Everything about dental implants, how it works, possible complications

What is dental implantation?

Dental implantation is a modern method of restoring lost teeth, which guarantees high aesthetics, reliability and durability. In this article, we explain what dental implantation is, how the procedure is performed, possible complications, and important post-treatment recommendations.

Dental implantation is a procedure in which an artificial root, known as an implant, is placed into the jawbone to replace a missing tooth. A crown or prosthetic restoration is then placed on the implant, restoring chewing function and the natural aesthetics of the smile.

Dental implantation is not only a functional tooth replacement but also an effective way to maintain overall oral health. It prevents damage to adjacent teeth, prevents bone atrophy and ensures a natural-looking smile.

Advantages of implantation compared to other prosthetic methods

Dental implants have many advantages over traditional methods such as dental bridges and removable dentures:

• Preservation of adjacent teeth

When installing a bridge prosthesis to replace a single missing tooth, the adjacent healthy teeth must be ground down, which can damage them and increase the likelihood of caries development. Implantation, on the other hand, does not affect the adjacent teeth, so they remain intact.

• Durability of structures

Statistics confirm that implants installed according to all the rules can last more than 15–20 years, while the average service life of bridges is about 10–15 years, and removable dentures — only 5–7 years.

• Restoration of natural chewing function

Implants transfer chewing pressure directly to the bone tissue, similar to a natural tooth, ensuring natural functionality.

• Prevention of bone tissue atrophy

When a tooth is missing, bone is gradually lost. An implant stimulates bone tissue (through loading), preventing its atrophy. Removable dentures, on the other hand, do not have this property. It has been confirmed that tooth loss leads to a 25% loss of bone volume within the first year after extraction. Implantation helps to stop this process.

• Aesthetics and naturalness

Modern implants with ceramic crowns are virtually indistinguishable from natural teeth. This is crucial for both aesthetics and the patient’s psychological comfort.

The main types of dental implants

A wide selection of implants allows dentists to tailor the optimal treatment for each patient, considering their unique anatomy, financial capabilities, and aesthetic preferences.

Modern technologies and materials ensure successful implantation and long-lasting results.

Fixation directly into the bone is considered the most durable and stable implantation method. Unless contraindicated, this approach is preferred. Other implant types are used only when bone issues arise, such as thinning, severe atrophy, or conditions like osteoporosis.

• Implants are classified according to their method of attachment:
• Endosteal implants (intraosseous)

These are the most common type of implants, which are placed directly into the jawbone. They are screw-shaped, cylindrical or conical. After healing, an abutment and prosthesis are placed on the implant.

• Subperiosteal implants (subperiosteal)

These implants are placed under the periosteum but above the jawbone. They are used when bone tissue volume is limited and the patient either does not want or cannot undergo bone grafting (augmentation).

• Zygomatic (cheekbone) implants

Due to their considerable length, these implants can be fixed in the zygomatic bone, which allows dental prostheses to be installed even in cases of severe atrophy of the upper jaw.

• Intramucosal, microimplants.

They are used as additional supports during orthodontic treatment.

• Based on the material used in their manufacture, implants are classified as titanium or zirconium. Both types of implants demonstrate high survival rates. Titanium implants have a 10-year survival rate of approximately 95–99% in patients, which is why they are considered the gold standard Titanium implants are more mechanically stable and resistant to stress, while zirconium implants are rarely used because they are brittle.
• Dental implants are divided into several main types based on their shape and design. This classification is important because the shape determines the stability of the implant, its engraftment and durability.
• Screw implants

The most common type of implants in modern dentistry. Their design includes a thread that performs two important functions:

• ensures primary mechanical stability immediately after installation;
• promotes better osseointegration, as the thread increases the contact area with the bone.

The shape of the thread is also important: it can be narrow, wide or multi-profile (e.g. triangular or trapezoidal) to adapt to different bone densities.

• Cylindrical implants

These implants are cylindrical in shape with no pronounced threading or with a minimally textured surface. They are less common in practice because they do not provide as much initial stability as screw implants. They are mainly used in cases where conditions allow the implant to stabilise thanks to careful fitting into the prepared socket.

Cylindrical implants used to be much more common, but today they have been almost completely replaced by screw implants due to the latter’s greater reliability.

