What Are the Clinical Stages of Dental Implant Treatment?
Dental Implant Stages
From Planning to the Permanent Tooth
An implant is an artificial root, usually made of titanium, that is placed in the jawbone to replace the root of a missing tooth. Once it has fused with the bone, a crown, bridge or denture is fitted on top, restoring the missing tooth in terms of both appearance and chewing.
Implant treatment is not a single procedure but a series of consecutive stages. In this article we explain, in the light of clinical studies, what is done at each stage, when additional procedures are needed and how long-lasting the results are. If you would like to know about the length of treatment, the number of appointments and the healing period from the patient’s point of view, you can also read our article on dental implant treatment stages and duration.
1. Examination and 3D Imaging
Planning begins with an examination of the mouth and a review of your general health history. You will be asked about diabetes, smoking, the medicines you take and any previous treatments, and the condition of your gums and neighbouring teeth is assessed.
A panoramic X-ray and, when needed, three-dimensional tomography (CBCT) are used to measure the height and width of the jawbone and the position of the sinus and the nerve. Based on these measurements, the size and angle of the implant and the exact point where it will be placed are decided; in suitable cases, digital planning and a surgical guide are used.
If there is untreated gum disease in the mouth, this is treated first. Strong evidence shows that the risk of inflammation around the implant (peri-implantitis) is higher in people who have had severe gum disease, whose plaque control is inadequate or who do not attend regular maintenance (Berglundh et al., 2018). For this reason, gum health is an integral part of the implant plan.
2. Tooth Extraction and Implant Timing
If a tooth needs to be extracted, the timing of implant placement is planned separately. According to the consensus classification of the International Team for Implantology (ITI), there are four options (Chen and Buser, 2009):
- Type 1, immediate placement: The implant is placed at the same appointment as the extraction.
- Type 2, early placement: The implant is placed once the gum has healed, usually within 4-8 weeks.
- Type 3, early placement: Partial healing of the bone is awaited; placement usually takes place after 12-16 weeks.
- Type 4, late placement: The implant is placed after the bone has fully healed, after a period of more than 6 months.
Immediate placement shortens treatment time, but it requires careful case selection, particularly for front teeth. In studies of this method, gum recession of 1 mm or more was seen in a considerable proportion of cases (median 21.4%) (Chen and Buser, 2009). The outer bone wall of the front teeth is often very thin: one study measured a median vertical bone loss of 7.5 mm in the 8 weeks after extraction at sites with a thin bone wall (Chappuis et al., 2013). This is why timing is chosen individually, according to the structure of the bone and gum.
For options in which the implant and a temporary tooth are placed on the same day in suitable patients, see our dental implants in one day page.
3. Bone Grafting and Sinus Lift, If Needed
After a tooth is lost, the jawbone gradually becomes thinner. Studies in humans have reported that within 6 months of extraction, bone width decreases by 29-63% and bone height by 11-22%, with most of the loss occurring in the first 3-6 months (Tan et al., 2012).
If there is not enough bone, a bone graft is placed at the same appointment as the implant or beforehand. If the sinus limits the bone in the back of the upper jaw, the sinus floor is raised with a sinus lift. These procedures do not adversely affect implant success: a review of 108 studies showed, with high-level evidence, that the survival of implants in grafted sites is similar to that of implants in natural bone (Jensen and Terheyden, 2009). In sites treated with a sinus lift using the lateral window technique, the average survival of rough-surface implants was found to be 97.1% (Chiapasco et al., 2009).
When bone needs to be added, treatment takes longer; however, when properly planned, it creates a reliable foundation for the implant.
4. Placing the Implant
Implant surgery is carried out under local anaesthesia, and the patient does not feel pain during the procedure. The gum is opened (in suitable cases, without an incision), the implant site is prepared in the bone step by step and the implant is placed. The implant’s initial stability in the bone (primary stability) is measured; this value is one of the main criteria for deciding when the tooth can be loaded.
The implant is then either closed with a cover screw or fitted with a healing cap that will shape the gum. Stitches are placed if needed.
Mild swelling and tenderness may occur over the next few days; cold compresses, soft foods and the medicines recommended by your dentist make this period easier. For detailed advice, see our care after implant treatment page.
5. Fusion with the Bone (Osseointegration)
Osseointegration is the process by which bone tissue attaches directly to the implant surface and holds it firmly in place. In the conventional approach, implants were left unloaded for 3-4 months in the lower jaw and 6-8 months in the upper jaw (Esposito et al., 2013).
Because improved implant surfaces now speed up bone healing, the current ITI definition describes conventional loading as loading carried out more than 2 months after the implant is placed (Gallucci et al., 2018). If bone quality and primary stability are sufficient, the teeth can be loaded earlier, even within the first week. A Cochrane review covering 26 randomised trials reported that there was no convincing evidence of a clinically important difference between immediate and conventional loading, but that a sufficiently high insertion torque (about 35 Ncm) appears to be a prerequisite for immediate loading (Esposito et al., 2013).
6. Abutment and Impression
Once fusion is complete, the gum over the implant is shaped with the healing cap so that it resembles the gum around a natural tooth. The abutment, the part that connects the implant to the permanent tooth, is then selected or custom made.
The impression is taken with conventional impression materials or with an intraoral scanner. The permanent tooth can be planned as a screw-retained or cemented restoration; a screw-retained design allows the tooth to be removed and refitted when necessary.
