Dental Implants With Just One Surgery? – Expert Dentist, Dr. Ramsey Amin Explains

Dental Implants With Just One Surgery? – Expert Dentist, Dr. Ramsey Amin Explains

Dental Implants With Just One Surgery? – Expert Dentist, Dr. Ramsey Amin Explains

Traditionally most dental implants were placed using a two stage surgical technique.  That means you would have two surgeries for just one implant!

The first surgery would be to place the actual implant in the bone.  At that time the dental implant would be covered by the gum so it is not visible.  That is the part that people refer to as the "screw."

Here is an x-ray example of short implants that had to be buried due to the patients medical condition:

The second surgery would happen a few months later to "uncover" the implant from under the gums.  This allows the gum to heal around the implant as it is newly exposed in your mouth.

In my office in Burbank, nearly 95% of my patients do not need the second procedure.  Not only does this prevent you from needing a second procedure, but it helps reduce the cost.  It increases the price, when you have to have two surgeries rather than one. One stage implants help me decrease the cost to patients.

Here is an example of a one stage surgery (note that the implants are taller so they are visible in the mouth):

What makes the determination for one or two stage?  It varies, but I find that many dentists and surgeons still do two stages because that is the way they have "always done it." There is  a lot of scientific proof to allow the implant to be done in one stage.

The other determination is mostly in how "tight" the implant is when it is first put in.  That tightness is very much controlled by the skill and experience of your implant dentist.  This is especially critical for dental implants in your upper jaw, where the bone is usually very soft.

I do on occasion use the two stage technique when it is better for your situation.  I may do it if I am doing a large bone graft at the same time the implants are being placed.

The most common area of the mouth to use the two stage surgery is the upper back molars. This area has very soft bone so implants in this area may not get as "tight" when first placed.

Having a tight implant also positively relates to the long term success of your implant.  I accurately measure how tight or loose your implant is using a torque wrench.

So there you have it… One stage, one surgery if it is predictable for your particular situation.

Please ask questions in the comments section below this post.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California


  1. Renee bishop

    I have been looking into implants for molars 30 and 31. 30 was lost when I was a teenager (I am now 59) and I had a bridge until I lost tooth 31 about 4 years ago and had a bone graph in the pocket at the time of the extraction of 31. I have been to several dentist for consults and have been told several different stories. Today’s dentist said I should put in three smaller molars attached like a bridge for added strength in that area and angle the three pins for stability. I have plenty of bone height but the bone is narrow according to the dentists I have seen. With all the different info from different dentists I decided to do some research on line and found your videos. They were very informative. Thank you.

    Can you do two regular size implants? Can you tell me about how much it would cost with the porcelain crowns.

    November 14, 2014 at 7:23 am Reply
    1. Ramsey Amin DDS

      Hello Renee,

      Since you lost the teeth so long ago, your bone has shrunk tremendously. Depending on the size, length and diameter of the dental implant sometimes you have to do 2-3 implants to replace just two teeth. If you under-engineer a situation that has very narrow bone, the implants will be bound to fail with progressive bone loss that starts usually at year 2 or 3 after having the procedure done.

      Remember that your natural teeth in this area had multiple roots. Dental implants are just one root. Replacing 2 molars is replacing four natural roots. Dental implants have a different biology then teeth in the numbers do not always equate.

      My guess is you have a both vertically and horizontally deficient area of your jawbone. In my own practice I go through a unique type of bone graft called a vascularized pedicled bone flap which widens your bone tremendously. This allows implants of normal diameter to be placed.

      I would also suggest that if your bone is narrow and the implants are small that the implants be connected to one another. This will help achieve long-term stability of the bone at the very top of the implant which is the most critical.

      Here are some web links that should help you:

      Bone Widening Graft of Lower Back Jaw – Picture Series – Dr. Ramsey Amin

      Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      November 17, 2014 at 12:52 am Reply
  2. ddsquestion

    I have two baby teeth one each side that did not get replaced with bicuspids. One is OK. But the other which had to be crowned to help with alignment of the teeth for Orthodontistry as it was submerged. At that time implant dentistry would have been in science fiction novels. So one of the teeth the submerged one has has crowns on it for over XX yrs since is was a baby tooth. The crowns had to be replaced due to either changes in the tooth due to natures responses or loosening cement or difficulty in seating the crown on a lower prepared baby tooth.

