Single Posterior Dental Implants

Patients looking to replace missing teeth in the posterior areas constitute the majority of dental implants performed annually. According to the CDC, there are over a million people who are missing at least one back tooth. 

Missing back teeth can lead to a host of problems, including:

• Limited chewing function
• Shifting teeth
• Self-consciousness about having a space between teeth

Lower first molars are the most common tooth for a person to be missing. An individual who is missing a lower first molar can experience discomfort when chewing and can also see teeth shift dramatically over time.

Replacing a single posterior tooth is the most common implant procedure, and the process is not as complex or costly as you might think.

What is the process for single posterior implants?

The first step is tooth extraction. Then the resulting space must be allowed to heal for a minimum of three months.

The healing period allows the bone to fill in or solidify to the point that an implant can be placed with a high likelihood of success.

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An implant is then placed into the space (with no crown on it) so that the bone can grow around the implant threads and “lock” the implant into the bone. This process, called osseointegration, is the key to the long-term success of the implant itself. If bone does not have adequate time to heal and densify, there is an increased risk of implant failure.

Typically, the initial surgical procedure is performed with local anesthetic, much like would be used when filling a cavity or receiving a crown. Recovery and down time are minimal; in many cases, stitches or post-op pain medications aren’t required.

The implant is then covered and protected by a small “button.” Practicing excellent oral hygiene is all that is required for the implant to successfully integrate to the bone and the healing time is one or two days.

Second phase: abutment and crown

After three or more months of healing time, the implant has integrated or fused to the bone and the implant is ready to support the abutment and crown.

At this point, the restorative dentist places an abutment or “post” onto the implant and tightens it to a very specific torque value, ensuring that the abutment and crown do not come loose.

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Then a master impression or digital scan is taken and sent to a lab for the fabrication of the final porcelain or zirconia crown.

Finally, the crown is either cemented or screwed onto the implant for a final result nearly identical to a natural tooth in function, aesthetics, and long-term maintenance.

How do you determine if you need a dental implant?

There are many reasons why one might need a simple single implant. These include:

• A severely cracked or broken tooth
• A missing tooth
• An infected tooth

While there are alternative treatment options—including bridges and partials—in most cases the best and most natural choice for replacing a missing tooth is a dental implant.

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Patients that choose an implant to replace a missing tooth have satisfaction rates far higher than patients that choose alternative treatment options.

Cost of a simple single implant

The cost of a simple single implant varies widely, but according to research done by Implant Evolution, the cost of a simple single implant and crown ranges from $2,380 to $5,745, with an average cost of $3,420.

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Learn more about costs in our guide to Understanding the True Cost of Dental Implants.

Dental implant brands and materials

There are a handful of well-respected companies that manufacture dental implant systems, and more than 99% of the dental implants they produce are manufactured using surgical grade Type V titanium alloys, which are similar in composition to the materials used to create artificial joints.

Titanium is ideal for dental implants because it is:

• Non-corrosive
• Non-magnetic
• Lightweight, and
• Incredibly strong under stress

In addition, osteocytes (bone cells) integrate well with titanium and tend to grow towards the metal itself. This mechanism, called osseointegration, is the reason dental implants can withstand massive chewing forces over long periods of time. 

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In part, that’s because implant designs have improved dramatically compared to the implants produced in past decades. Advancements in implant design have:

• Helped to increase long-term success rates, and
• Deliver consistent strength, allowing for many years of use

Historically, porcelain fused-to-metal crowns have been used with great success, but recent advancements in both porcelain and zirconia laboratory restorations give implant dentists the ability to create crowns and bridges that are much more lifelike, durable, and cosmetically pleasing.

Preoperative advice and tips

Before implant surgery, the surgeon may prescribe specific medications, typically an antibiotic, or even vitamin supplements. It may also be necessary to stop taking certain medications preoperatively.

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Smoking cessation is imperative because it leads to more implant failures than any other activity. In part, that’s because nicotine reduces blood flow, which inhibits the healing process.

