Treatment Process

How is a dental implant done? What happens, stage by stage

Known informally as a 'screw-in tooth': the screw that replaces the root, the tooth fitted onto it, and the time in between

An implant is not a single procedure; it is a process made up of several steps in a set order. On this page we explain what actually happens at each stage, from the examination chair to the day the tooth is fitted, why it happens in that order, and why the number of stages changes from one patient to another. Pain, the first week and the total time are covered on separate pages; this page is about the procedure itself.

Short answer

A dental implant is made up of three parts and is carried out in three main stages. First, an examination and 3D imaging are used to draw up a plan. Then, under local anaesthetic, a small site is prepared in the jawbone and the screw-shaped implant is placed. Finally, a connector and a tooth are fitted onto the implant. With conventional implants, this last stage waits for the bone to fuse with the implant; if the implant sits firmly enough on the first day, the tooth can be fitted the same week.

Parts: A screw in place of the root, a connector, a tooth
Main stages: Planning, placement, fitting the tooth
During the procedure: Local anaesthetic; sedation if needed
What decides the number of stages: The bone, the anchorage measured on day one, and preparation needed

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-09-13

Why the stages happen in this order

The reason people informally call it a 'screw-in tooth' is the implant's shape. An implant is a small, threaded screw placed in the jawbone in place of the root of a lost tooth, usually made of titanium. The tooth you see in the mouth is not the screw itself. A small connecting piece, called an abutment, sits on top of the screw, and the tooth is then screwed or bonded onto this piece. So a screw-in tooth is a three-layer structure, and the stages come from building these layers one after another.

The first stage is measuring the bone. The length, width and angle of the implant cannot be chosen by looking at the mouth; the height, width and density of the bone can only be seen on a 3D CBCT scan. The same scan also shows the position of the nerve canal in the lower jaw and the sinus cavity in the upper jaw. The path the screw will follow is mapped out on this scan; the work done on the day of surgery is carrying out this plan that has already been drawn up.

The second stage is placement. The area is numbed, in most cases the gum is opened with a small incision, and a site is prepared in the bone, widened step by step. While the site is being prepared, the drill is cooled with plenty of water, because bone that overheats cannot hold the implant. The implant is screwed into this site, and how much resistance it meets in the bone is measured. This measurement is the first piece of information that decides when the tooth can be fitted.

The third stage is healing. With conventional implants, bone cells attach to the implant surface over time, and the implant starts to behave like part of the bone. This fusion, known as osseointegration, takes months, and no chewing load is placed on the implant during that time. The top of the implant is either closed with a cover screw and left under the gum, or a small healing cap is fitted that pokes out through the gum. Which one is chosen decides whether a second small procedure is needed later.

The fourth stage is making the tooth. If the implant was left under the gum, its top is first uncovered with a small procedure and a healing cap is fitted; this is called the second stage. Once the gum has taken shape around this cap, an impression or a digital scan is taken, the connector is fitted, and the tooth made in the laboratory is fitted into place. The last job is the bite adjustment: making sure the new tooth does not touch before the others when you bite.

There are also plans where this sequence is shortened, and knowing this makes it easier to understand the different timetables you hear from different clinics. If the implant sits firmly enough in the bone on the day it is placed, the tooth can be fitted without waiting for it to fuse. A Cochrane review that pooled randomised trials found no convincing difference in implant loss between immediate, early and conventional loading in the patients included in those trials. With one-piece implants that gain anchorage from the deep, dense layer of the jawbone, the screw and the connector are already a single block, so there is no second stage at all.

Who the number of stages is shorter for, and who it is longer for

The points below are why the same implant can take two appointments for one patient and five for another. None of them decides on its own; each is read together with the CBCT scan and the anchorage measured during placement.

The tooth can be saved

Enough bone, of sufficient densityThe implant sits firmly in the bone on the day it is placed. In an area like this, a healing cap that pokes out through the gum can be fitted on day one, and no second stage is needed.
A clean socket where a tooth has been extractedIf there is no infection at the extraction site and the implant can find enough anchorage in the walls of the socket, the extraction and the placement can be done in the same session. This decision is usually made on the day of the extraction, once the area has been seen.
Several implants being joined by one bridgeIn full-mouth plans, when implants are joined by a single bridge from day one, the load is shared between them. This is the situation where a decision to fit teeth within the first week is most often made.
General health that is under controlIf there is nothing slowing down healing, no extra wait is added between the stages. Giving a full list of the medicines you take at your first examination means the plan does not need to change later.