• Plate implants

They are shaped like narrow plates. They are designed for cases where the jawbone is very narrow and standard implants cannot be installed without additional bone grafting (augmentation) procedures.

Due to the smaller area of contact with the bone, these implants have a higher risk of rejection compared to screw implants.

The choice of implant shape is always individual and depends on:

• bone tissue volume (height and width of the alveolar ridge);
• bone density (bone tissue types according to Lekholm & Zarb);
• implant location (chewing area or smile area);
• the patient’s general condition.

By number of installation stages

In modern dentistry, there are two main approaches to dental implantation:

• Single-stage (immediate) implantation

This method involves placing an implant immediately after tooth extraction, provided that there is sufficient bone volume for reliable fixation. A temporary crown and abutment can be placed on the implant just 2–3 days after the procedure. Many patients dream of such a quick recovery, because a new tooth can be obtained in just one or two visits. However, for a successful result, there should be no inflammatory processes in the oral cavity, and the bone tissue should have sufficient density and thickness. Only if there are no contraindications will the dentist recommend this option.

• Two-stage (classical) implantation

This is the traditional method, which is considered the safest and most versatile. First, the implant is screwed into the jawbone, where it gradually takes root over a period of 4–6 months. After that, the dentist shapes the gums and installs an abutment to complete the structure. This approach guarantees a high percentage of implant survival and is suitable in most cases.

Classification of implants according to the number of units used for prosthetics is key to choosing the optimal treatment:

• Single implants

Used to replace a single missing tooth. The implant is placed in the jawbone in the place of the missing tooth, after which a crown that mimics a natural tooth is fixed onto it.

• Bridge prostheses on implants

Used to replace several adjacent missing teeth. Implants are placed in the spaces of the missing teeth and serve as a support for a bridge that restores the intermediate teeth.

• Full dentures on implants

They are used to replace the entire dentition on the upper or lower jaw. Depending on the clinical situation, 4 to 8 implants are installed, which serve as a support for fixing a complete denture.

Who is the ideal candidate for implantation?

1. Individuals with missing teeth or partial/complete loss of teeth.

Implantation is the optimal solution for such patients. Dental implants restore chewing function and aesthetics and preserve the health of the jawbone, preventing its atrophy.

2. Patients with healthy and sufficient bone tissue.

For successful implantation, a strong and voluminous jawbone is required, which will be able to integrate the implant (osseointegration). If there is insufficient bone tissue, preliminary bone augmentation or the use of special types of implants (zygomatic, subperiosteal) may be required.

3. Patients without serious contraindications, namely:

• uncontrolled diabetes mellitus
• severe cardiovascular diseases
• active inflammatory processes in the mouth (periodontitis, gingivitis)
• immune system disorders
• taking certain medicines (e.g. bisphosphonates)
• smoking (in large quantities)

These factors can significantly reduce the chances of successful osseointegration and increase the risk of complications.

4. Пацієнти віком старше 18 років.

Implantation is performed after the jawbone has finished growing (usually after the age of 18), but there is no upper age limit, provided that the patient is in good general health.

5. A patient who is prepared for responsible care and regular visits to the dentist.

Age restrictions and other risk factors

• Minimum age

According to the consensus of the European Association for Osseointegration (EAO) and the American Academy of Periodontology (AAP), implantation is performed only after the jaw has finished growing — usually after 18–20 years of age. This is important in order to avoid further migration of the implant due to bone growth.

• Upper age limit

Implantation is possible in elderly patients if their general health permits. Studies show that even patients aged 70+ can have a high success rate with the right selection of indications.

Main risk factors

• Smoking

Smoking increases the risk of osseointegration failure and the development of peri-implantitis (inflammation of the tissues surrounding the implant). Nicotine constricts blood vessels, reduces blood supply and slows down healing.

Smokers have approximately twice the risk of implant loss.

• Chronic diseases
• Diabetes mellitus (especially uncontrolled) slows down healing and lowers immunity, increasing the risk of infections and implant rejection.
• Osteoporosis and other bone diseases can reduce implant stability.
• Cardiovascular disease or anticoagulant therapy requires additional consultation with a general practitioner or cardiologist prior to implantation.
• Poor oral hygiene

Poor hygiene significantly increases the risk of developing inflammatory processes — gingivitis, periodontitis, peri-implantitis.

