Submerged vs Non-Submerged Implant Healing: What's the Difference?

Introduction

If you have been researching dental implants, you may have come across terms such as "submerged healing" or "non-submerged protocol" and wondered what they mean for your treatment. Many patients searching for dental implant information online find these clinical terms confusing, yet understanding the distinction can help you feel more informed before any consultation.

Dental implant placement involves a carefully managed healing process that allows the implant to integrate with the surrounding jawbone — a biological process known as osseointegration. The healing approach your clinician recommends — submerged or non-submerged implant healing — can influence surgical planning, treatment timelines, and how your gum tissue is managed throughout your care.

This article explains both protocols in clear, patient-friendly language. It covers the clinical reasoning behind each approach, what factors may influence the recommendation, and when it is appropriate to seek professional dental guidance. As with all implant-related decisions, suitability is determined by individual clinical assessment, and no two treatment plans are identical.

Featured Snippet: What Is the Difference Between Submerged and Non-Submerged Implant Healing?

What is the difference between submerged and non-submerged implant healing?

Submerged and non-submerged implant healing are two established protocols used after dental implant placement. In submerged healing, the implant is covered beneath the gum tissue and left to integrate undisturbed, typically requiring a second minor procedure to expose it. In non-submerged healing, a healing abutment remains visible above the gum, allowing tissue to form around it in a single surgical stage. Clinical suitability determines which approach is appropriate.

Understanding Dental Implant Healing: The Basics

Before exploring the two protocols, it helps to understand what happens immediately after an implant is placed. A dental implant is a small titanium fixture that is surgically inserted into the jawbone to act as an artificial tooth root. Over a period of weeks to months, the surrounding bone tissue gradually bonds to the implant surface through osseointegration.

During this healing phase, the implant must remain as stable as possible to allow successful integration. Mechanical disturbance or excessive loading at this stage can compromise the outcome. This is why the post-placement healing period is closely managed by your dental team.

Two well-recognised approaches exist for managing how the implant site heals at the gum level: the submerged (two-stage) protocol and the non-submerged (one-stage) protocol. Both are clinically validated and widely used. The choice between them depends on a range of individual factors that your clinician will assess, including bone density, the location of the implant, and whether any grafting procedures have been performed.

If you would like to understand more about how dental implants work from placement to restoration, our dental implants overview provides a helpful starting point.

The Submerged Implant Healing Protocol (Two-Stage Approach)

The submerged protocol — sometimes called the two-stage approach — involves placing the implant fixture fully beneath the gum tissue at the time of surgery. The gum is then closed over the implant with sutures, leaving the implant completely hidden from view while osseointegration takes place.

Stage one is the placement surgery itself. Once completed, the site is sutured closed and the implant remains submerged, protected from the oral environment.

Stage two occurs after an appropriate healing period — typically three to six months, depending on the individual — during which the clinician performs a minor procedure to re-expose the implant. A small incision is made in the gum, a healing abutment is attached, and the tissue is encouraged to form the correct contour around the emerging implant.

This approach is often considered when:

• Bone grafting has been performed alongside implant placement
• Bone volume or density requires careful, undisturbed integration
• The implant site carries higher functional demands
• Initial stability at the time of placement is a clinical concern

The submerged protocol has a long clinical history and remains a reliable option for complex cases. The additional surgical stage is typically a minor procedure carried out under local anaesthesia.

The Non-Submerged Implant Healing Protocol (One-Stage Approach)

The non-submerged — or one-stage — protocol differs in that a healing abutment (a small component that sits above the implant) is attached at the time of placement and remains visible above the gum line throughout the healing period.

Because the gum tissue heals around the healing abutment rather than over it, no second surgical procedure is needed to expose the implant. Once osseointegration is complete and the tissues are well-formed, the healing abutment is simply replaced with the permanent restoration component.

This approach may be appropriate when:

• Good primary implant stability is achieved at placement
• Adequate bone volume is present without the need for grafting
• Soft tissue management is straightforward at the implant site
• Clinical assessment supports a one-stage approach

Patients often appreciate the one-stage protocol as it avoids a second minor surgical procedure and may reduce the overall treatment timeline. However, it is important to understand that the "one-stage" description refers to the surgical phases, not the total time from placement to final restoration, which still requires an appropriate osseointegration period.