Saving it is unlikely to hold

Not enough boneIn a conventional plan, the bone the implant will sit in is built up first; a bone graft or a sinus floor elevation is added as a separate stage and brings its own healing time. In plans where anchorage is taken from the deep, dense layer of the jaw, this stage is not needed in most cases.
Low anchorage measured during placementIf the bone is soft, the implant may not sit with the expected resistance. In this case the implant is closed under the gum and left to heal without any load. This means the timetable has lengthened, not that the procedure has failed.
An active infection in the areaThe infection is cleared first and the area is left to heal. An implant placed on infected ground is exposed to one of the recognised causes of early implant loss.
Smoking or uncontrolled diabetesBoth slow down the healing of bone and gum. Your dentist may keep the waiting time between stages more cautious in these patients; for smoking, the most effective step is to stop before the procedure.

From examination to fitting the tooth: step by step

The sequence below is based on the conventional two-stage route. In shortened plans, some steps are combined into the same day or skipped altogether; which ones is noted within each step.

1
Examination and imaging
Your gum health and remaining teeth are checked. On a 3D CBCT scan, the dimensions of the bone, the nerve canal and the sinus cavity are measured. Your general health and the medicines you take are discussed at this appointment.
2
Drawing up the plan
First, where the tooth will sit in the mouth is decided, and the position, length, width and angle of the implant follow from that. If needed, a guide is made to steer the surgery.
3
Preparing the mouth
Any tooth or root that needs extracting is extracted, and any gum infection is treated. If a bone graft is needed, it is done at this point and left to heal. This step is skipped in mouths that do not need preparation.
4
Numbing and preparing the site
The area is numbed with local anaesthetic; sedation can also be given to anxious patients. The gum is opened, or in some plans the site is reached through a small puncture. The site is prepared in the bone with progressively wider drills, cooled with water.
5
Placing the implant
The implant is screwed into the site and the resistance it meets in the bone is measured. Its top is closed with a cover screw or a healing cap, and the gum is stitched. If anchorage is sufficient and the plan allows for it, an impression for a temporary tooth or bridge can also be taken on this day.
6
The healing period
With the conventional route, the implant carries no load during this period and fuses with the bone. To avoid a gap in a visible area, a temporary tooth or denture that puts no pressure on the implant can be used. Stitches are removed within the first few weeks.
7
The second stage and the impression
If the implant was left under the gum, its top is uncovered with a small procedure and a healing cap is fitted. Once the gum has taken shape, an impression or a digital scan is taken and the connector is chosen.
8
Fitting the tooth and the bite adjustment
The tooth is screwed or bonded onto the connector. Contacts are checked as you bite and as you slide your jaw sideways, and adjustments are made so the load does not build up on a single point. How to clean around the implant is shown at this appointment.

The ways an implant can be done

The same implant can be carried out in different sequences. The difference between them is not the quality of the method; it is the condition of the bone and the anchorage achieved on the first day.

Two-stage, closed healing

The implant is closed under the gum, fusion is left to complete, and it is then uncovered with a small procedure. This is the longest-established route, and it is often chosen where the bone is soft or where bone has been grafted.

Single-stage, open healing

A healing cap is fitted on the first day and stays above the gum. No second procedure is needed; fusion is still awaited, and once it is complete the process goes straight to taking an impression.

Implant placed in the same session as extraction

The tooth is extracted and the implant is placed into the socket the same day. If the socket is clean and anchorage is sufficient, one surgical step is removed; when the tooth is fitted is a separate decision.

Immediate loading

If anchorage is sufficient, a tooth or bridge is fitted onto the implant within the first week. In full-mouth plans this bridge is usually temporary; the permanent tooth is made once the gum and bone have settled. In Implant72's three-day plan, by contrast, the teeth fitted on day 3 are the final teeth, with no separate permanent stage.

Anchorage in the deep layer with a one-piece implant

Thin, one-piece implants are placed to lock into the dense cortical layer deep in the jaw. Because the connector is part of the implant itself, there is no second stage, and the bridge can be fitted the same week. This is used for full-mouth treatment and multiple missing teeth.

What is watched for at each stage

The points below are the known risks at each stage and what is done to prevent them. Knowing them makes it easier for you to ask your dentist the right question.

Closeness to the nerve and the sinus

At the back of the lower jaw is the nerve that gives feeling to the lip and chin, and at the back of the upper jaw is the sinus cavity. Planning the placement on a CBCT scan reduces the risk of getting too close to these structures; a two-dimensional X-ray does not show this distance.

The bone overheating

If the bone overheats while the site is being prepared, the cells around the implant are damaged and fusion may not take hold. Cooling the drill and working step by step are for this reason an integral part of the procedure.

