Dental implants, explained

What an implant actually is

A dental implant is a three-part replacement for a missing tooth:

1. The implant itself — a small screw-shaped fixture, most commonly made of medical-grade titanium (sometimes zirconia), placed surgically into the jawbone where the missing tooth's root used to be.
2. The abutment — a connector piece that emerges through the gum.
3. The restoration — the visible crown, bridge, or denture attachment that sits on top of the abutment.

The implant fuses with the surrounding bone in a process called osseointegration, which usually takes between three and six months depending on the site and the bone quality. Once osseointegrated, the implant functions like a tooth root and can support a replacement tooth that bites, chews, and looks like a natural one.

The 2017/2018 World Workshop produced an international consensus on the classification of implant-related conditions; the conceptual vocabulary in this article aligns with that classification.¹

Who is a candidate

The decision is not made by reading. A specialist consultation establishes candidacy based on:

• Bone volume and density at the proposed site (assessed clinically and with imaging — usually a CBCT scan for anything beyond a single straightforward implant).
• Periodontal status of the remaining teeth. Active periodontitis must be controlled before implants are placed; uncontrolled gum disease worsens implant outcomes.³
• General health. Uncontrolled diabetes, certain medications (notably some bisphosphonates and antiresorptive agents used for osteoporosis or cancer), heavy smoking, and a history of head-and-neck radiotherapy all change the risk profile and sometimes change the recommendation.
• The patient's commitment to maintenance. Implants that are not cleaned and maintained can develop peri-implantitis — a gum-disease-equivalent around an implant — which is one of the leading causes of implant failure. In a large Swedish population study, 45% of patients had peri-implantitis (bleeding or suppuration with bone loss greater than 0.5 mm) nine years after treatment, and 14.5% had moderate-to-severe peri-implantitis (bone loss greater than 2 mm) (Derks et al., 2016).⁴ The patient's willingness to maintain home care and attend follow-ups is part of candidacy.

How the procedure is sequenced

A typical single-implant case has three to four stages over four to nine months:

1. Planning

A consultation, a CBCT scan (where indicated), photographs, sometimes models or a digital scan of the mouth. The specialist plans the implant position digitally, choosing the diameter, length, and angulation that match the available bone and the planned final restoration. The plan is shared with your general dentist or prosthodontist so the restorative design is agreed before the surgery.

2. Surgical placement

Performed under local anaesthetic (intraoral injection), usually with the option of conscious sedation for anxious patients. The procedure for a single implant in a healed site takes 45 to 75 minutes. Most patients return to normal activities the next day; soreness and swelling are normal for the first 48–72 hours and managed with simple pain medication.

If the site needs bone grafting (because there is not enough bone for the implant), the grafting can sometimes be done at the same visit and sometimes needs a separate preceding visit with several months of healing in between.

3. Healing (osseointegration)

Three to six months in most healed sites; sometimes shorter in selected immediate-loading scenarios; sometimes longer in poor-quality bone or grafted sites. The implant integrates with the bone during this period. The patient wears a temporary tooth replacement where the gap is visible.

4. Restoration

Once osseointegration is confirmed, your general dentist or prosthodontist takes an impression (or a digital scan), the laboratory makes the final crown (or bridge, or denture connection), and the restoration is fitted. The patient leaves with a functional, natural-looking replacement.

What the published survival data actually shows

A systematic review of long-term studies with at least 10 years of follow-up found a pooled implant survival rate of about 94.6% and a pooled success rate of about 89.7% at 10 years (Moraschini et al., 2015).² These figures reflect cohorts of patients in research-grade follow-up and may not match real-world outcomes in all populations. Critically, survival (the implant is still in place) and success (the implant is in place, functioning, and free of peri-implant disease) are different metrics; this is why the success figure (89.7%) sits below the survival figure (94.6%).

Implants are not lifetime guarantees. The most consistent predictors of long-term success are:

• Specialist surgical placement (correct positioning, correct loading).
• Controlled periodontal status at the time of placement.
• Non-smoker or former smoker.
• Patient compliance with home care and maintenance recalls.

The most common reasons for late implant failure are peri-implantitis (gum-disease-equivalent around the implant) and mechanical complications (loose screw, fractured restoration). Both are managed in coordination between the surgical placer and the restoring dentist.

What specialist placement adds

A periodontist is one of two dental specialties (the other being oral and maxillofacial surgery) for which implant placement is core surgical training. The case for specialist placement:

• Diagnostic depth. A periodontist plans the site in three dimensions, considering the implant position not just for surgical convenience but for the final aesthetic and biomechanical outcome years later.
• Soft-tissue management. Periodontists are trained to manage and graft the gum tissue around an implant — important for cosmetic results in the front teeth and for long-term peri-implant health.
• Bone grafting. Most complex bone-augmentation procedures are within periodontal and OMFS scope.
• Coordination with restoration. The implant position is dictated by the planned crown; a periodontist works back from the restoration plan to position the implant, not the other way around.

The honest framing: a well-trained, experienced general dentist can place straightforward implants successfully. For complex cases (compromised bone, aesthetic zones, multiple implants, full-arch restorations), specialist placement materially changes the outcome distribution.

This pillar links to four detailed L3 pages: what a dental implant is, dental implant cost in Pretoria, periodontist vs general dentist for implant placement, can dental implants fail, and what All-on-4 is.