What is a dental implant, really?
Dr Pushkar SobtiAll-on-X implantologist, Delhi
When I put a dental implant in a patient's hand for the first time, the reaction is almost always the same: "That's it?" Most people picture something large and mechanical. What they are holding is a small titanium post, usually 3.5 to 5 millimetres wide and 8 to 13 millimetres long. It weighs less than a gram.
That small post does the job of a tooth root. Everything else in an implant tooth is built on top of it.
The three parts of an implant tooth
A dental implant is not one piece. A complete implant tooth has three parts, and each has a separate job.
At the bottom is the implant itself, a threaded titanium post that sits in the jawbone where the root used to be. Once it has healed in, everything else is built on it.
On top of that goes the abutment, a connector that screws into the implant and comes up through the gum. We have ours custom-made for each patient, so it follows the shape of that person's gum and holds the crown at the right angle.
The crown is the part you actually see. We design it on screen and mill it from zirconia in our own lab, matching the shape and shade of the teeth around it.
When a full arch of teeth is replaced, as in All-on-4, the idea is the same. Four to six implants carry one fixed bridge instead of separate crowns.
Why titanium bonds to bone
In the 1950s a Swedish researcher, Per-Ingvar Brånemark, was studying blood flow in bone. He placed small titanium chambers in bone, and when he tried to remove them he found he couldn't. The bone had grown tightly onto the titanium surface. He called it osseointegration, and in 1965 he treated his first dental implant patient.
Titanium works because its surface forms a thin, stable oxide layer that the body does not treat as foreign. Bone cells grow directly onto it. Modern implants also have specially treated surfaces that give bone more to grip and help it attach faster.
That bonding takes time. After the implant is placed, the bone usually needs about three to four months to fuse with it fully. In suitable cases we can fit temporary teeth much sooner, which I will explain later in this series.
How an implant differs from a natural tooth
An implant comes close to a natural tooth, but it isn't the same, and I'd rather patients know the differences before they start.
It can't get a cavity, because titanium and zirconia don't decay. The gum and bone around it can still get inflamed if plaque is left to build up, though, so brushing and check-ups matter just as much as they did with your own teeth.
It also feels slightly different. A natural tooth sits in a cushion of ligament fibres and gives a tiny bit when you bite. An implant is fused straight to the bone, so it feels very solid. Most patients stop noticing that within a few weeks.
The implants I use
Not all implants are the same. The design of the thread, the surface treatment and the connection to the abutment all affect how well an implant holds and how long it lasts. In my practice I use three systems: Nobel Biocare NobelActive TiUltra, Hiossen ET IV and Osstem TS IV CA. I choose between them for each patient based on the bone quality seen on the CBCT scan and the type of restoration planned.
A single implant with a custom abutment and a zirconia crown starts from ₹35,000 at our clinic, placed with guided surgery and with a 3-year warranty on the crown.
Questions
How big is a dental implant?
Most implants are about 3.5 to 5 mm wide and 8 to 13 mm long. The exact size is chosen for each patient from the CBCT scan, based on how much bone there is.
Is a dental implant a screw?
The implant itself is a small threaded titanium post that sits in the jawbone like a root. On top of it go an abutment, which connects, and a crown, which is the tooth you see.
Can you be allergic to a titanium implant?
True titanium allergy is very rare. For patients who want a metal-free option, zirconia (ceramic) implants exist, and I cover them later in this series.
Next · Sat 24 Oct
What happens to your jaw when a tooth is lost. Why a missing tooth changes more than your smile, and why time matters.