Fitting a tooth without measuring anchorage

Fitting a tooth in the first week is only the right decision if the implant has sat with sufficient resistance. Fitting the tooth when the measured value is low can disrupt fusion. For this reason a same-week tooth plan can change during surgery, and you should be told this from the outset.

Infection during the healing period

Not keeping the area clean, and smoking, raise the risk of infection in the early period. Pain and swelling increasing instead of easing after the first few days is a sign outside the expected course of healing.

What to expect between the stages

The plan below describes the conventional route. In plans with immediate loading, the first two steps fit into the same week.

The day of placement
Numbness lasts a few hours. The day is spent with cold compresses, the medicines you have been given, and soft food. The area is not brushed hard, and the mouth is not rinsed on the first day.
The first week
Swelling and tenderness ease after the first few days. Stitches are removed at the end of this period, or a little after. We have covered the day-by-day course on a separate page.
The fusion period
With the conventional route, the implant carries no load during this time. If you are using a temporary tooth or denture, it is adjusted so it puts no pressure on the implant. Healing is assessed at check-ups.
After the tooth is fitted
Your bite is checked once more in the first few weeks. After that, the implant needs daily cleaning and regular check-ups; the gum around it can become inflamed if it is neglected.

Message us right away if

Numbness is still there the next day. Numbness in the lip, chin or tongue that has not gone by the next day can mean the nerve has been affected. It needs to be assessed the same day, without waiting.
Pain and swelling increase after the third day. The expected course is for them to ease. An increase can be a sign of infection or that healing has been disrupted.
The healing cap or temporary tooth becomes loose. The gum can grow over a loose cap, and a temporary tooth that moves can put unwanted load on the implant. Do not try to tighten it yourself; let your clinic know.
You have a fever or spreading swelling. This can mean infection has spread into the soft tissue. Call your clinic the same day; if you are struggling to swallow or breathe, go straight to A&E.

What decides the number of stages and the scope

For the same implant, two appointments may be enough for one patient while another needs five. These are the items that decide the scope:

Preparing the mouth: If an extraction, gum treatment or root cleaning is needed, these are done before the implant and added to the plan as separate steps.
Whether a bone graft is needed: In plans with a bone graft, a separate period is left for healing and the number of appointments increases. In plans where anchorage is taken from the deep layer, this item is absent in most cases.
The healing route: With closed healing, a second small procedure is needed to uncover the top of the implant. With open healing and with a one-piece implant, this step is not part of the plan at all.
The need for a temporary tooth: On the conventional route, in visible areas and in full-mouth plans, a temporary tooth or bridge is used throughout healing. The permanent tooth is made separately and is a distinct stage of the plan.

Frequently asked questions

Is a 'screw-in tooth' the same thing as an implant?

Yes, in everyday language they describe the same treatment. An implant is the screw-shaped part placed in the jawbone in place of the root; the tooth you see in the mouth is fitted onto it. The word 'screw-in' sometimes also refers to the tooth being attached to the implant with a small screw; a large share of implant teeth are attached this way.

How many stages is an implant done in?

With the conventional route there are three main stages: planning, placing the implant, and fitting the tooth after fusion. If the implant is closed under the gum, a small second procedure is added in between. If a bone graft is needed, one more stage is added; if anchorage is sufficient on the first day, placement and fitting the tooth fall within the same week.

When is the tooth fitted after the implant screw is placed?

This depends on how firmly the implant sits in the bone. With the conventional route, months are allowed for fusion, and a temporary solution can be used during that time. If the anchorage measured during placement is sufficient, a tooth or bridge can be fitted within the first week. This decision is settled during surgery, not before it.

What is a healing cap, and when is it removed?

It is a small piece fitted onto the implant that pokes out through the gum. Its job is to let the gum heal into the shape the tooth will take. It is removed when the impression is taken and when the tooth is fitted, and the connector is put in its place. Removing it is a quick procedure and usually does not need numbing.

Which is the hardest stage of getting an implant?

The day of placement is usually the one that causes patients the most anxiety, but because the area is numbed, most patients feel pressure rather than pain during the procedure. The stage that decides the outcome the most is planning: if the position and angle of the implant are chosen wrongly, the later stages cannot fully make up for it.

Can the implant screw be seen from outside?

Normally not; the implant sits inside the bone, and the connector stays level with or below the gum. If the gum or bone recedes over time, the metal edge of the implant can become visible. In the front area, where the gum is thin, this is something given extra thought during planning.

Can more than one implant be placed in the same session?

Yes. With multiple missing teeth, or in full-mouth plans, all of the implants are usually placed in the same session. The session takes longer, but a separate operation is not needed for each implant, and healing runs in proportion to the area the surgery covered.

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