What Is an Endosteal Implant?

A Permanent Dental Implant for Replacing a Missing Tooth

When you lose an adult tooth, it’s important for your dental health that you get it replaced. If you don’t, you risk teeth shifting, further instability in the mouth, and additional tooth loss. It may also cause damage to the underlying bone. One option for replacing lost teeth is an endosteal implant, which is often referred to as a dental implant. In a multi-step surgery, this type of implant is permanently embedded into your upper or lower jaw bone.

This article explains who would be a good candidate for an endosteal implant, what the implantation procedure is like, and how to take care of an implant once you have it.

Endosteal vs. Subperiosteal Implants

There are two primary types of dental implants used to replace missing teeth:

  • Endosteal: These implants are placed in the bone. A support structure–such as a specialized screw or cylinder–is put into the underlying jaw bone and becomes incorporated into its structure. This type of implant can be used for one or multiple crowns.   
  • Subperiosteal: These implants are placed on the bone. Instead of drilling into the bone, subperiosteal implants are positioned on top of it and is often connected to the bone through mini implants. Metal posts poke out from the implant, going through the gums to serve as support for the crown. This procedure is usually best for people unable to wear dentures or those who don't have sufficient bone mass to support an endosteal implant.
Cropped Hand Holding Teeth Against Pink Background

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Best Candidates for Endosteal Implants

Since endosteal implants are embedded into bone, the procedure can be invasive and requires significant recovery time. Thus, the treatment may not be appropriate in all cases. It’s not recommended for children or teens whose jawbones are still growing and developing.

In addition, the following conditions may rule you out as a candidate for endosteal implants:

Before getting an endosteal implant, you may have to undergo treatment for or otherwise manage these conditions.  

Implant Process

The surgery to place a dental implant is relatively invasive, which means it requires some deep incisions. This work is performed by an oral or maxillofacial surgeon. Typically, the surgery is done under local anesthesia, so you’ll remain awake with your mouth numbed.

There are three main steps to the endosteal implant procedure:

  • Imaging and placement: A dental X-ray or another type of imaging technique is used to assess the area where the tooth or teeth are missing. The surgeons then make a small incision in the gum and drill a hole into the bone. They may use a surgical guide and stent to place a specialized screw or cone, known as the “implant body,” into this space, leaving a gap.  
  • Installing a temporary crown and healing: Either during the first appointment or at a following appointment, the surgeon adds an extension, called an “abutment,” and a temporary crown is put on. Next, you must undergo a period of healing—anywhere from a few weeks to several months—as bone matter grows around the screw. This process is called “osseointegration.”
  • Installing a permanent crown: Two weeks after the temporary crown is placed, you’re ready for the final step. The false tooth, also known as a prosthesis or crown, is placed onto the abutment. Using scanning technology, the prosthetic is customized to fit perfectly into place. It’s color-matched to the surrounding teeth, so it will appear natural.      

If multiple teeth are missing, a dental bridge—a false tooth or group of teeth—can be attached to the implant. Also, dental implants can be used to stabilize rows of dentures if many teeth are missing.

Supplementary Procedures

If the bone mass in the upper jaw (maxilla) or lower jaw (mandible) is insufficient, they won’t be able to hold the implant in place. To ensure a successful dental implant, additional procedures may be required. These include:

  • Tooth extraction: If any part of the tooth you want to replace is still in your gum, you’ll first need to have it removed. Tooth extraction ("pulling" a tooth) is a standard dental procedure. Keep in mind, you’ll need to fully recover from the extraction before implant surgery.
  • Bone augmentation: Prior to surgery, an oral surgeon may have to perform bone grafting. Bone material harvested from another part of your body or synthetic materials are bonded to the affected area. Over time—often several months—this is incorporated into the surrounding structure, strengthening it.   
  • Sinus lift: Teeth towards the rear of the upper jaw, or “maxilla,” are among the most difficult to replace. The bone here is more likely to be insufficient, and there’s little room for error due to proximity to the sinus (the passages going back from your nostrils). Augmenting this area by lifting the sinus and then reinforcing the maxilla may be necessary.  
  • Ridge expansion: This is used if your bone mass in your mandible and/or maxilla is insufficient. In this procedure, the oral surgeon pulls away gum material, revealing the affected area, and adds artificial bone material to the bone, or "bone ridge," to correct the problem. As with augmentation, there’s a significant recovery period before the implant surgery.


Immediately After Surgery

With every stage of the procedure—and especially following installation of the endosteal implant body into the bone—you’ll feel some after-effects, including:

  • Some bleeding within the first 12 to 24 hours after the procedure
  • Soreness and discomfort around the affected area
  • Swelling in the face or gums for the first two to three days after surgery
  • In rare cases, temporary numbness in the lower jaw

Within the first week after surgery, a critical period for recovery, there are several things to keep in mind:

  • You’ll be given antibiotics to prevent infection as the site heals.
  • You’ll get guidance on how to properly clean and care for your implant.
  • You’ll have to avoid certain hard-to-chew foods.
  • You may have to avoid certain exercises or physical activities.
  • For bleeding, you can dab excess blood with dry gauze; then press wet gauze on the affected area for 20 minutes.
  • Don’t move your head excessively for the first 12 hours after surgery.
  • Don’t use a straw as the suction can put stress on the area that was operated on.

You’ll also be instructed on how to properly clean and care for your implant, such as how to brush and floss safely. Follow those directions closely and be ready to come back in for a follow-up within two weeks.