Patients must have the motivation and skills for thorough hygiene, which is a prerequisite for long-term implant success.

• Other factors

Psycho-emotional state: patients who are not ready for multi-stage treatment or are not committed to regular check-ups may experience lower treatment effectiveness.

• Alcohol and drugs have a negative effect on tissue regeneration and osseointegration.

How dental implantation works — a step-by-step process

With the classic method, dental implantation takes place in several stages:

1. Surgical stage. During this stage, the implant is placed directly into the bone. Anaesthesia is always used for this procedure, which completely eliminates pain. The dentist makes a small incision in the gum, then prepares a site in the bone tissue where the implant is placed. After installation, the implant is covered with a special cap, and if necessary, the wound is sutured. The implant should fully heal within 3-6 months. During this period, swelling or slight discomfort may occur in the area of the operation. To reduce pain, the doctor may prescribe painkillers.
2. At the final stage, a custom crown is installed, crafted to match the shape and shade of the patient’s natural teeth. It fully restores both function and aesthetics, making the new tooth look natural and attractive. Thanks to modern technology, the patient can enjoy their perfect smile in the mirror by the end of this visit.
3. At the final stage, a crown is installed, made to match the shape and colour of the patient’s teeth. It completely restores function and aesthetics, and the new tooth looks natural and attractive. Thanks to modern technology, the patient can admire their perfect smile in the mirror during this visit.

The main stages of dental implantation (describe the process)

• Consultation and diagnosis prior to implantation

During the initial consultation, the implantologist collects a complete medical history:

• the patient’s general state of health (presence of chronic diseases, harmful habits, etc.),
• condition of the oral cavity (hygiene, presence of periodontitis, caries, etc.),
• the patient’s expectations regarding the outcome.

The dentist carefully examines the condition of the mucous membrane and gums, determines occlusion and tooth contacts. If necessary, plaster models or digital scanning are used.

X-ray diagnostics are also performed:

🔹 Panoramic radiography (orthopantomogram) – allows assessing the condition of bone tissue, detecting pathologies, and determining the location of anatomical structures (sinuses, nerves).

🔹 Cone beam computed tomography (CT) – the gold standard in implant planning. It provides accurate 3D images that help assess bone height, thickness and density, the location of important anatomical structures and the possible need for bone grafting (augmentation).

Based on the data obtained, a step-by-step plan is drawn up: the number of implants, the need for additional procedures (sinus lifting, bone augmentation), types of prostheses. This approach increases the effectiveness and safety of implantation.

• Preparation for surgery

Before implantation, sanitation is performed: treatment of caries, removal of foci of infection (periodontitis, pulpitis), removal of teeth that cannot be preserved. This reduces the risk of inflammatory complications after implantation.

The patient must maintain thorough hygiene – regular brushing, use of dental floss or interdental brushes. Poor hygiene increases the risk of developing peri-implantitis (inflammation of the tissues surrounding the implant).

It is important for patients with diabetes mellitus to achieve disease compensation (glycated haemoglobin <7%).

If the patient is taking anticoagulants or other medications, the doctor consults with a cardiologist/therapist regarding possible treatment adjustments.

Smokers are advised to quit smoking before implantation (at least 2 weeks in advance), as this significantly reduces the risk of implantation failure.

In some cases (presence of risk factors), your doctor may prescribe prophylactic antibiotics prior to implantation to reduce the risk of infection.

The process of dental implantation

• Before the procedure begins, the patient is given a local anaesthetic to ensure that the operation is painless. In some cases, depending on the complexity of the procedure and the patient’s wishes, sedation or general anaesthesia may be used.
• The surgeon makes a small incision in the gums to access the jawbone. Then, using a special instrument, he forms a hole in the bone where the implant will be placed.
• A titanium implant is inserted into the prepared hole, which will serve as an artificial tooth root. After that, the gums are sutured, and a protective cap or gum former can be placed on the implant.
• After the implant is placed, the process of osseointegration begins — the fusion of the implant with bone tissue. This process takes 3-6 months, depending on the individual characteristics of the patient and the jawbone.
• After successful osseointegration, the second stage is performed — the installation of the abutment. To do this, the surgeon makes a small incision in the gums to expose the implant and attaches the abutment to it — a transitional element between the implant and the future crown.
• After the gums around the abutment have healed, the dentist takes impressions of the dentition to make a custom crown. The crown is made to match the shape, size and color of the patient’s natural teeth, ensuring its aesthetic appearance and functionality. Once the crown has been made, it is fixed onto the abutment.