7. Fitting the Permanent Tooth
At the final stage, the permanent tooth is fitted. An implant-supported crown is used when a single tooth is missing, an implant-supported bridge when several teeth are missing, and, in jaws with no teeth at all, fixed prostheses supported by four or six implants, such as All-on-4. Zirconia or porcelain fused to metal is most often chosen as the crown material; for the differences between these materials, see our article on types of dental crowns and veneers.
During fitting, the bite is adjusted and the fit of the gum around the crown is checked. At this stage the patient learns how to clean around the implant.
8. Check-ups and Long-Term Maintenance
The long-term results of implant treatment are good. In a review combining studies that followed 7,711 implants for an average of 13.4 years, survival was 94.6% (Moraschini et al., 2015), and in another review including 18 prospective studies, 10-year survival was 96.4% (Howe et al., 2019). In 20-year prospective studies, this rate is 92% (Kupka et al., 2024).
The greatest threat to an implant’s lifespan is inflammation around the implant. According to the weighted average of studies, inflammation of the gum around the implant (mucositis) was seen in 43% of patients, and peri-implantitis with bone loss in 22% (Derks and Tomasi, 2015). Regular professional maintenance markedly reduces this risk: the European Federation of Periodontology guideline reported implant survival of 99.3% in patients who attended regular maintenance and 97.8% in those who attended irregularly, and strongly recommended regular maintenance (Herrera et al., 2023). The interval between check-ups is set according to each person’s level of risk.
In smokers, the risk of implant loss is about 2.4 times higher than in non-smokers (Mustapha et al., 2022). Stopping smoking, or at least taking a break from it during the treatment period, supports success.
Frequently Asked Questions About Dental Implant Stages
How long do the implant stages take in total?
If there is enough bone and the teeth are to be loaded conventionally, treatment usually takes a few months. If immediate loading is possible, temporary teeth can be fitted within the first week. When a bone graft or sinus lift is needed, treatment takes longer. For details, see our article on how long implant treatment takes.
Is implant surgery painful?
The procedure is carried out under local anaesthesia, so no pain is felt during it. Mild swelling and tenderness may occur over the next few days; this is usually easily controlled with painkillers.
Can implants be placed if there is not enough bone?
In most cases, yes. Bone volume can be increased with a bone graft or sinus lift. The survival of implants in grafted sites has been found to be similar to that of implants in natural bone.
Can an implant be placed on the same day a tooth is extracted?
Yes, if the bone and gum are suitable; this is called immediate placement. Cases are selected carefully, particularly for front teeth, to reduce the risk of gum recession. When conditions are not suitable, a wait of a few weeks or months is needed.
Do implants last a lifetime?
In long-term studies, the vast majority of implants are still in use after 10-20 years. The most important factors that determine their lifespan are oral hygiene, regular check-ups and smoking. The crown on top, however, may need to be replaced over the years because of wear or fracture.
Does smoking affect implants?
Yes. In smokers, the risk of implant loss is about 2.4 times higher, and more bone loss is seen around the implant. Stopping smoking before treatment and during the healing period is recommended.
Sources
- Berglundh T, Armitage G, Araujo MG, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45 Suppl 20:S286-S291. doi:10.1111/jcpe.12957
- Chen ST, Buser D. Clinical and esthetic outcomes of implants placed in postextraction sites. Int J Oral Maxillofac Implants. 2009;24 Suppl:186-217.
- Chappuis V, Engel O, Reyes M, et al. Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res. 2013;92(12 Suppl):195S-201S. doi:10.1177/0022034513506713
- Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012;23 Suppl 5:1-21. doi:10.1111/j.1600-0501.2011.02375.x
- Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants. 2009;24 Suppl:218-236.
- Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24 Suppl:237-259.
- Esposito M, Grusovin MG, Maghaireh H, Worthington HV. Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database Syst Rev. 2013;(3):CD003878. doi:10.1002/14651858.CD003878.pub5
- Gallucci GO, Hamilton A, Zhou W, Buser D, Chen S. Implant placement and loading protocols in partially edentulous patients: a systematic review. Clin Oral Implants Res. 2018;29 Suppl 16:106-134. doi:10.1111/clr.13276
- Moraschini V, Poubel LA, Ferreira VF, Barboza EdS. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. Int J Oral Maxillofac Surg. 2015;44(3):377-388. doi:10.1016/j.ijom.2014.10.023
- Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent. 2019;84:9-21. doi:10.1016/j.jdent.2019.03.008
- Kupka JR, König J, Al-Nawas B, Sagheb K, Schiegnitz E. Clin Oral Investig. 2024;28:541. doi:10.1007/s00784-024-05929-3
- Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 2015;42 Suppl 16:S158-S171. doi:10.1111/jcpe.12334
- Herrera D, Berglundh T, Schwarz F, et al. Prevention and treatment of peri-implant diseases: the EFP S3 level clinical practice guideline. J Clin Periodontol. 2023;50 Suppl 26:4-76. doi:10.1111/jcpe.13823
- Mustapha AD, Salame Z, Chrcanovic BR. Smoking and dental implants: a systematic review and meta-analysis. Medicina. 2022;58(1):39. doi:10.3390/medicina58010039
ORAL AND DENTAL HEALTH POLYCLINIC
YOU MAY BE INTERESTED
TREATMENTS THAT YOU CAN RECEIVE
Implant Treatment
Porcelain Laminates
Bonding Application
Orthodontics
Ekiz Oral and Dental Health Polyclinic
We are happy to help you achieve the smile of your dreams. You can contact us at any time.
+90 212 809 47 47
Working Hours: Weekdays 09:00 - 18:00, Weekends 10:00 - 16:00
[email protected]
For any questions and appointments...
Sarıyer/Istanbul
Vadikoru, No:10/A Inner Door No:100
