Dental Implant is a surgical procedure to replace a missing tooth root and fused with the bone providing a fixed or permanent foundation or support for crown, bridge(s), or dentures. The back of the lower jaw has the highest success rate of dental implantation and osseointegration because it is denser than the posterior (back) section of the upper jaw.

The pre‐operative protocol covers a review of the patient’s medical history and recording of the vital signs such as pulse rate. The patients will pre‐rinse with chlorhexidine solution to reduce the bacterial load. Subsequently, the patient should be anesthetized, typically with maxillary infiltration of both the buccal and palatal, and/or a mandibular block.

Steps in surgical procedure for a simple implant

  1. Create access
  2. Perform osteotomy
  3. Place the implant
  4. Site closure

Access to the Bone

There are two approaches to creating access, namely flap reflection or a surgical punch (flapless).

  • Flap reflection

The flap reflection allows the surgical site to be visible, easy to access, and accurate positioning for implant placement. But the reflected tissue must be sutured back in place after implant insertion.

  • Surgical punch

A surgical punch is a simpler process for an experienced dentist to gain access to the cortical bone surface. But, it necessitates accurate location of the cut hole on a first‐time basis. The tissue punch removes keratinized gingiva.


Performing the Osteotomy

Three basic steps are important in performing the osteotomy (surgical cutting or removal of bone) regardless of the mode of access:

  • Center the osteotomy
  • Establish the length of the osteotomy
  • Establish the width of the osteotomy

Osteotomy procedure

  1. Establish the center of your final restoration
  2. Purchase point made with a high‐speed surgical bur
  3. Center B‐L, M‐D
  4. Establish the length (implant depth)
  5. Length is established with a locator drill (sharp‐tipped drill)
  6. Use radiographs to check angles
  7. The most common implant body length is 10mm.
  8. Establish the width
  9. Width is based on the width of bone and on the tooth to be restored
  • Anterior 3.2–4.7mm width
  • Premolar 3.7–4.7mm width
  • Molar 4.7–7mm width

Surgical Procedure

Step 1

  • An initial bone incision is made with a locator drill to a depth of 6–8mm.
  • After taking a radiograph and carrying out an analysis to check the accurate positioning of the hole using a locating indicator, the locator drill is then used to drill to the full length (depth) required for the implant, typically 10mm.

Step 2

  • The initial osteotomy in soft bone is progressively widened using osteotomy drills of increasing diameter.
  • Coarser thread and heavier-duty drills are used for dense bone.
  • Toto maintains a clean (saliva‐free) work siworksiteevent burning and possible bone necrosis, the osteotomy site is continuously irrigated with sterile saline solution. Ideally, the osteotomy should be isolated from saliva to prevent contamination.

Step 3

  • Remove the implant body from its packaging and insert it into the prepared site using the provided carrier.
  • After initial placement, torque the implant/ carrier in place with the torque driver.
  • Remove the carrier and, after reviewing the positioning and placement, fine-tune positioning: the implant platform should be flush with the bone level or 0.5–1mm below the bone level.
  • Note: The torque wrench should be set to 50Ncm. If the implant cannot be inserted to the required depth (10mm and at the bone level or 0.5–1mm below the bone level), back the implant out and use the corresponding dense bone drill to widen the osteotomy. It is important to not over‐torque the implant to place.

Step 4

  • Insert the healing abutment or cover screw with driver to 15Ncm and suture the reflected flap tissue in place.
  • Note that it is important to maintain the buccal keratinized tissue accomplished at the initial flap design

When suturing the flap, some dentists recommend the use of Cytoplast Polytetrafluoroethylene (PTFE) suture material, since this material is found easy to handle and passes through tissue easily without snagging or tearing.

