Dental implants
An implant replaces the root of a tooth that is no longer there. Here it is considered when the tooth cannot be kept — and not before: if one has been proposed to you and you are unsure, you can ask for a second opinion.
First: can the tooth be saved?
This page starts where most end.
Your own tooth has something no implant reproduces: the ligament joining it to the bone, with the receptors that tell you how hard you are biting. An implant anchors straight into bone, and that sensitivity is gone.
So before considering an implant, whether the tooth can be kept with root canal treatment, retreatment or apical surgery is assessed. Often it can, even when elsewhere the answer was no.
When it genuinely cannot — a vertical root fracture, advanced bone loss, destruction beyond restoring — then an implant is the best solution available. But it is a solution for a lost tooth, not an alternative to keeping one.
Digital planning and guided surgery
Placing an implant is above all a problem of position. A few degrees of angle or a millimetre of depth decide whether the final restoration works and whether the bone will hold.
The process starts with a CBCT, giving the real bone volume in three dimensions, and an intraoral scanner that captures the mouth digitally without impression material. The exact position of each implant is planned on those two models before anything is touched.
That planning produces a 3D-printed surgical guide that steers placement so the implant ends up precisely where it was planned. The decisions are made on screen, unhurried, rather than in the middle of surgery.
When there is not enough bone
When a tooth has been missing for a while, the bone that held it resorbs. Sometimes there is not enough left to anchor an implant reliably.
In those cases bone regeneration restores the lost volume, or a sinus lift is carried out in the upper jaw, where the maxillary sinus has often expanded into the space the root once occupied.
These procedures lengthen treatment, which is why some clinics would rather not propose them. But placing an implant in insufficient bone mortgages the result in the medium term.
PRGF
Plasma rich in growth factors is obtained from the patient’s own blood and applied to support tissue healing.
Dr. Gaviño trained in its use in implantology and implant-supported prosthetics on a dedicated postgraduate course, and PRGF is also the basis of his published research into pulp regeneration. It is a technique he knows both from the clinic and from the laboratory.
After the implant
An implant is not a treatment that ends the day it is placed. It needs a period of integration into the bone before it can carry the restoration, and afterwards check-ups and maintenance like any tooth.
Peri-implantitis — infection of the tissue around an implant — is the main cause of long-term failure, and depends largely on hygiene and follow-up. That is explained before starting, not afterwards.
Scientific publications
- 2021 Dentin Growth after Direct Pulp Capping with the Different Fractions of Plasma Rich in Growth Factors (PRGF) vs. MTA: Experimental Study in Animal Model Journal of Clinical Medicine
- 2021 Regenerative endodontic procedure combined with apical surgery of a necrotic permanent incisor with extensive periapical lesion using plasma rich in growth factors (PRGF): A Case report with 6 years post-op evaluation using CBCT Journal of Clinical and Experimental Dentistry
- 2020 Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3-year follow-up International Endodontic Journal
- 2017 Use of Platelet-rich Plasma in Endodontic Procedures in Adults: Regeneration or Repair? A Report of 3 Cases with 5 Years of Follow-up Journal of Endodontics
Frequently asked questions
- Does placing an implant hurt?
- Placement is done under local anaesthetic and is not painful. Recovery is usually milder than people expect, particularly when surgery has been guided and the access minimal.
- How long from placement until I can chew on it?
- The implant needs to integrate into the bone before it can take load, and that period depends on the case and on whether bone had to be regenerated. The timeline is set out from the start, with a temporary solution in the meantime.
- Do implants last a lifetime?
- They can last a very long time, but there are no absolute guarantees. It depends on hygiene, maintenance, smoking and check-ups. Anyone promising an implant forever is selling, not informing.
- I have been told I do not have enough bone. Does that rule me out?
- Usually not. Bone regeneration or a sinus lift can restore the volume needed in most cases. It lengthens treatment, but it allows the work to be done properly rather than forced.
- Why do you try to save the tooth first?
- Because a natural root has proprioception and distributes biting forces in a way an implant does not reproduce. Wherever a tooth can be saved with a reasonable prognosis, keeping it is a better outcome than replacing it.
- Can the body reject an implant?
- Titanium does not cause immune rejection, contrary to what is sometimes said. What can happen is that it fails to integrate into the bone, or that infection develops around it over time — which is what hygiene and check-ups are there to prevent.
An assessment before deciding
Whether you have lost a tooth or been told you are going to, it is worth seeing every option with the imaging in front of you.