Dental Implants: Types, Procedures And How They Work

The dental implant, which has traditionally been a small titanium or titanium-alloy screw that a dentist inserts into the jawbone, serves to hold a custom-made dental crown in place. The Food and Drug Administration has since approved zirconia implants for use as well. Zirconia, a hard white ceramic material, has grown significantly in popularity in the last five years.

If there isn’t sufficient bone to support the implant, you’ll need a bone graft. Bone deficiency can be due to aging, gum disease, injury or other causes. If the implant is going into the upper jaw, the bone around the sinuses needs to be built up, potentially requiring the patient to undergo a sinus lift beforehand.

Dental implants aren’t suited for children whose facial bone structure is still developing, although older teens can have them done. Implant surgery is also less likely to be successful in smokers and people who take immunosuppressive drugs or have just undergone head or neck radiation therapy, have uncontrolled diabetes or are nighttime teeth grinders. (Your dentist can assess whether you’re a teeth grinder, a condition known as sleep bruxism, because of the telltale damage it causes).

When all circumstances are ideal, it is possible to have an implant placed immediately after a non-restorable tooth is extracted. But for the most part, patients should expect that the process to receive dental implants can take as long as a year to complete because it involves multiple procedures, and you need to heal from each one before moving on to the next.

Here are the steps you can expect to undergo for a dental implant surgery:

1. Dental exam: Before the implant process begins, your dentist needs to conduct a thorough exam. One of the big improvements since the early days of dental implants is the use of 3D imaging employing a CT scan. Not having to rely solely on two-dimensional X-rays helps the dentist better assess your dental health, especially the bone that will support the implant.
2. Removal of tooth or teeth: The next step is the removal of the tooth or teeth that will be replaced. This is usually done by an oral surgeon, although there are dentists who specialize in implantology and do the entire process start to finish.
3. Bone graft: If the initial exam shows you don’t have sufficient bone to support the implant, your dentist will need to perform a bone graft, where bone is harvested from elsewhere in your body and added where it’s needed. There are also synthetic and natural donor bone options.
4. Insertion of implant: After that heals, your dentist drills into the jawbone and puts the implant itself into place. This also requires a period of healing afterward (if the bone graft is minor, these two surgeries may be performed at the same time). The implant is essentially an artificial tooth root, so it needs to be anchored deep into the bone, just as a natural tooth is. As you heal from the implantation and bone grows around the new implant—a process known as osseointegration—you will wear a temporary, removable denture to cover the gap where your original tooth was taken out.
5. Abutment added: After two or three months, when enough bone has grown in to stabilize, the part of the implant that will hold the crown in place—the abutment—is added, and the gum area is closed around its edges. Now, the gum needs to heal, which can take four to six weeks.
6. Crown inserted: In the final step, the crown is put in place. Your crown is custom manufactured to match the color, shape and size of your other teeth. This is done by making molds or digital impressions of your existing teeth and jaw after the abutment is placed.

Does Dental Implant Surgery Hurt?

Some procedures involved with dental implants can be painful, although no more so than a root canal. Usually patients are given local anesthesia and sometimes a sedative. You can expect to be sore for a few days afterward. You will need to avoid hard or crunchy foods until all the procedures are complete and the new crown is securely in place.

Even in healthy candidates, possible complications from the required surgeries include infection of the implant site, damage to other teeth or nerves in the mouth, and, with upper jaw implants, problems caused by the implant entering the sinus cavity above it.

How to Take Care of Dental Implants

“Caring for a single implant is just like taking care of a regular tooth,” says Matthew R. Young, D.D.S., a diplomate of the American Board of Oral Implantology and a fellow of the American Academy of Implant Dentistry. “You brush it, floss it and see a dental hygienist every six months.”

However, Young notes, “When you get into full-mouth reconstruction, that’s different.” He recommends using a water flosser to clean under the bridge—a custom-made structure that supports the teeth. He also advises seeing a hygienist who has experience cleaning dental implants, since the procedures and tools are somewhat different than for natural teeth.

For would-be implant candidates with special issues such as very limited amounts of supporting bone, there are other options. Here are several you may encounter.

Zygomatic Implants

For those with severe bone deficiencies, there is a type of long implant that anchors in the upper facial bones, known as a zygomatic implant (the zygoma is the cheekbone). This method is used when the entire set of upper teeth need to be replaced, not for individual teeth.

It can also be more affordable than individual implants because multiple teeth are supported on only four posts. However, it carries the risk of additional complications, so choose your dental practitioner carefully.

All-on-4 Implants

The trademarked All-on-4 procedure uses only four standard implant posts to anchor a full-arch bridge in place (that’s eight implants total for a full mouth). While this option is generally faster and more affordable, the prosthetic bridge is bulkier and less responsive than natural teeth and more akin to wearing traditional dentures.

Mini and Short Implants

Mini and short implants are exactly what they sound like: skinnier (mini) or shorter versions of a standard implant. They may be employed when there is bone deficiency, but the trade-off, says Young, is “the success rate isn’t as high.” He recommends sticking with a standard implant if at all possible.

From start to finish, dental implants cost $3,000 to $4,500 a tooth, estimates Levin. For an entire mouthful of implants, the price tag could amount to $60,000 to $90,000.

The wide price range of dental implants is due to the variety of mouth conditions. Some people may need additional procedures like a bone graft or sinus lift, others will not.

Dental implants have a long track record of success, but once in a while, they do fail when the bone doesn’t grow in strongly enough around them. That means your dentist will have to remove the implant and try again after waiting a few months. Generally, if the implant failure is in the first year or so, the dentist will do the repair free of charge.

However, at that point, you may also want to consider other options, like a conventional bridge to replace one or several missing teeth or dentures, which are “false teeth” to replace all upper and/or lower teeth.

Elani HW, Starr JR, Da Silva JD, & Gallucci GO. Trends in Dental Implant Use in the US, 1999-2016, and Projections to 2026. Journal of Dental Research. 2018;97(13):1424-1430.

Abraham CM, Suppl 1: A Brief Historical Perspective on Dental Implants, Their Surface Coatings and Treatments. The Open Dentistry Journal. 2014;8:50–55.

Moy PK, Medina D, Shetty V, Aghaloo TL. Dental implant failure rates and associated risk factors. The International Journal of Oral & Maxillofacial Implants. 2005;20(4):569-77.

Implants vs. dentures and bridges. American Association of Implant Dentistry. Accessed 05/10/2021.

Pierall S, Kohal RJ, Jung RE, Vach K, Spies BC. Clinical outcomes of zirconia dental implants: A systematic review. Journal of Dental Research.2017;96(1):38-46.

An alternative for severe bone loss of the upper jaw. American Association of Implant Dentistry. Accessed 05/10/2021.

Mini Implants vs. Standard Dental Implants: What Is the Difference? American Association of Implant Dentistry. Accessed 05/10/2021.