How Dental Implants Work: The Procedure Step by Step
Medically reviewed by Dr. Sergio Calleja, DDS, MPH — Board-Certified Oral & Maxillofacial Surgeon · Last reviewed 2026-04-09
Getting a dental implant is a staged process rather than a single visit. The surgery to place the implant is often quick — frequently about an hour for a single tooth — but the healing that follows takes months, because bone has to grow onto the implant before it can carry a tooth.
Here is the journey, step by step, as it happens at our practice.
- 1
Consultation and 3D Planning
Dr. Calleja examines the area, reviews your health history, and takes a low-radiation 3D CBCT scan — a cone-beam CT that maps your jawbone, nerves, and sinuses in fine detail. This is where we confirm you have enough bone, decide whether a graft is needed, and plan the exact position and angle of the implant to avoid the nerve in the lower jaw and the sinus in the upper jaw. Many implants are placed using a custom surgical guide printed from this plan.
- 2
Extraction or Bone Grafting, If Needed
If a failing tooth is still present, it is removed first. If the bone is too thin or too short to hold an implant — common after a tooth has been missing for a while — a bone graft or sinus lift rebuilds the site. Grafting may be done at the same appointment as the implant or as a separate step that heals for a few months first, depending on how much bone is needed.
- 3
Implant Placement
On surgery day the area is fully numbed, and we offer in-office IV sedation or general anesthesia so you can be comfortably asleep if you choose. The surgeon makes a small opening in the gum, prepares a precise channel in the bone, and threads the titanium implant into place. A single implant often takes about an hour. Most patients feel well enough to return to normal activities within a day or two.
- 4
Healing and Osseointegration (3–6 Months)
This is the quiet, essential phase: over roughly three to six months, bone grows onto the implant and fuses it firmly in place. You usually go home the same day with a small healing cap or temporary tooth over the site. There is nothing to “do” during integration except keep the area clean and let biology work — the implant is silently getting stronger week by week.
- 5
Abutment and Final Crown
Once the implant has integrated, the abutment (the connector) is attached, and impressions or a digital scan are taken. Your restorative dentist then makes and fits the final custom crown, matched to your other teeth. When it clicks or screws into place, you have a complete, natural-looking tooth — and the bite is checked so it meets your other teeth correctly.
The Team Approach: Who Does What
Most implant treatment is a partnership. The oral & maxillofacial surgeon handles the surgical part — planning, any grafting, and placing the implant in the bone — because that is the anatomy and the anesthesia they are specifically trained for. Your general or restorative dentist then handles the prosthetic part — designing and fitting the abutment and final crown that you see and chew with.
Dr. Calleja coordinates directly with referring dentists across Southern Maryland and the DMV throughout treatment, so the surgical plan and the crown plan fit together seamlessly from the first scan to the final bite.
Immediate vs. Delayed Placement
When a tooth needs to come out, there are two broad timelines. In immediate placement, the implant goes in the same day the tooth is removed, which can shorten the overall process and sometimes allows a temporary tooth right away. In delayed placement, the socket is allowed to heal for a few months first before the implant is placed.
Neither is universally “better.” Immediate placement works well when there is enough healthy bone and the implant is stable at the outset, and published success rates for well-selected cases are high. Delayed placement tends to be more predictable when bone is thin, infection is present, or risk factors like smoking are involved. Dr. Calleja recommends the timing that gives you the most reliable long-term outcome for your specific anatomy.
Frequently Asked Questions
How long does implant surgery take?
Placing a single implant often takes about an hour, and many straightforward cases are quicker. Multiple implants, grafting, or a full arch take longer. You will get a specific time estimate at your planning visit.
Will I be awake during the procedure?
That is your choice. An implant can be placed under local anesthesia alone (numb but awake), or with in-office IV sedation or general anesthesia so you are comfortably asleep. Dr. Calleja is trained and credentialed to provide these anesthesia options in the office.
How long is the whole process from start to finished tooth?
For most single implants, plan on roughly three to six months from placement to final crown, driven by the time bone needs to fuse to the implant. Cases that need bone grafting first can take several months longer. Same-day options exist for selected patients.
Do I need a bone graft?
Not everyone does. Grafting is needed when there is not enough bone height or width to fully surround an implant — common after long-standing tooth loss, gum disease, or in the upper back jaw where the sinus sits low. Your 3D scan tells us for certain, and grafting is a routine part of implant care when it is needed.
Can one implant replace several teeth?
A single implant replaces a single tooth. For several missing teeth, two or more implants can support a fixed bridge, and a full arch can be restored on as few as four to six implants — so you do not need one implant per tooth.
Have Questions About Dental Implants?
Dr. Calleja evaluates every case personally at the Waldorf and California, MD offices — consultations in English or Spanish.
This page is general patient education, not personal medical advice. Every patient's anatomy and health history are different — treatment details, risks, and recovery vary case by case and are reviewed with you during your consultation. For emergencies, call 911.