Dra. Cléo Salustiano In this article
SummaryStep by stepWhat happens at each phase of an implant?What to expect afterward, and what sustains the result?FAQRead nextHow a dental implant is done, step by step
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Quick summary of this article+
An implant replaces the tooth's root with a post placed in the bone, which receives the prosthesis after integration. The stages: assessment with a CT scan, treating oral health, bone preparation with grafting when needed, placement surgery under local anesthesia, stitches with or without a healing abutment, osseointegration (the longest phase, lasting months, which can't be rushed), uncovering and abutment placement, the prosthetic phase with impressions, try-in and bite adjustment, and regular maintenance. Afterward, swelling and mild discomfort are expected; smoking and loading too early are the main threats to integration. In Mooca, with Dr. Cléo Salustiano (CRO-SP 170844).
A dental implant replaces the root of a missing tooth with a post, usually made of titanium, placed in the bone. After a period of integration, a prosthesis is attached on top — the visible part that restores shape and function. Treatment happens in phases, and most of the time is biological waiting, not procedures.
Understanding this sequence helps explain why an implant takes months and why that time can't be shortened for convenience: the bone needs to grow around the post, and that has its own pace.
In this article, Dr. Cléo Salustiano (CRO-SP 170844) describes the process step by step, from imaging to maintenance, and explains what each stage takes care of.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the dental implants page to learn how the treatment is done here and book your assessment.
Step by step
- Assessment with imaging. A CT scan shows bone quantity and quality, structures to respect and the space for the future crown. It's the map that determines whether, where and how to place the implant.
- Treating oral health. Cavities, inflamed gums and active periodontal disease are treated first, because periodontal disease is a direct risk factor for peri-implantitis.
- Bone preparation, when needed. Bone grafts and related procedures restore volume to give the implant a firm base, with their own healing period.
- Placement surgery. Under local anesthesia, the site in the bone is prepared with drills under irrigation and the implant is placed in the planned position.
- Stitches and healing abutment. The area is closed. Depending on the case, the implant stays submerged or receives a healing abutment, which shapes the gum contour.
- Osseointegration. The longest and quietest phase: the bone organizes around the implant and surrounds it. It takes months and can't be rushed.
- Uncovering and abutment placement. Once integration is complete, the intermediate piece connecting the implant to the prosthesis is placed, with the gum already shaped around it.
- Prosthetic phase. Impressions or scanning, crown fabrication, try-in, color and contact adjustments and permanent placement. Bite adjustment prevents overload.
- Maintenance. Regular checkups assessing the surrounding gums, specific hygiene and managing risk factors. Peri-implantitis progresses without pain.
What happens at each phase of an implant?
The first step is an assessment with imaging. A CT scan shows the amount and quality of available bone, the position of anatomical structures that must be respected and the space available for the future crown. This map determines whether an implant is possible, where and how.
Oral health is treated first. Cavities, inflamed gums and active periodontal disease are addressed ahead of the implant — not as a formality, but because active periodontal disease is a direct risk factor for peri-implantitis, the main cause of losing implants that have already integrated.
When there isn't enough bone, it's prepared first. Bone grafts and related procedures restore volume so the implant has a firm base. This step adds time to treatment and has its own healing period before placement.
During placement surgery, under local anesthesia, the gum is opened in the area, the site in the bone is prepared with a sequence of drills under irrigation — temperature control here is critical, because overheating compromises integration — and the implant is screwed into the planned position.
The area is closed with stitches. Depending on the case, the implant stays submerged under the gum or receives a healing abutment, a piece that passes through the gum and shapes the contour where the prosthesis will emerge.
Then comes osseointegration, the heart of the treatment and the longest phase: the bone organizes around the implant and surrounds it, giving it the firmness needed to bear load. It takes months and can't be rushed. It's a quiet phase with no procedures — the work is biological.
Once integration is complete, the implant is uncovered if it was submerged, and the abutment (the intermediate piece connecting the implant to the prosthesis) is placed. By then the gum has already shaped itself around the healing abutment, and the contour starts to take form.
Next is the prosthetic phase: impressions or a digital scan, fabrication of the crown in the lab, try-in, adjustment of color and contacts and, finally, permanent placement. Adjusting the bite here isn't a minor detail — overload is one of the factors behind late failure.
