A little bit about implants…

Implant Procedure

Before discussing the implant process timeline, it’s important you understand the components of a dental implant. There are three main components: the implant body, the implant abutment and the implant crown. The implant body you can think of as the screw that gets placed into the bone. The crown is the porcelain part that replicates the form and function of the tooth. The abutment is the part that connects the crown to the implant body.

The length of the implant process varies on a case by case basis. Factors such as the presence or absence of the tooth, density and the condition of the bone, as well as location in the mouth, dictate the duration of treatment.

If the tooth is still present and needs to be extracted prior to implant placement, the entire process takes 6 to 9 months over 4 appointments. There is an “extract and graft” phase and an “implant phase”.

Extract & Graft Phase (4 months)

The “extract and graft” phase involves the extraction of the tooth and placement of a bone graft in the extraction site. The bone graft preserves the height and width of the bone, increasing the chance of success of the implant. If it is a front tooth, we will fabricate a removable temporary before and deliver it at the end of this appointment. We need to allow the bone to heal for 4 months prior to moving on to the “implant phase”.  If the tooth has been missing for more than one year, and there is sufficient bone to house an implant, then we would move immediately into the “implant phase”, which takes 3 to 5 months over 3 appointments

Implant Phase (3 to 5 months)

Prior to placing the implant, you may need a CBCT image, which provides the dentist with a 3D representation of the implant site. Depending on how much bone you have available, it may be necessary to make a surgical guide, which helps the dentist with positioning and placing the implant during the surgery. 

The first appointment is the implant body placement. This is usually the only surgical appointment of the process. This appointment typically lasts around one hour. Most patients describe post-operative pain as mild to moderate, and can manage this pain with the medications we prescribe. Most patients are able to return to their regular day-to-day activities the next day, including work, but to be on the safe side, we recommend planning on taking it easy for a day or two after surgery. You’ll also want to avoid strenuous activity (sports, weight lifting) and alcohol for 5 days, and smoking for at least 7 days, but preferably 2 months. If you’re a smoker, this could be a great motivation to quit!

After allowing 2 to 4 months for the implant to osseointegrate or fuse to the bone, you return for the second of three appointments. We take impressions and send them to the lab so they can make the implant abutment and crown. We do not usually have to numb for this appointment, and it usually takes 30-45 minutes.

The lab will send back the crown in 2-3 weeks, and you will return for the third and final appointment, the implant abutment and crown delivery. The implant abutment and crown are screwed or cemented into place. No numbing is necessary and it takes 30-45 minutes.

Order and Explanation of Each Appointment in the Implant Process

The following list of appointments includes every possible appointment in the process; your individual case will most likely not include all of them. Refer to the Schedule of Payments by Appointment for the list of included appointments for your case. 

  1. Impressions for temporary(ies) –  If we are removing and replacing a tooth that’s visible when you smile, and you want a temporary to use during the implant process, we will first take impressions for a “flipper” temporary and, if you want a backup temporary, an Essix temporary. A flipper is a removable acrylic tooth that latches onto the neighboring teeth via pink acrylic hooks. An Essix temporary is a clear tray that snaps onto all the teeth in the arch, and white acrylic that matches your teeth fills the tray in the area of the missing tooth.    
  1. Extraction, bone graft and delivery of temp(s) – This appointment involves the removal of the tooth or teeth, and the placement of a bone graft (treated cadaver bone) in the site(s) to preserve and prepare the bone for the future implant(s). Without a graft, the ridge of bone can collapse into the post-extraction holes, compromising implant success or worse, eliminating the site as a candidate for a dental implant. In most cases, we also need to place a collagen membrane over the top of the bone graft to serve as a protective barrier. If a flipper and/or Essix temporary are a part of your treatment, we will deliver the appliance(s) at the end of this appointment.

—————————4 MONTHS OF HEALING—————————

  1.  Site evaluation after healing (only sometimes necessary) – This appointment involves the evaluation of the site and the capture of a 3D x-ray to aid in planning the implant surgery and fabricating a surgical guide. A surgical guide is an appliance the dentist uses in cases where the margin of implant placement error is too small for an unguided surgery. Some cases may only require a 3D x-ray to clarify the exact amount of available bone, while other more demanding cases will require a 3D x-ray AND the surgical guide to direct the precise placement of the implant.
  1. Placement of the implant – This appointment is the surgical placement of the implant body (the screw that gets placed into the bone and will support the crown once it has healed). If the bone into which the implant is placed is strong, a piece called a “healing abutment” is hand screwed into the implant, which is a round metal attachment that extends up to the level of the gums. If the bone is weak, this piece is left off, so that the implant can heal below the level of the gums without any forces interrupting its boney integration process. In these weak bone cases, we will need to uncover or re-expose the implant after this healing process is complete.  

—————————3 MONTHS OF HEALING—————————

  1. Implant Uncovering – This appointment is only necessary for implants that were placed into weak bone and did not have the gum-level healing abutments inserted at the end of the implant placement appointment. The implant is uncovered or exposed by reflecting the gum tissue back, and the healing abutment is now inserted into the implant. The gums are allowed to heal around the healing abutment for 2 weeks before impressions are taken. (Note: if exposing the implant was minimally invasive and bleeding can be controlled, it sometimes is possible to take the impressions the same day as the uncovering).
  1. Impressions for the implant abutment and crown – With the implant integrated and the gums fully healed, impressions are taken and sent to the lab for the fabrication of the abutment and the crown. Lab turnaround time is 2-3 weeks.

Delivery of the implant abutment and crown – The final step in the implant process is the delivery of the abutment and crown. The crown can be either screwed into or cemented to the implant

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