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A dental implant is a small titanium post placed in the jaw where a tooth root used to be. Once the bone has grown onto it, a crown is attached, and the result is a tooth that stands on its own, with the neighboring teeth left untouched. Implants replace a single tooth, several teeth in a row on an implant bridge, or all the teeth in a jaw with a fixed bridge or a snap-on denture. At Vizcaya Dental Arts Dr. Flavio Kottar does the assessment, the 3D planning, the surgery and the crown, so one clinician is responsible for the whole result.
Implants are not right for every mouth. They need enough space, enough bone and healthy gums, and they are planned around the final tooth.
Should the tooth be saved first?
Before we talk about replacing a tooth, we talk about keeping it. A tooth that can be predictably restored with a filling, a root canal and a crown, or gum treatment is usually worth saving.
There is one situation where we may suggest replacing sooner: when a failing tooth is slowly taking the bone around it with it. If keeping the tooth for another year or two would leave less bone and a worse foundation for the implant, waiting makes the eventual result worse. We show you what we see on the X-rays and the scan and explain which way the balance tips in your case.
Who is a good candidate
At the consultation we look at four things:
- Gum health. Active gum disease needs to be treated first. The bacteria that cost people their teeth are just as capable of causing inflammation around an implant.
- Bone and space. The implant needs enough bone around it in every direction, and the gap needs room for a crown that looks and functions like a tooth. If a tooth has been missing for years the bone may have shrunk, and some cases need grafting before or during placement.
- Soft tissue. The gum around the implant has to be healthy and thick enough to look natural and stay stable, which matters most for front teeth.
- Your health and habits. Smoking and poorly controlled diabetes make implants more likely to fail. Neither is an automatic no, but we discuss them, because we do not want to place an implant that is likely to be lost. Oral hygiene matters most of all: patients who struggle to keep their teeth clean are at higher risk of peri-implantitis, the infection of the gum and bone around an implant.
How we plan an implant
We take a CBCT scan, a three-dimensional X-ray of the area, and assess the bone, the position of nerves and sinuses, the neighboring teeth and the gum. Then we plan backwards from the tooth you will end up with: where the crown needs to sit for your bite and your smile decides where the implant goes. Because Dr. Kottar both places the implant and makes the crown, the plan does not pass between a surgeon and a dentist.
Replacing a front tooth
With a front tooth the result is judged by the gum:
- Whether it follows a natural curve
- Whether the small triangles of gum between the teeth are preserved
- How much of this shows when you smile
When a front tooth has to be removed, our usual preference is to place the implant at the same visit. In suitable cases we use partial extraction therapy, or socket shield, in which a thin sliver of the root is deliberately left in place against the outer bone to help preserve the gum contour. It is technique-sensitive and not right for every tooth, and we have had good results with it in selected cases. When a front tooth has been missing for some time, there may be extra steps to rebuild bone or gum before the implant can be placed.
For front teeth we usually make a temporary tooth, on the implant or over the gap, so you are not without a tooth while the bone heals. For back teeth a temporary is rarely needed, though it can be done.
Replacing back teeth and short spans
Most of the implants we place replace a single back tooth, often a molar lost to a crack or an old failed root canal. One implant, one crown, and the teeth either side are left alone.
When several teeth in a row are missing, you do not need an implant for every tooth. Two or three implants on a side can carry a fixed bridge that restores the chewing surface, and we do this routinely for patients who have been missing back teeth for years. Whether a conventional bridge on your own teeth would serve you as well is part of the same conversation; when the bone is poor, it often does.
What the treatment involves
- Step 1 of 5 Consultation and 3D scan
We examine the area, take a CBCT scan and discuss whether to save or replace the tooth. If an implant is right, we plan its position around the crown you will end up with and give you a written estimate.
- Step 2 of 5 Extraction and placement
If the tooth is still there, it is removed. In many cases the implant is placed at the same visit; in others the site heals first, sometimes with a graft. Placement is done with local anesthesia, with sedation available.
- Step 3 of 5 Healing
The bone grows onto the implant over roughly three to six months. You eat normally on the other side. Front teeth usually have a temporary during this time.
- Step 4 of 5 The final tooth
A small connector, the abutment, joins the crown to the implant. Nearly all of our crowns are screw-retained, which means we can remove them for maintenance without cutting anything. The crown is tried in, adjusted and checked for fit, contact and bite.
- Step 5 of 5 Maintenance
Regular cleanings and checkups, with an X-ray of the implant now and then, so that any problem is caught while it is small.
The whole sequence usually takes between four months and a year, depending on healing and on whether grafting is needed. We give you a realistic timeline for your case.
When more teeth are missing
Single teeth and short spans are most of what we do. If you are missing most or all of the teeth in a jaw, two other options use implants:
- An implant-supported denture snaps a removable denture onto two or four implants.
- A fixed full-arch restoration, sometimes called All-on-4, uses four to six implants per jaw to hold a complete set of fixed teeth. It is an excellent option when none of the teeth can be saved, and not something we recommend while teeth can still be kept.
Looking after an implant
An implant needs the same care as a natural tooth:
- Brush it.
- Clean between it and its neighbors with floss or a small brush.
- Keep your regular cleanings, with an X-ray of the implant now and then.
An implant cannot decay, but the gum around it can become inflamed, and once that reaches the bone it is hard to reverse. Looked after, it can last the rest of your life.
Frequently asked questions
Does getting a dental implant hurt?
The implant is placed with local anesthesia, so you feel pressure and vibration but not pain. Most patients describe the days afterward as easier than they expected, with soreness managed by ordinary over-the-counter pain relief. If dental visits make you anxious, nitrous oxide and oral sedation are available.
How long does the whole process take?
From the first visit to the final crown, usually between four months and a year. The implant needs several months to fuse with the bone before the tooth is attached. Cases that need grafting, or that start with an extraction and a healing period, take longer; some front-tooth cases where the implant goes in at the time of extraction move faster.
Can the implant be placed the same day the tooth is removed?
Often, yes, and for front teeth this is usually our preference because it protects the shape of the gum. It depends on the bone, the gum and whether there is infection. Placing the implant immediately does not mean a permanent tooth goes on it immediately; the crown still waits for the bone to heal.
Am I too old for an implant?
Age by itself is not the issue. What matters is healthy gums, enough bone to hold the implant, your general health and your ability to keep the area clean. We place implants for patients well into their later years.
What if I smoke or have diabetes?
Neither rules an implant out, but both raise the risk of the implant failing, so we talk about them honestly. Well-controlled diabetes is very different from poorly controlled diabetes, and cutting down or stopping smoking around the surgery and healing period makes a real difference.
Who does the surgery and who makes the tooth?
Dr. Kottar does both here in the office: the planning, the placement and the final crown. One clinician is responsible for the whole result, and the crown is designed before the implant is placed, not after.
How long will an implant last?
With good hygiene and regular checkups an implant can serve for the rest of your life, but that is not guaranteed. Implants tend to fail for the same reasons teeth do: gum disease, poor cleaning, smoking and uncontrolled medical problems. Looking after the gum around the implant is what protects it.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. Journal of Dentistry. 2019;84:9-21. DOI
- Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. Journal of Dentistry. 2015;43(5):487-498. PubMed
- Naujokat H, Kunzendorf B, Wiltfang J. Dental implants and diabetes mellitus: a systematic review. International Journal of Implant Dentistry. 2016;2:5. PubMed
