The Amazing Dental Implant: Part 1

Most people have a general understanding of dental implants, but a few misconceptions still linger. Today we’ll briefly review what a dental implant actually is and discuss the key factors that influence its long-term success.

What many people call an “implant” is a three-part system.

1. The implant: The implant is surgically placed into the jawbone and functions as an artificial tooth root. It is made of titanium and has threads on its surface that interact directly with the bone. On an x-ray, it looks much like a small screw. After placement, bone cells grow directly onto the implant surface through a process called osseointegration — a literal fusion between living bone and metal. This is the same biological process as artificial hips and knees.

2. The abutment: The abutment is the connector between the implant post and the visible crown. One side precisely fits into the top of the implant, while the other supports the crown. A small, precisely machined screw secures the abutment inside the implant body.

3. The crown: The crown is the visible, functional “tooth” that sits on top of the abutment. It is typically cemented in place. In many cases, the crown has a small access opening on the biting surface that allows the dentist to reach the abutment screw. This is the preferred design, as the opening can be filled with a tooth-colored material and easily reopened if future access is needed.

The crown is the end goal for both patient and dentist — it should look, feel, and function like a natural tooth. Because it experiences normal biting and chewing forces, it may eventually need replacement due to wear, chipping, or cosmetic changes. Having access to the abutment screw allows the crown and abutment to be removed if future issues arise.

The single most important factor in implant longevity is the amount of healthy bone surrounding it. Bone loss around natural teeth is called periodontitis; around implants, it is known as peri-implantitis. Bone loss can ultimately lead to the failure of both teeth and implants. For this reason, implants must be professionally cleaned and monitored just like natural teeth. Hard calculus can form under the gums around implants, and the bacteria it harbors triggers inflammation that damages bone and gum tissue.

Diabetes is a common contributor to bone loss around implants. Elevated blood sugar weakens the body’s immune response, including in the mouth, allowing bacteria to thrive and inflammation to increase. This makes implant placement and long-term maintenance more challenging.

Smoking is another major risk factor. Tobacco use reduces blood flow to the gums, impairs healing, and weakens the body’s defense against infection. Smokers have a significantly higher risk of peri-implantitis and implant failure.

The solution is straightforward: good daily home care, smoking cessation when possible, and regular professional cleanings as recommended by your dentist. These steps interrupt inflammation and protect the bone that keeps implants stable for years to come.