Time‐Line for a Simple Implant

  1. Surgery
  2. Two‐week follow‐up with radiographs and, if necessary, suture removal.
  3. Impressions. These are taken at six to eight weeks post‐surgery.
  4. Delivery of the crown at 10–12weeks post‐surgery

Postoperative Protocol

  • Eating or other potential trauma to the operative site should be avoided: adjacent teeth may be brushed but not the surgical site for at least 48hours.
  • Antibiotic may be prescribed, typically Amoxicillin 500mg, TID, for five to seven days provided the patient is not allergic
  • Chlorhexidine rinse BID for 10days.
  • Warm salt water rinses after meals.
  • Pain medications: recommend or prescribe as determined by the patient medical history. Typically, ibuprofen 600–800mg is sufficient for most healed site implant placement procedures.
  • Schedule a two‐week follow‐up appointment


The most basic surgical requirement for implant placement is having adequate bone volume and quality. The rule of 6’s illustrates that a patient should have a minimum of 6mm of bone in all dimensions as well as 6mm of interocclusal space. Consult your dentist if you are suitable to have dental implantation.



Dental implants can significantly improve the quality of life and the health of a person who needs them.

Below are some of the advantages and disadvantages of dental implants.

Advantages of Dental Implants

  • Dental implants look and feel like natural teeth and replace missing or newly extracted ugly teeth.
  • Dental implants are designed to fuse with the bone.
  • Slip-free. Dental implants are bone-supported dentures making them slip-free and fit perfectly. Thus, do not cause awkward speaking tones or discomfort when talking. A patient can laugh with no worry if the implant will fall.
  • Sliding dentures can be uncomfortable during mastication. Dental implants function like your natural teeth, comfy and painless.
  • Dental implants eliminate the discomfort of removable dentures.
  • Dental Implants can replace the natural teeth and comfortably perform mastication just the same.
  • Self-esteem. Dental implants are a replacement for your missing teeth. A new set of teeth can boost confidence especially when socially interacting.
  • Oral health. Individual implants replace missing teeth, filling the gap created by tooth loss. Preventing food debris from getting stuck and dental problems from developing.
  • Implants are very durable and will last many years. With good care, many implants last a lifetime.
  • Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.
  • Helps keep the jawbone from shrinking due to bone loss
  • Preserves the health of the surrounding bone and gums. Dental implants don’t require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your teeth are left intact, improving long-term oral health.
  • Helps keep the adjacent (nearby) teeth stable. When a gap is left by a missing tooth, the surrounding teeth tend to shift because that tooth is no longer helping to keep everything in line.
  • Improves quality of life

Disadvantages of Dental Implants

  • Damage to surrounding natural teeth during implant placement
  • Injury to the surrounding tissues during surgery, such as sinus perforation
  • Injury during surgery (for example, fracture of the surrounding jawbone)
  • Inadequate function, such as feeling like the teeth do not bite together normally
  • A sensation that the tooth is loose or twisting in place resulting from an abutment screw loosening
  • Implant body failure (looseness of the implant body)
    • due to systemic infection, which may be more likely in patients with uncontrolled diabetes
    • due to local infection in bone and gums supporting the implant body
    • due to delayed healing, which may be more likely in patients who smoke
  • Difficulty cleaning the gums around the implant, resulting in poor oral hygiene
  • Untreated periodontal disease
  • Post-surgical numbness due to nerve impingement or damage
  • Always notify health care providers and imaging technicians that you have dental implants before any magnetic resonance imaging (MRI) or x-ray procedures. Dental implants can distort or interfere with these images. FDA is not aware of any adverse events reported for MRI or x-ray procedures with dental implants.

In some cases, the disadvantages of dental implants outweigh the advantages, especially if you have medical concerns that make surgery difficult. You may decide against getting dental implants for the following reasons:

  • Dental implants may require supplemental procedures. Before the actual dental implant process, procedures like oral surgery and bone grafting may be recommended first depending on the clinical situation of the patient. If your teeth have been missing for a long time you may undergo bone grafting. These procedures are an additional expense of getting dental implants and lengthening the dental implant process.
  • Dental implants are expensive. A dental implant procedure is more expensive than tissue-supporting dentures. The whole expense of dental implants is rarely covered by health insurance.
  • Dental implants require surgery. Getting dental implants is a more invasive process than getting a bridge or denture since it requires oral surgery. We may conclude that the risks of dental implant surgery exceed the possible benefits if you have health issues that put you at a higher risk for complications or infection.
  • Dental implants have a longer, 4 to 8 months, treatment time.
  • Regular maintenance is required.


It is important to present the pros and cons to the patient. Sometimes disadvantages may outweigh the advantages if you have other health issues. To understand better, it is recommended to consult your dentist directly for more in-depth information.