After an implant is surgically placed into the jawbone, an abutment is then attached to the titanium implant. It's to the abutment(s) that the custom-fitted crowns are attached.

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Dental Implant Abutments

Dental implant procedures are increasingly two-step processes, but they can take three -- and often it's by choice. After an implant goes into the bone, a post, or abutment, needs to be attached to the titanium implant. The abutment is what will hold the new crown or false tooth and it's often added with the implant, but sometimes it's during a second, minor surgery when the gums are opened again, and the abutment is fastened to the implant. The gums are given several more weeks to heal around the abutment -- but not over it -- before the next step [source: NIDCR].

Because the abutment extends up out of the implant and through the gums, it shows and can't be as easily concealed. An implant alone does not show, so some individuals opt for having the second minor surgery to add the abutment later so they don't have the abutment, well, butting out of the gums for the months it takes for the implant to set into the bone [source: Mayo Clinic]. Often, though, just as with a one-step procedure, a temporary crown or denture can be fitted and worn during the healing process.

Whether the procedure is done in a one- or two-step process, it is very important to be exceptionally thorough in keeping the mouth, teeth and gums clean and healthy. As the bones heal and the gums close up around the abutment, a firm foundation is being set for the crowning piece of the process: the dental crown itself. When all of the bone-cutting, gum-incising work is over, the human body responds by growing bone and plumping and firming gum tissues to receive new teeth.

After the gums have healed completely, a dentist or other specialist can then make impressions of the mouth and set the custom-fitted crown -- or implant prosthesis -- onto the abutment and make adjustments as needed. If replacing a single tooth, often a fixed implant is fashioned and screwed and glued onto the post. Removable implants are an option if replacing several teeth or even a full set, and these types of prosthetics are similar to bridges in that they can be snapped on and off for cleaning or repair. Aside from follow-up exams to check healing and progress, after this final step of restoration, the new tooth or teeth are good to go, often for a lifetime [source: Mayo Clinic].

Sometimes, before making it to the crowning, even getting to the initial first-step implant surgery requires some additional work. We'll look at other prep and failure issues, next.