of the implant phase 2

    placement of the implant phase 2

  4. Soft tissue adaptation

    After placement of the implant, a specific healing device is screwed into the implant. There are 2 possible alternatives:

    • Healing abutment

      The healing abutment passes through the mucosa, and the surrounding mucosa is adapted around it.

      dental implant healing abutment

      healing abutment

    • Cover screw

      The cover screw is flush with the surface of the dental implant and is designed to be completely covered by mucosa. A second procedure would then be required to uncover the implant at a later date (two-stage procedure).

    The choice of one or two-stage procedure centers on how best to reconstruct the soft tissues around lost teeth.

    The gingiva is adapted around the entire implant to provide a thick band of healthy tissue around the healing abutment. When a cover screw is used, the implant is "buried" and the tissue is closed to completely cover it.

  5. Temporary restoration

    When the procedure is completed, a temporary restoration is constructed especially if the implants are loaded (with the prosthetic device) after more months.

    The temporary restoration will replace the missing teeth during the biological process of osseointegration (which may take more than 3 months).

After the operation

After the surgical procedure, some medication may be prescribed (depending on each case) : pain relievers, anti-inflammatory medication, antibiotics etc.

It is advisable to protect the areas where the procedure was performed in the early days after surgery. A proper and thorough oral hygiene is essential.

Most often, there are no major side effects. Bruising and swelling of the gums and face, pain, and minor bleeding are not uncommon - and not necessarily indicate that something has gone wrong. However, it's wise to keep the surgeon apprised of those symptoms.

Sutures are usually removed after 7-10 days. During this appointment, the doctor will assess the healing process.

Placement of dental implants is a surgical procedure and carries the normal risks of surgery.

Last review and update: February 2019

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