What Happens During Dental Implant Surgery, Step by Step

Surgery is the short part of an implant. The work that decides whether it goes well happens earlier: an examination, a check of your medical history and a 3D scan (CBCT) that measures the height and width of the bone and maps the nerve in the lower jaw and the sinus above the upper teeth. Without that scan the implant position is a guess.

From the scan, the dentist chooses the implant length and width and the exact angle, sometimes using a printed guide that fits over your teeth and directs the drill. Gum disease, infection and any need for a graft are dealt with first. The bone graft guide explains when extra bone is needed before or during placement.

Tell the dentist about every medicine you take, especially blood thinners, diabetes tablets and bone-strengthening drugs. You can usually eat normally beforehand unless you have been told to fast for sedation.

The area is numbed with local anaesthetic, the same kind used for a filling or an extraction. You stay awake and can hear the instruments, but you should feel pressure and vibration, not pain. Some people also ask for oral sedation if they are anxious. Say so at the planning visit rather than on the day.

A small cut is made in the gum and the tissue is lifted back to expose the bone. In some cases a thin gum with a healthy ridge can be treated with a tiny punch opening instead of a flap, which means no stitches and a gentler recovery.

A series of drills of increasing width shapes a channel in the bone, usually with water cooling to protect the bone from heat. This is the part that sounds worse than it feels: it is loud and you feel pushing, not sharp pain. If you do feel pain, the dentist adds anaesthetic.

The implant is then screwed into the channel by hand tool or a slow-turning motor. The dentist checks that it sits firmly, which is called primary stability. Firm grip at placement decides whether the tooth can be loaded early or must wait.

A cover screw or a short healing cap is then attached to the top. A cover screw sits beneath the gum, which is stitched closed over it. A healing cap pokes through the gum, so the tissue heals around a collar shape ready for the next stage. The pieces are described in the guide to the parts of a dental implant.

The gum is stitched, often with dissolving stitches, and you bite on gauze for a short while. A single implant commonly takes 30 to 60 minutes in the chair. Several implants, extractions or a graft take longer, and a full arch can take a half day.

The sensation is pressure, vibration and the sound of the drill. You may notice a metallic taste or a feeling of being held open for a long time, and your jaw may be tired afterwards from keeping the mouth wide.

Delayed placement means the tooth is removed, the socket heals for weeks to months and the implant goes in later. Immediate placement puts the implant into the socket on the day the tooth comes out. It saves a surgery, but it needs a clean socket with no active infection, enough bone to hold the implant firmly and a gum that is healthy. It is not suitable for every tooth.

Both routes then need the bone to bond with the implant, a process called osseointegration. The healing time is similar either way.

Expect numbness for a few hours, then soreness, some swelling of the cheek and a little oozing. Bite gently on clean gauze if it bleeds, keep your head raised, use a cold pack on the cheek in the first day and eat soft, cool food. Paracetamol or ibuprofen can be used as directed on the label. Avoid ibuprofen with stomach ulcers, kidney disease, asthma that it triggers or blood thinners, and ask a doctor if you are pregnant. Do not rinse hard, spit or smoke.

What is normal and what is not is covered in dental implant side effects. Call the dentist the same day for bleeding that does not stop or swelling that keeps growing after day three. Spreading facial swelling, fever or difficulty swallowing or breathing needs same-day care, and hospital emergency care if breathing or swallowing is affected. The wider picture is on the dental implants page.