Before You Sit Down: The Planning That Makes Surgery Predictable

By the time you arrive for implant placement, most of the hard thinking has already been done. Your dentist will have taken a CBCT scan — a three-dimensional X-ray — to map bone height, bone width, and the position of nerves such as the inferior alveolar nerve in the lower jaw or the maxillary sinus above. Sometimes a surgical stent or guide is made from that scan, which slots over your teeth and shows exactly where the drill should go.

You will also have signed a consent form and discussed your medical history. Blood-thinning medication, uncontrolled diabetes, smoking, and a history of bisphosphonate use all change the plan, so be honest about everything. If you are having sedation, you will have been asked to fast beforehand and to arrange a lift home.

The typical appointment lasts between 30 and 60 minutes for a single implant, and longer if several are being placed or if a bone graft is added at the same time.

Getting Numb: Anaesthesia and Sedation

Almost all implant surgery is carried out under local anaesthetic. Your clinician will dry the gum, apply a topical numbing gel, and then give the injection slowly — usually into the buccal and lingual tissues around the site, and occasionally a nerve block for lower back teeth. Modern anaesthetics such as articaine or lidocaine with adrenaline take effect in about five to ten minutes.

Before starting, your dentist should test the area, often by pressing firmly on the gum or asking whether you can feel a light scratch. If you can, more anaesthetic is given. There is no prize for tolerating pain.

• Local anaesthetic alone: you stay fully alert, aware of pressure and vibration but not sharp pain.
• Local with oral sedation: a tablet taken before the appointment to take the edge off anxiety.
• Local with intravenous sedation: you remain responsive but relaxed and often remember very little afterwards.

Sedation is not the same as a general anaesthetic. You keep your own airway and can still cooperate with instructions.

Making the Incision and Preparing the Site

Once you are comfortably numb, the dentist makes a small incision in the gum, usually along the crest of the ridge, and lifts a flap of tissue back to expose the bone underneath. Some cases can be done "flapless", using a small punch to create a circular opening instead, which tends to mean less bleeding and quicker recovery.

What follows is the part most people find surprising: the drilling. It is not one hole but a carefully graded sequence. A narrow pilot drill marks the position and angle, then progressively wider drills enlarge the channel, each one following the path of the last. Your dentist will irrigate continuously with cool sterile saline to stop the bone overheating — bone is living tissue, and heat is its enemy.

You may feel firm pressure and hear a high-pitched whirring, but you should not feel the drilling itself. The sound travels through your jawbone directly to your ear, which is why it always sounds louder than it actually is.

Inserting the Implant

The titanium implant is then threaded into the prepared site, either by hand with a ratchet or with a slow-speed motor set to a low torque. Your dentist is aiming for a specific insertion torque — commonly somewhere in the region of 30 to 45 Ncm — because that figure tells them how well the implant is gripping the bone. If the bone is soft, they may widen the site less or choose a slightly wider implant.

Once the implant is at the right depth, its top should sit level with, or just slightly below, the bone surface. At this point your dentist chooses between:

• A cover screw, which is closed over by the gum. The implant heals completely out of sight and is uncovered in a second small procedure months later.
• A healing abutment, which pokes through the gum so no second surgery is needed. Many clinicians now prefer this approach.

If a bone graft or membrane is being placed around the implant, it goes in at this stage, before the tissue is closed.

Closing the Site: Sutures and What Happens Next

The gum is repositioned and held with sutures. These may be resorbable, dissolving on their own over two to four weeks, or non-resorbable, in which case you will return in seven to ten days to have them removed. Removing them takes seconds and rarely needs anaesthetic.

You will be asked to bite gently on a gauze pad for a while to help the clot form. Before you leave, expect clear instructions: no smoking, no vigorous rinsing or spitting for 24 hours, no straws, avoid hot drinks until the numbness fades, and take painkillers as advised — usually paracetamol or ibuprofen. Swelling typically peaks at 48 to 72 hours and then settles.

What You May Feel Throughout the Procedure

Pressure, vibration, tugging, the sensation of being worked on — all normal. Sharp pain is not. If you feel anything that makes you wince, raise your hand and say so; more anaesthetic can be given at any point without disrupting the surgery.

Afterwards, as the local anaesthetic wears off over two to four hours, expect a dull ache rather than severe pain. Most people manage it with ordinary painkillers for a day or two. Contact your clinic if you develop throbbing pain that worsens after day three, a bad taste, fever, or bleeding that will not stop — these can signal infection or a problem with the healing. Otherwise, rest, keep the area clean, and let the implant do its quiet work of fusing with your bone.