    Anyway. a nice Oral Surgeon feels a bone graft is needed one because it is submerged and two the thought is the bone maybe ankylozed with and to the root. Recommended grafting the socket. The roots are spread out like they are apart and trying to meet at their tips but do not as too far away to. So that would be a healing period of months.

    Is this better to do than a keyhole surgery and why one or the other? If the bone was dense would keyhole surgery be a better success? Is the implant the same size whether keyhole surgery is done or regular flap surgery is preformed? Does keyhole surgery need high tech things like CAT scans or another interactive surgical method for more precise placement? Is any of covered by “great” not Dental Insurance or Medical Insurance?

    Leaving the roots in place, since they are partly ankylozed in place? With a submerged baby tooth does that make a more challenge with nerves. Since the loss of a baby molar opens up an wider gap than a premolar would and the implant probably lower down to begin with, is that a risk due to the principle of leverage on a longer distance from the top of the tooth to the collar of the implant so what needs to be done to increase its success? Is it better to have a three teeth bridge done instead? (if they may need crowns someday in future anyway?) But the teeth being slightly tilted to the lower baby molar and being the lower jaw is it longer lasting the implant or such a bridge. With experience crowns eventually get loose on their own due to cement failure and chewing forces etc. So a three teeth bridge if failed could do more harm to those crowned teeth when and if it was replaced in the future?

    Do lower bridges fail or succeed more often than upper similar bridges in length of serviceable time? How about the implant done in place of a submerged baby molar tooth? Is there a recommended way to do it in less steps also!

    November 5, 2014 at 12:17 am Reply
    1. Ramsey Amin DDS


      Ankylosed baby teeth oftentimes require extensive surgery to remove them which will leave behind a bony defect. Bone grafting at the time of removal will be excellent. Reevaluation with a 3-D scan after 4-6 months will help determine the need for computer guided surgery and the location of nerves and sinuses.

      The decision to do flap versus non-flap surgery is based on a number of factors and your surgeons skill and experience. A non-flap surgery seems easier but requires a higher level of experience since the procedure is being done blind. Flap surgery is the standard of care and also allows the repositioning of your gum line. Unfortunately medical and dental insurance only cover a very small part of the entire procedure.

      Leverage forces should be determined by evaluating your bite which is called occlusion.

      Computer Guided Dental Implant Surgery, Things You Need To Know

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      November 17, 2014 at 3:07 am Reply
  3. Hi Vishnu,
    Yes, gum related problems can affect the healing. Make sure you take care of your other teeth in the area.
    If the implant is visible in your mouth, brush it with your toothbrush during the healing phase. This will help increase the success rate!
    Ramsey A. Amin, D.D.S., D.A.B.O.I.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow-American Academy of Implant Dentistry

    September 26, 2010 at 2:15 pm Reply
  4. vishnu

    hi, Dr. Amin, i have finished the first stage of my dental implants surgery,
    my question is “will gum related problems affect the implants healing?”
    and “how to take care of implants during the healing process, that is for the next stage?”
    Thanks in advance.

    September 12, 2010 at 1:51 pm Reply
  5. Gina Herrara

    Thank you for the insight. I wished I lived near you so you could be my dentist

    August 10, 2010 at 8:38 pm Reply
  6. Thanks for your kind words from a fellow dentist!

    May 3, 2010 at 8:59 am Reply
  7. dentist in rocklin

    thanks for sharing this quality is very tough to get good information when you really need it as there is so much junk on the internet.your post seems very useful for myself.

    May 3, 2010 at 3:24 am Reply
  8. Hi Sally,
    Great to hear from you!!! I figured you must have moved away since it has been so long.
    I am glad to hear that the work I did for you is doing so well. I remember when you had your removable partial denture that you hated so much.
    Have your dentist send me your current x-rays and keep in touch!
    Dr. Ramsey Amin

    April 25, 2010 at 4:46 pm Reply
  9. Sally Ward

    Hi Dr. Amin!
    I was on google and stumbled upon this! I havent seen you in about 5 years since I moved north.
    Just wanted to let you know that the implants you put in for me in 2001 are doing great. Nine years of great teeth!!! My dentist that I see now is always commenting how nicely they were done. He also says the bone graft looks like day one.
    Thanks again and I hope you get this message. If I ever move back, I will come see you!

    April 23, 2010 at 10:01 pm Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!