And treatment doesn't end at delivery. Maintenance begins: regular checkups assessing the gums around the implant, specific hygiene and managing risk factors. Since peri-implantitis progresses without pain, it's the checkup that catches it early.
| Phase | What it takes care of |
|---|---|
| Assessment with CT scan | Shows available bone, structures to respect and space for the crown |
| Treating oral health | Removes the most direct risk factor for peri-implantitis |
| Bone preparation (graft), when needed | Creates a firm base where bone volume is lacking |
| Placement surgery | Positions the implant in the prepared site, under irrigation and temperature control |
| Stitches with or without a healing abutment | Closes the area and, with a healing abutment, shapes the gum contour |
| Osseointegration | The bone surrounds the implant and makes it firm enough to bear load — takes months |
| Abutment | Connects the implant to the prosthesis |
| Prosthetic phase | Impressions, crown, try-in, color and bite adjustment to prevent overload |
| Maintenance | Catches peri-implantitis early, since it progresses without pain |
What to expect afterward, and what sustains the result?
In the first few days after surgery, swelling, mild discomfort and tenderness in the area are expected, improving progressively. Cooler, softer foods, taking it easy, cold compresses and the prescribed medication help keep it under control. Intense or worsening pain, increasing swelling or discharge call for contacting the office.
Keep up your hygiene, taking extra care around the surgical area and following the instructions you received. Keeping the area clean is part of healing — neglecting hygiene there is the mistake that most often leads to complications afterward.
Avoid smoking during the healing period. Smoking reduces blood flow to the tissues, impairs healing and is the most consistent risk factor for implant failure. If quitting completely isn't feasible, cutting back already makes a difference during this period.
Respect the osseointegration time. Putting load on the implant too early is one of the classic causes of early failure. In some cases an immediate temporary prosthesis is possible, but that's a technical decision assessed case by case, not a patient preference.
Once the crown is in place, care is like that of a natural tooth with extra attention: a soft-bristled toothbrush, floss — there are flosses made specifically for implants and prostheses — an interdental brush or water flosser as advised, and special focus on the area where the prosthesis meets the gum.
If you grind or clench your teeth, a night guard, when indicated, distributes the load and protects the whole setup. An implant has no periodontal ligament, so it doesn't cushion force the way a natural tooth does — which makes controlling overload more important, not less.
And keep up with your checkups. Bleeding or redness around the implant, swelling, discharge, a bad taste or a feeling of looseness are signs that call for an assessment without waiting for your next visit. Maintenance is part of the treatment, not an optional extra.
How is a dental implant done?
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In phases: assessment with imaging, treating oral health, bone preparation when needed, surgery to place the post in the bone, a few months of osseointegration, placement of the abutment and crown, and regular maintenance.
Why do I need a CT scan?
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Because it shows the amount and quality of available bone, the position of anatomical structures that must be respected and the space for the future crown. It's the map that makes the procedure predictable.
What is osseointegration?
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It's the process in which the bone organizes around the implant and surrounds it, giving it the firmness to bear load. It's the longest phase of treatment, takes months and can't be rushed.
Does the surgery hurt?
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Not during the procedure: it's done under local anesthesia and the area is numb. Afterward, swelling, mild discomfort and tenderness are expected, improving day by day.
What is a healing abutment?
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A piece that passes through the gum after the implant is placed and shapes the contour where the prosthesis will emerge. Not every case uses one — in some, the implant stays submerged under the gum.
What is the abutment?
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The intermediate piece that connects the implant to the prosthesis. It's placed after osseointegration, once the gum has shaped itself around the area.
Will I be without a tooth during treatment?
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It depends on the case. There are temporary solutions assessed individually, and in some situations an immediate temporary prosthesis is possible — but that's a technical decision tied to the implant's stability, not a preference.
Why can't an implant be rushed?
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Because putting load on it before integration is one of the classic causes of early failure. The bone needs to grow around the post, and that biological process has its own pace.
Do I need a bone graft?
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Only when there isn't enough bone. In that case, the graft restores volume to give the implant a firm base and has its own healing period, which adds time to treatment.
Can I smoke during treatment?
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It's not recommended. Smoking reduces blood flow to the tissues and impairs healing, making it the most consistent risk factor for failure. If quitting isn't feasible, cutting back already makes a difference during this period.
Why does bite adjustment matter so much?
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Because an implant has no periodontal ligament and doesn't cushion force the way a natural tooth does. Premature contact concentrates load and is one of the factors behind late failure.
What care does an implant need afterward?
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A soft-bristled toothbrush, floss — there are flosses made specifically for implants — an interdental brush or water flosser as advised, and special attention to the area where the prosthesis meets the gum.
Which signs call for an assessment?
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Bleeding or redness in the gum around the implant, swelling, discharge, a persistent bad taste, pain when chewing or a feeling of looseness. Peri-implantitis progresses without pain, which is why maintenance is essential.
Where can I get a dental implant in Mooca?
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Dr. Cléo Salustiano (CRO-SP 170844) sees patients at Rua Hipódromo, 1141, in Mooca, São Paulo, Monday to Sunday, 8 a.m. to 10 p.m., in Portuguese, English and Spanish. An assessment with imaging determines the plan for your case.