Preoperative requirements typically include the following do’s and don’ts:

• Do brush your teeth prior to your appointment
• Do wear loose-fitting, comfortable clothing
• Don’t drink alcohol for at least 24 hours prior to the procedure
• Don’t eat or drink anything for at least eight hours prior to surgery if you are scheduled to have general anesthesia

Patients are also instructed to bring a friend or family member who can wait in the waiting room during the procedure and drive the patient home afterwards.

It is extremely important that patients follow all instructions precisely because each directive is specifically designed to increase the chances of successful implant surgery.

Bone density requirements & required preoperative scans

Sufficient bone quantity and quality are both required to have a site that is acceptable for implant placement.

Additionally, proper diagnosis and preoperative planning are essential to successful implant placements and restorations.

Implant dentists now have amazingly advanced technologies available in the office that aid in preoperative diagnosis and surgical planning.

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When it comes to surgical planning, the standard of care in implant dentistry is cone beam or CBCT imaging. The 3-D images allow an implant surgeon to investigate all of the internal anatomies located within the surrounding surgical area and to produce the best possible surgical plan.

For instance, bone quality and quantity can be observed and measured precisely so that the correct implant design can be chosen. Anatomical structures, such as nerves, arteries, and muscles, can be mapped precisely so that they are avoided during the surgical procedure. The use of cone beam imaging or other CT scans leads to fewer risks, safer implant procedures, and better outcomes. 

Anesthesia: Are you sedated for dental implant procedures?

In most cases, the choice of whether or not to be sedated is up to the patient.

Simple implant procedures are typically performed using local anesthetic, which numbs the treatment area intraorally. It is very safe and predictable and “right” for the majority of simple implant procedures.

More complex cases can require conscious sedation or general anesthesia, which can also be used if a patient has elevated anxiety levels.  

Typically, there is an additional cost for sedation that is not included in the implant fee. Patients are encouraged to discuss sedation options with their implant dentist during the consultation phase.

Are single implants a same day procedure?

Implants can sometimes be placed the same day a tooth is extracted, but this is not always the case.

Many times, there is not enough bone present post extraction or the implant does not fit precisely into the tooth socket.

Implants must have an intimate fit into the bone and cannot exhibit any movement whatsoever after placement.

Immediate implant placements have a slightly higher failure rate than the conventional implant process. However, immediate implant surgeries are becoming increasingly popular and success rates are steadily increasing, especially when coupled with bone grafting procedures.

Duration of the process for simple single implants

Most experienced implant dentists can place a simple single implant in less than an hour.

After a three- to four-month healing period, the implant is ready to support an abutment and crown. At this point, the implant dentist places the abutment or “post” onto the implant. Then the crown is either cemented or screwed onto the implant.

Two short appointments are all that is needed for the final restoration and local anesthesia is often not necessary.

Proper upkeep, issues with recovery & rejection, and peri-implantitis

Implants can fail and this does happen on occasion.

Smoking, poor bone quality, and underlying health issues (such as diabetes), are factors that can contribute to implant failure.

Peri-implantitis—a condition that can occur in tissues around dental implants, one that is characterized by inflammation and progressive loss of supporting bone—is another concern. The onset of peri-implantitis can occur early during follow-up and often progresses in a non-linear and accelerating pattern. There is evidence that patients who exhibit poor plaque control skills and are less diligent about maintenance care have an increased risk of developing peri-implantitis.

The good news is that when an implant does fail, it is generally not a significant problem and the implant can be replaced soon thereafter.

Post-surgery tips and advice for proper healing of single implants

Post-operative care is imperative to the successful healing and bone integration of dental implants.

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Most patients are instructed to rinse post surgically with saltwater to promote healing, while the oral rinse Peridex™ promotes antimicrobial cleansing of the surgical site and reduces the chance of infection. A natural or holistic rinse from StellaLife®.is often used to promote soft tissue or gingival healing. Practitioners are using these products more and more often to promote soft tissue or gingival healing with impressive results.

These focused post-surgery exercises promote healing, combat infection, and lead to better overall outcomes.

How to prevent dental implant failure

As for behaviors that can lead to implant failure, smoking is far and away the biggest detriment to implant healing due to vasoconstriction and limited blood flow to the surgical site.

It is also imperative that the patient does not aggravate or chew directly on the implant(s) for a period of eight weeks. Implants that are left undisturbed have the best chance of successful bone integration.