Here’s how implants work in our office, since it’s the first thing people want to know.
We plan it. A surgeon we trust places it. We build the tooth on it, and we look after it for as long as you’re our patient.
What makes that worth choosing is who does the planning. Dr. Sandquist used to place implants himself. He doesn’t do the surgery anymore, but he’s been on both sides of it: deciding where an implant goes, and then building a tooth on wherever it ended up. He brings that experience to every implant plan, and it’s most of what this page is about.
If you’re still deciding whether an implant is right for you at all, that question has its own article, including the one thing to settle before any tooth comes out. This page is about what getting one with us actually involves.
What placing implants taught him about planning them
An implant isn’t placed first and then fitted with a tooth. It’s placed for a tooth, and the tooth can only turn out as well as the implant’s position allows.
Because he’s placed them, Dr. Sandquist knows what a surgeon can realistically do at a given spot: where the bone will take an implant, where it won’t, and when a site that looks simple on an X-ray is going to need more. Because he’s restored them for decades, he knows exactly what a position mistake costs when it’s time to build the tooth.
- Angled wrong, and the screw access or the abutment ends up where it shows, or where your bite puts bad pressure on it.
- Too shallow or too deep, and it’s hard to get the gumline right around the finished tooth, which matters most in the front.
- Too close to the tooth next to it, and there’s no room for healthy gum and bone in between, or for cleaning.
- Where the bone was instead of where the tooth needs to be, and the crown has to be built out at an angle to reach the bite.
Every one of those can happen with an implant that heals perfectly into the bone. The surgery succeeds and the tooth is still compromised, because the position is set at surgery and can’t be changed later. Knowing both halves is how we prevent those problems while planning, instead of discovering them when it’s time to build the tooth.
Why he stopped doing the surgery
We’d rather tell you than leave you wondering.
Some implant sites need more than an implant. The bone has to be built up first, or the anatomy makes the placement a bigger procedure than it looked on the X-ray. Those were surgeries he wasn’t going to do, and a straightforward single implant can turn into one of them without much warning. Once that was clear, placing some and referring the rest stopped making sense.
So the surgery goes to surgeons who do this work every day. What he kept is the understanding of it. That’s what lets him plan a case the surgeon can actually carry out, and build a tooth that works on the result.
It’s the same way we handle every other surgical procedure: diagnosed and planned here, done by the specialist, and restored here.
What “planned here” means
An implant is planned backward. The question isn’t where the bone happens to be. It’s where the finished tooth needs to sit, and so where the implant has to go to hold it there.
- Where the tooth needs to be. How it meets the tooth opposite it, how it sits next to its neighbors, and how it looks at the gumline.
- What the bone allows. That’s what 3D CBCT imaging is for: how much bone there is, and where the nerves and sinuses are.
- Where those two don’t line up. Sometimes the bone isn’t where the tooth needs it, and it has to be rebuilt first. It’s much better to find that out while planning than during surgery.
That plan goes to the surgeon with you, so nobody has to work it out from scratch, and the implant ends up where the tooth needs it, not wherever was easiest.
How a case works
- Exam and records here. We look at the tooth or the space, the teeth around it, your bite and your gum health, take 3D images, and go over your health history, because an implant is surgery.
- The plan, and a straight conversation about it. That includes whether a questionable tooth is worth trying to save first.
- The surgeon. A consultation, then taking out the tooth if it’s still there, bone grafting if it’s needed, and placing the implant.
- Healing. Usually months, and often twice: once for a grafted socket, and again while bone grows onto the implant. The full timeline is here, and it’s worth reading before you start, not halfway through.
- The tooth, here. The abutment, the crown and the bite.
- Checkups, here, for good. We check it and X-ray it on a schedule, for the reason in the next section.
In the meantime, if it’s a front tooth, we fill the space while the implant heals, usually with a small acrylic partial or a clear tray with a tooth set in it. For most back teeth, people just live with the space during the surgical phase. Nobody sees it, and an appliance back there is usually more trouble than it’s worth.
Once in a while, a tooth can go on at or near the time the implant is placed. That depends on how firmly the bone grips the implant the moment it goes in, so it’s something we find out on the day, not something to plan around.
