Chapter 04 • Question 1

How Are Dental Implants Placed?

📺 10:00 video📖 18 min read

BDS – Dental Surgeon (GDC Reg: 83324)

Understanding how dental implants are placed helps reduce anxiety and prepares you for the procedure. While the thought of having a titanium post placed into your jawbone sounds daunting, the actual process is methodical, controlled, and typically causes less discomfort than patients expect.

The Basic Process

Dental implant placement involves surgically inserting a small titanium or zirconia post into your jawbone where a tooth root would normally be.

Anaesthetic: Local (occasionally with sedation)
Duration: 30-90 minutes per implant
Complexity: Depends on bone quality and location

Before Surgery: Planning and Preparation

Pre-Surgical Assessment

Before the actual placement day, your dentist completes thorough planning:

Clinical examination: Comprehensive assessment of mouth, teeth, gums, and bite
Medical history review: Medications, health conditions, allergies, factors affecting surgery
Diagnostic imaging: X-rays and CT scans (CBCT) create detailed 3D images showing bone density, nerve locations, and optimal positioning
Digital planning: Computer software virtually "places" the implant, creating precise surgical plan and sometimes custom surgical guides

The Day of Surgery: 9-Step Process

Step 1: Arrival and Setup (10-15 minutes)

Check-in, complete paperwork, review consent forms
Vital signs checked (blood pressure, pulse)
Review treatment plan and answer last-minute questions
Settle into surgical chair, protective coverings placed
Sedation administered if you've opted for this

Step 2: Anaesthesia Administration (5-10 minutes)

Local anaesthetic (typically articaine or lidocaine with adrenaline) injected into gum tissue around implant site.

What you feel: Initial pinch of needle, then pressure as anaesthetic is delivered. Some practices use topical anaesthetic first to numb injection site.

Waiting period: 5-10 minutes for full effect, completely numbing the area.

Reality check: This is the only uncomfortable part for most patients. Once numb, you feel pressure and movement but no pain.

Step 3: Accessing the Bone (10-20 minutes)

Incision: Small incision in gum tissue, creating flap to access bone
Flap reflection: Gum tissue lifted away to expose jawbone
Bone visualization: Dentist can see exactly where to place implant
Alternative - flapless surgery: Small punch through gum without lifting flap (only suitable for specific situations)

What you feel: Pressure but no pain. May hear instrument sounds.

Step 4: Preparing the Implant Site (20-40 minutes)

Most critical phase requiring precision:

Marking position: Exact spot marked on bone per surgical plan
Initial pilot drill: Very small drill creates initial channel, establishing position and angle
Progressive widening: Series of larger drills carefully widen channel to match implant diameter
Drilling technique: Controlled speeds (~1,200 rpm), copious sterile saline irrigation to prevent overheating, incremental depth increases
Surgical guide use: Custom guide (if created) directs drills at exact pre-planned position
Final preparation: Site cleaned, checked for sharp edges, verified correct size

What you feel: Pressure and vibration, drill and water sounds. Sensation often compared to cavity preparation but longer.

Step 5: Implant Placement (5-10 minutes)

Initial placement: Implant inserted by hand or slow-speed motor for controlled positioning
Final seating: Advanced to final position with torque wrench or slow motor
Torque measurement: Measures insertion resistance (35+ Ncm considered excellent)
Primary stability check: Assesses how stable implant is immediately—should not move with hand pressure
Position verification: X-rays may be taken to confirm optimal position and depth

Step 6: Adding Bone Graft (If Needed) (10-20 minutes)

If gap exists between implant and surrounding bone:

Bone graft material: Particulate bone placed around implant to fill gaps
Membrane placement: Sometimes collagen or synthetic membrane placed over graft
Purpose: Encourages bone growth around implant, improving long-term success
Not always needed: Many implants don't require grafting if bone is adequate

Step 7: Covering or Exposing the Implant (5-10 minutes)

