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Dental Implants With Just One Surgery? – Expert Dentist, Dr. Ramsey Amin Explains

Traditionally most dental implants were placed using a two stage surgical technique.  That means you would have two surgeries for just one implant!

The first surgery would be to place the actual implant in the bone.  At that time the dental implant would be covered by the gum so it is not visible.  That is the part that people refer to as the "screw."

Here is an x-ray example of short implants that had to be buried due to the patients medical condition:

The second surgery would happen a few months later to "uncover" the implant from under the gums.  This allows the gum to heal around the implant as it is newly exposed in your mouth.

In my office in Burbank, nearly 95% of my patients do not need the second procedure.  Not only does this prevent you from needing a second procedure, but it helps reduce the cost.  It increases the price, when you have to have two surgeries rather than one. One stage implants help me decrease the cost to patients.

Here is an example of a one stage surgery (note that the implants are taller so they are visible in the mouth):

What makes the determination for one or two stage?  It varies, but I find that many dentists and surgeons still do two stages because that is the way they have "always done it." There is  a lot of scientific proof to allow the implant to be done in one stage.

The other determination is mostly in how "tight" the implant is when it is first put in.  That tightness is very much controlled by the skill and experience of your implant dentist.  This is especially critical for dental implants in your upper jaw, where the bone is usually very soft.

I do on occasion use the two stage technique when it is better for your situation.  I may do it if I am doing a large bone graft at the same time the implants are being placed.

The most common area of the mouth to use the two stage surgery is the upper back molars. This area has very soft bone so implants in this area may not get as "tight" when first placed.

Having a tight implant also positively relates to the long term success of your implant.  I accurately measure how tight or loose your implant is using a torque wrench.

So there you have it… One stage, one surgery if it is predictable for your particular situation.

Please ask questions in the comments section below this post.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California

11 thoughts on “Dental Implants With Just One Surgery? – Expert Dentist, Dr. Ramsey Amin Explains

  1. I have been looking into implants for molars 30 and 31. 30 was lost when I was a teenager (I am now 59) and I had a bridge until I lost tooth 31 about 4 years ago and had a bone graph in the pocket at the time of the extraction of 31. I have been to several dentist for consults and have been told several different stories. Today’s dentist said I should put in three smaller molars attached like a bridge for added strength in that area and angle the three pins for stability. I have plenty of bone height but the bone is narrow according to the dentists I have seen. With all the different info from different dentists I decided to do some research on line and found your videos. They were very informative. Thank you.

    Can you do two regular size implants? Can you tell me about how much it would cost with the porcelain crowns.

    1. Hello Renee,

      Since you lost the teeth so long ago, your bone has shrunk tremendously. Depending on the size, length and diameter of the dental implant sometimes you have to do 2-3 implants to replace just two teeth. If you under-engineer a situation that has very narrow bone, the implants will be bound to fail with progressive bone loss that starts usually at year 2 or 3 after having the procedure done.

      Remember that your natural teeth in this area had multiple roots. Dental implants are just one root. Replacing 2 molars is replacing four natural roots. Dental implants have a different biology then teeth in the numbers do not always equate.

      My guess is you have a both vertically and horizontally deficient area of your jawbone. In my own practice I go through a unique type of bone graft called a vascularized pedicled bone flap which widens your bone tremendously. This allows implants of normal diameter to be placed.

      I would also suggest that if your bone is narrow and the implants are small that the implants be connected to one another. This will help achieve long-term stability of the bone at the very top of the implant which is the most critical.

      Here are some web links that should help you:

      Bone Widening Graft of Lower Back Jaw – Picture Series – Dr. Ramsey Amin

      Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  2. I have two baby teeth one each side that did not get replaced with bicuspids. One is OK. But the other which had to be crowned to help with alignment of the teeth for Orthodontistry as it was submerged. At that time implant dentistry would have been in science fiction novels. So one of the teeth the submerged one has has crowns on it for over XX yrs since is was a baby tooth. The crowns had to be replaced due to either changes in the tooth due to natures responses or loosening cement or difficulty in seating the crown on a lower prepared baby tooth.

