Index / Implants
Dental implants
The implant is
the easy part.
The tooth on top
is the whole job.
Placing titanium in bone is a solved problem. What decides whether an implant looks right, feels right and lasts is where it is placed, and that is dictated by the finished tooth — which is why the finished tooth is designed first.
Why people come here
- He teaches occlusion and full-mouth rehabilitation to other dentists
- Fellowships in three academies — FAGD, FACE and FICOI
- The complex cases other practices refer out
- A written, itemized plan before anything is scheduled
The principle
Plan the crown.
Then place the root.
An implant placed where the bone happened to be convenient produces a crown that has to be shaped around the compromise — an angle that is hard to clean, a screw hole in the wrong place, a gum margin that never looks like a tooth. The restoration spends the rest of its life apologizing for the surgery.
Planned the other way round, the finished tooth is designed first, the implant position follows from it, and whatever bone or gum is needed to support that position is built. This is restoratively driven implant dentistry, it is what the Misch Institute teaches, and Dr. Nosti is on its faculty.
In practice it means the planning stage is longer and the fitting stage is shorter. You will see the proposed result before any surgical appointment is scheduled.
Options
Four situations, four answers.
Which one applies to you depends on how many teeth are involved, how much bone there is, and what you want the finished result to do.
One missing or failing tooth
An implant and a custom ceramic crown, with the teeth on either side left exactly as they are — which a bridge cannot claim.
02A whole arch, failing or already gone
A fixed set of teeth carried on four to six implants, screwed in and not removable by you. Often with a provisional arch fitted the same day.
03A denture that will not stay put
Two to four implants with attachments, so the existing or a new denture snaps firmly into place and comes out for cleaning.
04Implants as part of a larger rebuild
Where worn teeth, failing crowns and missing teeth have to be solved together, the implants are one component of a single plan rather than a project of their own.
The sequence
What actually happens, in order.
Examination and scan
A full examination, a 3D scan to see the bone and the nerve, digital scans of the teeth, photographs, and the design of the finished result.
Visit oneWritten plan
An itemized written plan: what is being done, in what order, over what period, and what each stage costs. Nothing is scheduled before you have it.
Before anythingGroundwork if needed
Extraction, grafting or a sinus procedure where the site needs it. Sometimes combined with placement, sometimes months before it.
If requiredPlacement and healing
The implant is placed and left to integrate with the bone. Three to six months in most sites. You are never left without a tooth in a visible space.
3–6 monthsThe restoration
The abutment and the final crown, bridge or arch — designed from the plan, fitted, and the bite measured and verified.
Final visitsCandidacy
Who implants suit, and who they do not.
Reasons to pause
Not necessarily a no, but a conversation first
- Active gum disease — treated before any implant is placed, without exception
- Smoking, which measurably raises the failure rate and is discussed frankly
- Poorly controlled diabetes, which affects healing
- Some bone-density medications, particularly intravenous bisphosphonates
- Insufficient bone, which is usually a grafting question rather than a refusal
- Unmanaged heavy clenching, which has broken more implant restorations than bad surgery
A good implant case
Where the odds are strongly in your favor
- Healthy gums, or gum disease that has been treated and is stable
- Enough bone, or a site that can be grafted predictably
- A general medical picture that allows normal healing
- Willingness to keep it clean — an implant can still lose its bone support
- A bite that has been assessed, and corrected if it needed it
- Realistic expectations about the timeline, which is months rather than weeks
Questions
Implants, answered.
How long do implants last?
Long-term studies on well-maintained implants report survival in the range of ninety to ninety-five percent at ten years, and many are still in service far beyond that. The implant itself is the durable part; the crown or arch on top is a restoration and may need replacing at some point, which is normal.
The two things that end implants early are gum and bone disease around the implant, and mechanical overload from an uncorrected bite. Both are manageable, and both are why the bite is measured here.
Is it painful?
Placement is done under local anesthetic and patients are routinely surprised at how uneventful it is — most describe it as easier than an extraction. Afterward, expect soreness and swelling for a few days, managed with over-the-counter pain relief in the majority of single-implant cases. Grafting and full-arch surgery involve more.
Will I be without teeth?
Not in a visible space, at any stage. A temporary tooth, bridge or provisional arch is part of the plan from the start, and if a stage would leave a gap you will be told exactly how it is being covered before you agree to it.
Can I have the whole thing done in one day?
Teeth in one day is real and it is done here for suitable full-arch cases. What goes in on the day is a provisional arch, not the final one — the final teeth are made after the implants have integrated. Anyone promising you the finished result in a day is describing something else.
Is a bridge ever the better choice?
Yes. Where the teeth on either side of a gap already need crowns, a bridge uses preparation that was happening anyway and can be the more sensible option. Where those teeth are healthy and untouched, grinding them down to carry a bridge is a real cost and an implant usually wins. You will get the argument for both.
Keep reading
Next step
Start with an examination and a straight answer.
A consultation includes an examination, the records the case needs and a written, itemized plan. If what you are asking for is not the right treatment, Dr. Nosti will say so and tell you what is.