Two approaches exist:

Traditional (Submerged):

Cover screw placed on implant
Gum stitched closed over implant
Heals buried for 3-6 months
Second procedure to uncover

Modern (Non-Submerged):

Healing abutment attached
Gum stitched around (not over)
Abutment protrudes through gums
No second surgery needed

Modern non-submerged approach more common in current practice

Step 8: Closing the Surgical Site (10-15 minutes)

Suturing: Gum tissue stitched back into position with dissolvable or non-dissolvable sutures
Dissolvable sutures: Dissolve over 2-4 weeks, no removal needed
Non-dissolvable sutures: Removed at follow-up 7-14 days later
Technique: Precise suturing ensures good healing and optimal gum contours

Step 9: Post-Operative Instructions and Discharge (10-15 minutes)

Bite check: Ensuring stitches don't interfere with bite
Gauze placement: Bite down gently for 30-60 minutes to control oozing
Written instructions: Medication schedule, ice application, dietary restrictions, oral hygiene, emergency contacts
Prescriptions: Antibiotics (5-7 days), pain medication, antimicrobial mouthwash
Follow-up scheduled: Next appointment booked (typically 7-14 days)
Discharge: Released to go home (transport arranged if sedation used)

Special Circumstances and Variations

Immediate Implant Placement (Extraction Site)

When placing an implant immediately after tooth extraction:

Tooth extraction performed carefully, preserving surrounding bone
Extraction socket cleaned and may need modification
Implant placed into fresh extraction socket
Gap between implant and socket walls filled with bone graft
Similar healing timeline to standard implants

Multiple Implants

When placing several implants in one session:

Each implant site prepared and placed individually
Extended surgery time: 30-60 minutes per implant
Sedation often helpful for multiple implants
More efficient than separate appointments

Immediate Loading (Teeth Same Day)

Some cases allow temporary crown attachment immediately:

Only possible when implant achieves excellent primary stability
Provisional crown made and attached same day or within days
Temporary crown kept out of heavy contact—avoid chewing on it
Immediate tooth for front teeth restores appearance instantly
Slightly higher risk than traditional approach; careful patient selection essential

What You Experience During Surgery

Physical Sensations

Pressure: Throughout procedure—normal, doesn't indicate pain
Vibration: Drilling creates vibration in jaw—unusual but not painful
Sounds: Drill sounds, water irrigation, instruments
No pain: With adequate anaesthetic, no pain. Signal immediately if you feel any
Pushing/pulling: Sensation of tissues being manipulated

Emotional Experience

Anxiety: Common beforehand—sedation available if needed
Length perception: Often passes more quickly than expected
Relief: Most report "easier than expected" or "not as bad as I thought"

After Surgery

Drowsy (if sedated): Need time to recover before discharge
Numb: Anaesthetic lasts 2-6 hours—be careful not to bite cheek or lip
Minor oozing: Small amount of blood mixed with saliva is normal for first few hours
Capable: Most patients leave under own power (unless sedated) and manage post-op care independently

💡 Key Takeaways

Dental implant placement is a surgical procedure involving drilling into jawbone to insert titanium or zirconia post
The procedure is performed under local anaesthetic, taking 30-90 minutes per implant
Pre-surgical planning with CT scans ensures precise positioning before surgery begins
The 9-step process involves numbing, accessing bone, precisely drilling the site, placing implant, and closing with stitches
Modern drills use controlled speeds with constant irrigation to prevent overheating bone
Primary stability (how firm implant sits immediately) is critical for successful healing
Most patients describe feeling pressure and vibration but no pain during procedure
Implant is either buried under gums or has healing cap protruding—dentist decides based on various factors
Bone grafting may be added if needed to fill gaps around implant
The entire appointment including setup and post-op instructions typically lasts 1.5-3 hours
Most patients report the experience was "easier than expected" with proper anaesthesia
Post-operative discomfort is generally manageable with over-the-counter pain medication

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