Call your health care provider if you experience:

  • Trouble opening your mouth, speaking, or chewing
  • Swelling in the face after the first three days  
  • Toothache or pain in the mouth
  • Persistent bad breath
  • Swollen and painful gums
  • Looseness in the tooth or teeth
  • Emerging gaps between teeth
  • Discharge (pus) from the affected area

Home Treatments and Pain Management

Home care after an endosteal implant involves maintaining good dental hygiene; you’ll want to brush properly twice a day, floss daily and keep up with regular dental check-ups. In addition, smoking increases the chance of complications, so you should try to stop if you can.

Early on, you may experience pain and soreness. At-home treatments to help you recover include:

  • Medications: To manage pain, pain killers, including opioids like Percocet, may be prescribed; these should be used carefully and sparingly. Over-the-counter medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or other kinds of ibuprofen, can also help.  
  • Icing: Icing the skin surrounding the affected area can ease the swelling after your surgery. Apply a cold pack or bag of ice wrapped in a wet towel to the area for 15 minutes at a time. This can be repeated multiple times, but make sure to separate each session by 15 minutes.     
  • Careful positioning: Keep your head upright as much as you can for the first 12 to 24 hours after surgery. This prevents excessive blood flow to the region, which can help with recovery.  
  • Saltwater gargling: As your gums heal, another common recommendation is that you gargle a solution of saltwater several times a day. Stir a half tablespoon of salt into a cup or mug of warm water. For 10 seconds at a time, swish sips from the water in your mouth gently before spitting it out. Aim for at least two rinses a day.  

Overall Success Rates

Though complications of endosteal implants can be serious, overall, they are relatively rare. It’s a highly successful procedure. A vast majority—about 90% to 95%—of implants successfully incorporate into the jaw and correct the missing tooth without problems or complications.   

Alternative Options

If the underlying bone structure is insufficient or there are too many underlying health conditions, endosteal implants aren’t likely to be successful. Other means of correcting missing teeth include:

  • Fixed bridges: Dental bridges are one or more false teeth (restorations) that are placed in the mouth to correct issues. Crafted to fit in with your bite and smile, they’re bonded to existing teeth using specialized cement.
  • Partial dentures: Another option is the use of removable partial dentures to correct multiple missing teeth. These rows of false teeth are taken off at night and require cleaning and care, but they’re a non-invasive means of fixing your smile.
  • Full dentures: In cases where you’re missing all or most of your teeth, full dentures—replacing the upper and/or lower row—may also be considered. As with partial dentures, they’re taken off at night and special care is needed with cleaning them and eating.


Endosteal implants are dental implants that replace missing teeth. A surgical screw or cylinder (the implant body) is embedded into the jaw, and a post, or abutment, is installed. Once the bone has grown around the body and it’s strong enough, the oral surgeon positions a permanent crown on top.

Following the procedure, you may experience some discomfort and pain, and you’ll need to avoid difficult-to-chew foods. Pain medications, icing, and keeping up with follow-up appointments are essential during recovery.

A Word From Verywell 

Not only can endosteal implants restore the appearance of your teeth—giving you back your confidence—they’re needed to prevent subsequent dental health issues. If you’re missing a tooth or multiple teeth, it’s worth exploring your options. The sooner you start the conversation, the sooner you'll recover your smile.    

Frequently Asked Questions

  • How long is the endosteal implant process?

    It depends on the specific case and whether you require pre-treatments, such as dental extractions. Endosteal implants are typically three-stage procedures that require multiple appointments with extra time needed to allow for healing. Typically, the course of treatment is six to eight months.

  • Are dental implants permanent?

    Dental implants are highly durable and are intended to be permanent replacements for teeth. Over time, bone material grows around the screw or cylinder that supports the implant. Long-term adverse effects are rare. However, gum disease or other issues can arise due to poor oral hygiene.  

  • Are endosteal implants right for me?

    There are many factors to consider before deciding if it's right. Implants blend in with existing teeth, and upkeep only requires good oral hygiene habits and regular check-ups. However, implantation can be a lengthy process, which may make it difficult for some people. Also, those with poor oral health may not be able to have the procedure. Other options can be considered, such as fixed bridges and partial or full dentures.

  • How do I care for my endosteal implants?

    Especially in the first week, you’ll have to avoid hard-to-chew foods and smoking and take care when brushing and flossing. Once the implants are in, keep up with good oral hygiene habits and dental cleanings and check-ups.

  • Does insurance cover dental implants?

    It depends on your dental plan. Sometimes they are covered only under certain circumstances such as in the case of an accident or to prevent complications of missing teeth. If you do get coverage, make sure you have a good sense of what’s covered and what your deductible is.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Dental Association. Dental implants.

  2. American Academy of Periodontology. Dental implant procedures.

  3. AAOMS Oral and Maxillofacial Surgeons. Are dental implants safe? Pros and cons of dental implants.

  4. University of Washington School of Dentistry. After your oral surgery.

  5. The American College of Prosthodontists. Dental implants FAQs.

  6. Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. Factors influencing early dental implant failuresJ Dent Res. 2016;95(9):995-1002. doi:10.1177/0022034516646098

  7. American Dental Association. Tooth replacement options. Mouth Healthy.

  8. AAOMS Oral and Maxillofacial Surgeons. Does insurance cover dental implants?.

By Mark Gurarie
Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.