Відновлення після імплантації — строки та рекомендації

After the implant is placed, an important period begins, known as osseointegration — the process by which the implant fuses with the bone tissue. This period usually lasts from 3 to 6 months (ADA, 2023).

Osteointegration is a key stage, as it ensures the stability and durability of the implant, as well as its proper functioning during chewing.

Key recommendations for patients

• Food

• For the first few weeks, it is recommended to eat soft or liquid foods — this reduces the load on the implant.
• Avoid food that is too hot or cold, as well as hard or crunchy food (such as nuts or crackers) so as not to compromise the stability of the implant.
• You can gradually return to your normal diet, but only after consulting your doctor.

• Oral hygiene

• For the first 2 weeks, brush your teeth with a soft-bristled toothbrush to avoid irritating the implant site.
• Use antiseptic rinses as recommended by your dentist.
• Avoid excessive rinsing for the first 2-3 days so as not to interfere with clot formation.

• Medications

• Your dentist may prescribe antibiotics to prevent infection and painkillers to reduce discomfort.
• It is important to follow the prescribed treatment regimen and not to interrupt the course of antibiotics.

• Regime and rest

• After the operation, it is advisable to limit physical activity (sports, heavy work) for several days.
• Sleep with your head elevated to reduce swelling.

• Control inspections

• Regular visits to the dentist will help to identify potential problems in a timely manner.
• The first check-up is usually done 7–10 days after the operation.

The most common complications and their symptoms

Despite high success rates (95–98%), there are potential complications after implantation that require attention:

• сильний біль, який не зменшується;
• significant swelling or purulent discharge;
• elevated body temperature;
• a feeling that the implant is “wobbly” or unstable.

If any of these symptoms appear, you should immediately consult a doctor for examination and treatment.

Causes of complications after implantation and how to prevent them

The success of implantation largely depends on following the dentist’s recommendations and maintaining a healthy lifestyle. According to clinical studies, with proper care and health monitoring, implants last more than 20 years, and the risk of complications is minimal.

According to data from the American Academy of Periodontology (AAP) and reviews in the Journal of Periodontology (2022), the most common causes of complications after implant placement are:

1. Poor oral hygiene
   If the patient does not clean their teeth and gums thoroughly enough after implantation, bacterial plaque can accumulate. This can lead to the development of peri-implantitis — inflammation of the tissues around the implant. AAP studies have shown that almost 43% of patients with peri-implantitis had poor hygiene.
2. Smoking and harmful habits
   Smoking significantly slows down healing processes and reduces blood microcirculation in gum tissue. According to the American Dental Association (ADA), smokers are twice as likely to experience implant rejection.
3. Chronic diseases
   Conditions such as diabetes mellitus, osteoporosis, and immunodeficiency diseases can impair osseointegration (the process of implant fusion with bone). According to the National Institutes of Health (NIH), patients with uncontrolled diabetes have a 1.5–2 times higher risk of complications.
4. Failure to follow doctor’s recommendations
   Ignoring instructions regarding diet, physical activity, or implant care after surgery is also a common cause of problems. This can lead to micro-dislocation of the implant and the development of inflammatory processes.

How to prevent complications?

Thorough hygiene

• Regular brushing of teeth (twice a day).
• Brush with soft bristles to avoid damaging the implant site
• Use of antiseptic rinses (chlorhexidine, recommended in the protocols of the European Federation of Periodontology — EFP).

Regular check-ups at the dentist

• Preventive visits at least every 6 months.
• The dentist checks the condition of the gums, the stability of the implant and detects inflammation in a timely manner.

Giving up harmful habits

• Stop smoking at least 2–4 weeks before implantation and throughout the healing period.
• Restrictions on alcohol consumption.

