What happens when a patient undergoes dental implant surgery?

What Happens During Dental Implant Surgery

Dental implant surgery involves the surgical placement of a titanium post into the jaw bone beneath the mucosal layer, which then osseointegrates (forms a tight immobile bond) with the surrounding bone over a healing period, followed by attachment of prosthetic components to restore function and esthetics. 1, 2

Immediate Surgical Procedure

Pre-Surgical Assessment

• Advanced radiographic imaging (CBCT) is obtained to determine exact height, width, and contour of the alveolar ridge, and to identify critical anatomical structures like maxillary sinuses and mandibular canals 3, 1
• The surgeon confirms bone wall integrity and adequate bone volume at the implant site 4
• A surgical template may be prepared to ensure ideal implant positioning 4

Surgical Steps

• The implant osteotomy (bone preparation) is performed, often using a flapless approach in ideal conditions to minimize tissue trauma and reduce post-surgical morbidity 4
• The titanium implant is positioned with specific spatial requirements: at least 2 mm gap between the implant shoulder and the internal aspect of the facial bone wall, and the implant shoulder placed just apical to the mid-facial bone crest 4
• Any gaps between the implant and bone are filled with bone graft material (such as deproteinized bovine bone mineral) to reduce post-surgical bone resorption 4
• An absorbable hemostatic gelatin sponge may be packed into gaps to protect the graft, secured with sutures 4

Post-Surgical Timeline and Healing

Immediate Post-Operative Period (Week 1)

• Patients typically experience soft tissue edema (swelling) but should report no significant adverse events 4
• A provisional crown may be placed immediately in esthetic zones, constructed to be free of occlusal contacts 4

Bone Healing Phase (8 Weeks)

• The implant must undergo an 8-week bone healing period before prosthetic rehabilitation can begin 5
• During this period, osseointegration occurs as osteoblasts grow and directly integrate with the titanium surface 1, 2

Prosthetic Restoration Timeline

• At 8 weeks post-surgery, the implant should be exposed and a provisional crown placed immediately for soft tissue conditioning 5
• The definitive crown should be placed 4 months after the provisional crown, meaning total time from implant placement to final restoration should not exceed approximately 6 months 5
• At 10 weeks, marginal soft tissues should be healthy with no complications reported 4

Long-Term Outcomes (1 Year)

• Marginal tissues remain healthy with shallow probing pocket depths and absence of bleeding on probing 4
• The mid-facial mucosa level should be similar to adjacent natural teeth 4
• CBCT imaging confirms presence of thick, intact facial bone wall with the facial bone margin coronal to the implant-abutment junction 4

Critical Pitfalls to Avoid

Timing Errors

• Never leave an implant without prosthetic restoration beyond the 8-week bone healing period, as this risks inadequate soft tissue conditioning and suboptimal emergence profile development 5
• In esthetic zones (anterior maxilla), provisional crowns cannot be skipped as they are essential for proper soft tissue maturation 5

Surgical Positioning Errors

• Facial malposition of the implant must be avoided at all costs, as this is a common mistake that presents a significant risk factor for mucosal recession 4
• Failure to maintain the 2 mm gap between implant and facial bone wall can lead to increased oro-facial bone resorption 4

Infection Risk

• Implants that become infected are colonized by subgingival species including Porphyromonas gingivalis, Bacteroides forsythus, and Fusobacterium nucleatum 2
• Chronic implant infections can cause inflammation, suppuration, and pain requiring urgent treatment 4

Patient Function and Quality of Life

• Dental implants restore function to near normal in partially or completely edentulous patients, providing permanent restorations that do not interfere with oral function, speech, or self-esteem 3, 6
• The osseointegration process allows implants to support crowns, bridge abutments, and removable dentures with stability comparable to natural dentition 2, 7