    Anyway. a nice Oral Surgeon feels a bone graft is needed one because it is submerged and two the thought is the bone maybe ankylozed with and to the root. Recommended grafting the socket. The roots are spread out like they are apart and trying to meet at their tips but do not as too far away to. So that would be a healing period of months.

    Is this better to do than a keyhole surgery and why one or the other? If the bone was dense would keyhole surgery be a better success? Is the implant the same size whether keyhole surgery is done or regular flap surgery is preformed? Does keyhole surgery need high tech things like CAT scans or another interactive surgical method for more precise placement? Is any of covered by “great” not Dental Insurance or Medical Insurance?

    Leaving the roots in place, since they are partly ankylozed in place? With a submerged baby tooth does that make a more challenge with nerves. Since the loss of a baby molar opens up an wider gap than a premolar would and the implant probably lower down to begin with, is that a risk due to the principle of leverage on a longer distance from the top of the tooth to the collar of the implant so what needs to be done to increase its success? Is it better to have a three teeth bridge done instead? (if they may need crowns someday in future anyway?) But the teeth being slightly tilted to the lower baby molar and being the lower jaw is it longer lasting the implant or such a bridge. With experience crowns eventually get loose on their own due to cement failure and chewing forces etc. So a three teeth bridge if failed could do more harm to those crowned teeth when and if it was replaced in the future?

    Do lower bridges fail or succeed more often than upper similar bridges in length of serviceable time? How about the implant done in place of a submerged baby molar tooth? Is there a recommended way to do it in less steps also!

    1. Hello,

      Ankylosed baby teeth oftentimes require extensive surgery to remove them which will leave behind a bony defect. Bone grafting at the time of removal will be excellent. Reevaluation with a 3-D scan after 4-6 months will help determine the need for computer guided surgery and the location of nerves and sinuses.

      The decision to do flap versus non-flap surgery is based on a number of factors and your surgeons skill and experience. A non-flap surgery seems easier but requires a higher level of experience since the procedure is being done blind. Flap surgery is the standard of care and also allows the repositioning of your gum line. Unfortunately medical and dental insurance only cover a very small part of the entire procedure.

      Leverage forces should be determined by evaluating your bite which is called occlusion.

      Computer Guided Dental Implant Surgery, Things You Need To Know

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  3. Hi Vishnu,
    Yes, gum related problems can affect the healing. Make sure you take care of your other teeth in the area.
    If the implant is visible in your mouth, brush it with your toothbrush during the healing phase. This will help increase the success rate!
    Ramsey A. Amin, D.D.S., D.A.B.O.I.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow-American Academy of Implant Dentistry

  4. hi, Dr. Amin, i have finished the first stage of my dental implants surgery,
    my question is “will gum related problems affect the implants healing?”
    and “how to take care of implants during the healing process, that is for the next stage?”
    Thanks in advance.

  5. thanks for sharing this quality contents.it is very tough to get good information when you really need it as there is so much junk on the internet.your post seems very useful for myself.

  6. Hi Sally,
    Great to hear from you!!! I figured you must have moved away since it has been so long.
    I am glad to hear that the work I did for you is doing so well. I remember when you had your removable partial denture that you hated so much.
    Have your dentist send me your current x-rays and keep in touch!
    Dr. Ramsey Amin

  7. Hi Dr. Amin!
    I was on google and stumbled upon this! I havent seen you in about 5 years since I moved north.
    Just wanted to let you know that the implants you put in for me in 2001 are doing great. Nine years of great teeth!!! My dentist that I see now is always commenting how nicely they were done. He also says the bone graft looks like day one.
    Thanks again and I hope you get this message. If I ever move back, I will come see you!

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About Ramsey Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.