Control of common diseases

• In case of diabetes or other chronic diseases, it is important to consult a doctor to control them.
• A balanced diet and physical activity promote better healing.

Treatment of complications and when to see a doctor

Timely detection of complications and adequate treatment allow you to preserve the implant and ensure a long-lasting result. Do not delay your visit to the dentist when the first alarming symptoms appear.

Major complications and their treatment

1. Peri-implantitis — inflammation of the tissues surrounding the implant with gradual loss of bone support.
Symptoms: gum swelling, bleeding, pain, pus formation, increased implant mobility.
Treatment:

• conservative therapy — professional cleaning of the implant, use of antiseptic solutions;
• antibiotic therapy as indicated;
• In severe cases — surgical intervention: open curettage, bone grafting.

2. Infections after surgery

Symptoms: pain, swelling, redness, increased body temperature.
Treatment:

• antibiotic therapy prescribed by a doctor after examination;
• anti-inflammatory agents to relieve pain and swelling;
• in cases of severe purulent processes — drainage and sanitation of the affected area.

3. Implant rejection (implant failure)

Causes: infections, lack of bone mass, surgical technique errors, systemic diseases.
Treatment:

• in most cases, the implant is removed;
• після загоєння і стабілізації кісткової тканини можливе повторне встановлення;
• planning taking into account previous mistakes and correction of methodology.
  

When is it necessary to consult a doctor?

• if pain and swelling do not subside within 3-4 days after surgery;
• якщо з рани з’являються гнійні виділення або неприємний запах;
• if the implant begins to move or feels unstable;
• при значному підвищенні температури тіла (понад 38°C) після імплантації;
• if there is severe bleeding that does not stop;
• in case of a sharp deterioration in general well-being (dizziness, weakness).

Prevention of complications during treatment

• strict adherence to the dentist’s recommendations regarding oral hygiene;
• timely intake of prescribed medications;
• regular check-ups at the dentist;
• уникання куріння та алкоголю під час загоєння.

Caring for dental implants after surgery

Proper care after dental implantation is key to successful osseointegration (implant healing) and long-term functionality of the artificial root. Failure to follow recommendations can lead to inflammation, infection, and even implant loss.

1. Oral hygiene

• During the first two weeks, daily brushing with a soft toothbrush minimises trauma to the gums and tissues around the implant. Brushes with soft or ultra-soft bristles, such as Curaprox or Oral-B Sensitive, are recommended.
• One month after the operation, it is necessary to start using dental floss and an irrigator — this helps to remove food debris from between the teeth and around the abutment, where a regular toothbrush cannot reach.
• Antiseptic rinses — chlorhexidine 0.12% or 0.2% are used as directed by a dentist to prevent infectious complications. However, they are not recommended for long-term uncontrolled use, as they can affect the microflora of the mouth.

2. Load restrictions

During the first 2-3 weeks after implantation, avoid chewing hard food on the side of the implant. This reduces the risk of mechanical damage and prevents implant mobility.

A gradual return to normal activity should be supervised by a doctor.

3. Regular inspections and professional cleaning

Professional dental hygiene every 6 months allows you to remove plaque that can cause inflammation (peri-implantitis).

During the examination, the dentist assesses the condition of the implant and surrounding tissues and promptly identifies any complications.

4. Giving up harmful habits

Smoking significantly increases the risk of inflammatory complications and reduces implant engraftment.

Alcohol consumption slows down regenerative processes and impairs tissue healing.

5. Monitoring symptoms

If you experience pain, swelling, bleeding or bad breath, you should see your dentist immediately. These symptoms may indicate the development of complications.

List of sources

1. Research Misch CE, Contemporary Implant Dentistry, 2008 https://www.ncbi.nlm.nih.gov/
2. Jung et al., Journal of Dental Research, 2013
3. National Institutes of Health https://www.nih.gov/
4. Schropp et al., International Journal of Oral & Maxillofacial Implants, 2003
5. European Journal of Oral Implantology, 2015
6. American Academy of Implant Dentistry https://www.aaid.com/
7. PubMed – Dental Implant Overview https://pubmed.ncbi.nlm.nih.gov/32834322/

Journal of Clinical Medicine – Risks of Dental Implants https://pmc.ncbi.nlm.nih.gov/articles/PMC7071297/