The tooth you eventually see is only part of a dental implant plan. Dr. Alan Hecht, an oral surgeon at Somerset Oral Surgery, describes a process involving both his office and the patient’s dentist. The surgeon handles the implant, grafting and soft tissue work. The dentist makes the crown, so the two offices need to agree on what they are building before the patient gets to that final step.
When I interviewed Dr. Hecht on Oct. 8, he explained it with a construction comparison. “as the oral surgeons, we’re like the guys who dig the foundation and put that in. The house is made by the dentist.” It is a useful way to understand why an implant consultation is about more than putting something into an empty space. The foundation has to suit the tooth the dentist will make.
A single tooth can bring you to the surgeon by different routes
Dr. Hecht describes three starting situations. A patient may have a bad tooth that needs extraction, may already be missing the tooth or may have problems with all the teeth. In some all-teeth cases, he says the teeth are removed, several implants are placed and teeth are made on them. For a single tooth, the first two situations help explain why one person’s sequence can differ from another’s.
If the tooth is still there, the process begins with an evaluation. Dr. Hecht says patients usually arrive at the direction of a general dentist, periodontist or prosthodontist. The discussion includes the tooth that needs attention and the options for the space. The surgeon also confers with the general dentist about the plan.
Dr. Hecht says, “Sometimes we can do an implant right away. In most cases though we end up doing a delayed implant placement.” In that delayed sequence, the tooth comes out and the socket is usually grafted. He describes allowing two to four months for healing, depending on where the tooth is in the mouth. That is one stage of the process, not a total from the first consultation to the finished crown.
The scan is part of the planning, not a formality
After the grafted socket heals, Dr. Hecht says the practice takes a new CT scan. He evaluates the bone and plans the implant on the scan. The software lets him set its position, angulation, depth and size. He plans those details alongside the tooth the dentist will make.
Location matters because the obstacles differ. In the upper back jaw, Dr. Hecht says the sinus is the concern. In the lower back jaw, it is the nerve. The scan also helps him check whether there is enough bone for the proposed placement.
That makes “how long does an implant take?” a question about the sequence for your site. If extraction and grafting come first, those stages happen before implant placement. Healing after placement is another stage. Dr. Hecht describes upper-jaw implants healing for about three to four months, which should not be confused with the earlier socket-graft interval.
If the tooth is already missing, the starting point changes
For a tooth that has already been extracted, Dr. Hecht again uses a CT scan. He says there is adequate bone and soft tissue in most cases. In that situation, the implant is placed, heals for a couple of months and the general dentist puts the crown on. That is the sequence he describes for an existing space with the conditions needed for placement.
If the tooth came out a while ago, the findings may be different. Dr. Hecht says there may not be enough bone or soft tissue. That can mean grafting before the implant. The fact that a space is already empty does not, by itself, settle which stage comes next.
There is also a separate consideration for the upper six front teeth. Dr. Hecht says the practice tries to place an implant the same day with a temporary tooth when a specific set of conditions is met. Sometimes there is not enough bone or the implant would end up in the wrong position. In those cases, he describes extraction, grafting and healing before placing the implant later.
The crown shapes the work beneath it
Dr. Hecht says the practice stays in contact with the patient’s general dentist about where the implant sits and which implant the dentist likes to use. The surgeon’s work includes the implant, grafting and soft tissue preparation. The dentist then makes the visible tooth. Coordination matters because those jobs are connected even though they take place in different offices.
Dr. Hecht says, “patient never sees the implant that I do. They see the crown.” His point is that the work below it needs to allow the dentist to make the crown. The visible result is what the patient looks at, but its plan begins before that part is made.
After implant placement and healing, Dr. Hecht describes an “uncovering” step. He checks that the implant is ready for the crown. The patient then returns to the general dentist for that part of the process. The handoff between offices is part of the planned sequence.
Somerset Oral Surgery has three doctors: Dr. Hecht, Dr. Tyler Jacobs and Dr. Maya Ramachandran, an oral medicine specialist. Dr. Hecht says the options he gives a patient include doing nothing, a bridge or an implant. He describes implants as “the standard of care now,” which is his view. He also says he does not want the conversation to feel like selling something.
His personal way of explaining that recommendation is direct: “if this was my mother or my brother or my sister, you know, I’m putting an implant in there for you.” That is his personal view of the option he is discussing. Ask him to explain how that recommendation relates to the findings for your tooth. The evaluation and conversation with the dentist determine the proposed path.
Dr. Hecht says the thought of a hole and a screw concerns patients. He also says patients often tell him the procedure was easier than they expected. That is his account of what he hears, not an assurance of how another patient will feel. Tell the surgeon what worries you so it becomes part of the consultation.
This article shares information from the interview, not medical advice. The timing figures describe individual stages rather than a complete treatment schedule. Your own sequence needs to be explained by the providers evaluating the tooth and the space.
At the first consultation, ask three questions. Can the implant be placed when the tooth comes out, or does the site need grafting and healing first? What does the scan show about the bone and the nearby sinus or nerve? How will the surgeon and my dentist coordinate the implant placement, uncovering and crown?
More from City Lifestyle: