Second Stage Implant Surgery: What to Expect From Your Abutment Procedure
Second stage implant surgery is a minor, usually outpatient procedure that uncovers your dental implant and connects the abutment, the small piece your new tooth will eventually attach to.
At Prime Dental Care in Milwaukie, Dr. Thomas Cardwell provides restorative dental care for implants that are already in place. Knowing what the abutment step involves, and what follows it, can take much of the uncertainty out of the months between your implant and your finished tooth.
If you want help planning what comes after your implant, Prime Dental Care sets fees below other Milwaukie-area dentists for seniors over 55 and veterans who don’t have dental insurance. You can reach our office at 503-774-6355.
What Is a Dental Implant Abutment?
A dental implant abutment is the middle piece of an implant tooth: the implant acts as the root in your jawbone, the abutment rises through the gum, and the crown or denture attaches on top.
In many cases, the first abutment you receive is temporary. A healing abutment, also called a healing cuff or cap, helps the gum tissue heal into shape around the implant. Once that tissue has healed, a final abutment takes its place.
Final abutments can be designed for one specific mouth. According to the American Dental Association, computer-designed abutments are shaped to the individual patient, and their contours below the gumline need to look right without harming the surrounding bone or gum tissue.
When Is Second Stage Implant Surgery Done?
Second stage implant surgery is done once osseointegration is complete. That is the process in which your jawbone grows into, and joins with, the surface of the implant, giving your future tooth a solid base.
That bonding can take several months, and waiting for it accounts for much of the overall implant timeline. If you are still weighing whether an implant is worth the wait, our comparison of a dental bridge vs implant for seniors explains how the two options differ.
What Should You Tell Your Dental Team Beforehand?
Before second stage implant surgery, give your dental team a complete list of every medicine you take, including prescriptions, over-the-counter medicines, and supplements, along with any medical conditions you are managing.
If you have certain heart conditions or bone or joint implants, such as a hip or knee replacement, your healthcare professional may prescribe antibiotics before surgery to help prevent infection. If you smoke, raise it with your dental team as well, since smoking may play a part in implant failure and complications.
What Happens During Second Stage Implant Surgery?
Your surgeon reopens the gum over the implant, attaches the abutment to the implant post, and then closes the gum tissue around the abutment instead of over it. That leaves the top of the abutment just above the gumline, where your dentist can reach it during the next phase of treatment.
Not every implant goes through this step. Some surgeons attach the abutment on the same day the implant goes in, an approach known as one-stage surgery that removes the extra surgical step.
That convenience comes with a cosmetic tradeoff. Because the abutment extends past the gumline from the start, it shows when you open your mouth until your replacement tooth is finished, and some people would rather have a separate procedure than live with that look for months. Whether steps can be combined depends on your situation, the specific procedure, and the materials involved, so the approach is decided case by case.
Is Second Stage Implant Surgery Painful?
Second stage implant surgery is usually performed with medicine that numbs only the area being worked on. If dental procedures make you anxious, ask about sedation, an anesthesia option for implant surgery that helps you feel calmer.
Some discomfort can follow once the numbness fades. You may notice swelling of the gums and face, bruising of the skin and gums, pain at the implant site, and minor bleeding. Your surgeon may also prescribe pain medicine or antibiotics afterward.
How Long Do Gums Take to Heal After Abutment Placement?
Gum tissue usually takes four to six weeks to heal fully around the abutment, and your new tooth can’t be attached until at least two weeks have passed.
While your gums heal, you may need to eat soft foods, and your surgeon will give you instructions for keeping the area clean. Following them closely matters, because correct cleaning helps prevent infection and supports healing. Your surgeon will likely use stitches that dissolve on their own, and any that don’t are removed at a follow-up visit.
Call your surgeon if swelling or soreness gets worse in the days after the procedure instead of better, if bleeding will not stop, if pain in your jaw, mouth, or sinuses is not relieved by the medicine you were prescribed, or if you develop a fever over 100.4°F.
What Happens After the Abutment Is Placed?
From here, a general dentist or prosthodontist takes over to build your new tooth. Your dentist may temporarily swap the healing abutment for a special piece called a transfer coping, then take impressions of your teeth and abutments along with a record of how your bite fits together.
A dental lab uses those records to make your replacement tooth. This can take several weeks and multiple visits, including fittings to check how the tooth feels before it is attached. At Prime Dental Care, Dr. Cardwell places dental crowns on implants as part of this restorative stage.
A single crown is not the only possible result. A fixed tooth is screwed or cemented onto its own dental implant abutment and stays in place, while a removable option works like a denture that snaps securely onto a frame attached to the abutments and comes out for cleaning.
How Should You Care for Your Finished Implant?
Clean your implant, the tooth attached to it, and the surrounding gums as carefully as your natural teeth, and consider an interdental brush, which slides between teeth to reach the spaces around gums and metal posts.
Regular checkups let your dentist confirm the implant is healthy and working properly. Avoiding hard items such as ice and hard candy protects both the crown and your remaining natural teeth.
Frequently Asked Questions
Will I have a gap in my smile while the implant heals?
You may, since nothing sits on top of the implant during that time. A type of partial, temporary denture can be placed for appearance if needed, and you can take it out for cleaning and while you sleep. If the gap is in a visible spot, ask your dental team whether this option fits your situation.
Can I drive myself home after second stage implant surgery?
It depends on the type of anesthesia you receive. If you have sedation or general anesthesia, plan to have someone take you home and expect to rest through the end of the day. You may also need to limit what you eat or drink beforehand, so ask your surgeon for instructions when the appointment is booked.
What should I do if my healing abutment feels loose?
Contact your surgeon. Later on, if an implant, abutment, or finished tooth feels loose, chips, or breaks, contact your dentist.
What happens if the implant has not fused with the bone?
Most dental implants are successful, but sometimes the bone does not fuse enough to the implant. When that happens, the implant is removed and the bone is cleaned, and the procedure can be tried again in about three months.
Finishing Your Implant at Prime Dental Care
Second stage implant surgery is the step that turns a hidden implant into a working foundation. Once your dental implant abutment is in place, every remaining visit moves you toward a tooth you can chew and smile with.
Prime Dental Care specializes in senior dental care, and Dr. Cardwell builds conservative treatment plans around each patient’s current needs while preparing for what may come later. Our office accepts all major Medicare Advantage plans and is contracted with the VA Community Care Network.
If your implant has healed and you are ready for the next step, call Prime Dental Care at 503-774-6355 to schedule a consultation. We welcome patients from Milwaukie, Portland, Oak Grove, and across Clackamas County.