Two numbers worth knowing
How long they last. A systematic review of prospective studies that followed modern implants for ten years put survival at 96.4%. The same authors then reran the numbers to account for patients who dropped out of follow-up, which is the more realistic version, and got 93.2%. Patients 65 and older came in lower, at 91.5%.
Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent. 2019;84:9-21. Eighteen prospective studies. The sensitivity analysis suggested the risk of losing an implant may be roughly double in older age groups.
That’s an excellent record for anything in dentistry. Keep in mind it measures whether the implant is still there, not whether the crown on top has needed work, and crowns do wear and chip.
How often problems develop around them. People are rarely told this one. A systematic review put the average rate of peri-implant mucositis, which is inflammation of the gum around an implant, at about 43%. The rate of peri-implantitis, where that inflammation has started to cost bone, was about 22%.
Derks J, Tomasi C. Peri-implant health and disease: a systematic review of current epidemiology. J Clin Periodontol. 2015;42 Suppl 16:S158-S171. Reported rates varied enormously between studies, from 1% to 47% for peri-implantitis, largely because the studies defined it differently. Treat 22% as a weighted average across inconsistent definitions, not as your personal risk.
Here’s why that matters for you. An implant has no nerve inside, so it doesn’t ache early the way a decaying tooth does. If peri-implantitis shows up on an X-ray at a routine visit, it’s often manageable. If it’s found because it finally hurts, the implant often has to come out. That’s why we keep implants on a checkup and X-ray schedule, and why the upkeep isn’t optional.
Position plays into this too. An implant crowded against the tooth next to it, or with a crown built out at an angle, is harder to keep clean, which is one more reason the planning matters. And if you have active gum disease, we treat it before any implant goes in.
What it looks like done well
J.D. spent nearly twenty years with a collapsed bite and gum disease after old dental work changed the way her teeth came together. We rebuilt her mouth on implants, working with periodontist Dr. Ryan Gifford and lab technician Justin McElroy. She’s pain-free and back to singing with her sisters.
One patient lost all the teeth and bone on one side of his jaw in a car accident as a young man. He spent years looking for a surgeon who could rebuild that much bone. The right referral made it possible, implants gave him a working bite for good, and his old removable partial denture went in the trash.
See how we solved G.B.’s bone loss →
Not every case is that involved. Another patient had a single tooth fail and darken at the gumline after an old injury. It was taken out and replaced with an implant the same day, and the gum tissue was restored along with it.
And sometimes the real problem isn’t the one that brought someone in. One patient came to us unhappy with how crowns and bridges done abroad looked. A full exam found that none of them actually fit, which had already caused gum disease and cost him several back teeth. Treating the gum disease first and then restoring the implants gave him a bite that works, not just one that looks better.
See how we solved S.V.’s case →
An implant, a bridge, or a denture
Once a tooth is gone, an implant is usually the strongest choice, because it’s the only option that stands on its own without relying on the teeth next to it. It isn’t always the right choice for every mouth, every health history or every budget.
- A bridge is held up by the teeth on either side, which have to be shaped to support it. That’s a good trade when those teeth already need crowns, and a poor one when they’re untouched.
- A denture or a flipper comes out. A flipper is the usual way to fill a front space while an implant heals.
- How they all compare is laid out side by side.
When it’s a whole arch
Replacing a whole arch is a different procedure with different trade-offs, but the work is split the same way: the surgeon places the implants, and we build and look after the bridge that goes on top. We also take on full-arch cases done elsewhere that have broken down or that nobody will maintain. More on All-on-4 and full-arch implants →
Cost and insurance
An implant is several procedures from two offices, and the total depends on your case: whether a tooth has to come out, whether bone has to be built up, and what goes on top. We’d rather give you a real number after an exam than a misleading one on a website.
What we can tell you now is that dental insurance maxes out low, and an implant is the classic case where the coverage runs out long before the treatment does. How insurance works here, and how we help when it doesn’t stretch far enough, is worth reading before you get a quote anywhere.
Bring it in
If you’ve lost a tooth, been told you’re about to, or have an implant plan from another office you’d like a second look at, bring it in. We’ll tell you what we’d do in your position.
Call 702-734-0776 or tell us what’s going on.
Implants are placed by periodontists and oral surgeons we refer to. Planning, restoration and long-term care are done here. The survival and disease figures are pooled averages from the reviews cited and can’t predict how any one implant will do. This is general information, not a substitute for an exam.