The Clinical Science Behind Osseointegration

At the heart of both protocols is the biological process of osseointegration — the direct structural and functional connection between the titanium implant surface and the surrounding bone tissue. Understanding this process helps explain why both healing protocols are designed to protect implant stability during this critical phase.

When a titanium implant is placed into the jawbone, the surface of the fixture interacts with bone cells (osteoblasts) that gradually migrate toward and attach to the implant. Over weeks and months, new bone forms around the implant, creating a strong, stable foundation.

Titanium is used because it is biocompatible — the body does not recognise it as a foreign object and does not attempt to reject it. Many modern implant surfaces are also treated at a microscopic level to encourage faster and more reliable bone contact.

Both the submerged and non-submerged protocols are designed to protect this integration process. In submerged healing, the complete closure of the gum protects the implant from potential micromovement and oral bacteria during the most critical early phase. In non-submerged healing, the stable healing abutment allows soft tissue to develop naturally while osseointegration proceeds simultaneously.

The choice of protocol does not, in itself, determine whether osseointegration will succeed — what matters is that the selected approach is appropriate for the individual patient's clinical situation.

Factors That Influence Which Protocol Is Recommended

No single protocol suits every patient. Your clinician will consider a combination of clinical and anatomical factors when planning your implant treatment. Understanding these factors can help you have a more informed conversation during your consultation.

Bone quality and quantity: Where bone density is lower or where grafting is required, the submerged approach is often preferred to allow undisturbed healing beneath the gum.

Implant stability at placement: If excellent primary stability is achieved at the time of surgery, a non-submerged approach may be clinically appropriate.

Site-specific considerations: Implants placed in areas subject to greater biting forces, or where soft tissue management is more complex, may favour one protocol over the other.

Patient medical and dental history: Overall health, any history of bone conditions, smoking, or medications that may affect healing are all relevant to the treatment decision.

Aesthetic requirements: In cosmetically sensitive areas, how the gum tissue forms around the emerging restoration is particularly important, and this may influence protocol selection.

It is worth noting that neither protocol is inherently superior. Both have strong evidence bases, and experienced clinicians regularly achieve excellent long-term outcomes with both approaches. Treatment planning is always individual.

When Professional Dental Assessment May Be Appropriate

If you are considering dental implants, or if you are already partway through implant treatment and have questions about your healing, professional assessment is always the appropriate next step. The following situations are examples of when contacting your dental team is advisable:

• Persistent discomfort beyond the expected post-operative period following implant surgery
• Swelling or redness at the implant site that does not resolve as expected
• Looseness or movement around a healing abutment or temporary restoration
• Concerns about the appearance of the healing tissue
• Uncertainty about your healing protocol or treatment timeline

None of these situations should cause alarm. Post-operative healing varies between patients, and your dental team is best placed to assess what is normal for your individual situation and what may require attention.

It is important not to attempt to self-diagnose based on general information alone. If you have concerns at any stage of your implant journey, early communication with your clinician is always encouraged.

Oral Health During the Implant Healing Period

Regardless of which healing protocol is used, maintaining excellent oral hygiene during the healing period is one of the most important steps a patient can take to support successful integration.

Gentle cleaning: Your dental team will advise on how to clean the implant site during healing. This often involves a soft toothbrush and, in some cases, a prescribed antibacterial mouthwash. Avoid vigorous rinsing in the first 24 hours post-surgery.

Avoiding smoking: Smoking is widely recognised as a significant risk factor for implant complications. Nicotine impairs blood flow and can interfere with bone and soft tissue healing. If you smoke, discussing cessation support with your dental or medical team before and during implant treatment is strongly encouraged.

Diet considerations: During early healing, your clinician may advise a soft diet to minimise loading on the implant site. Avoid hard, crunchy, or very hot foods as directed.

Attending follow-up appointments: Regular review appointments allow your clinician to monitor osseointegration progress and address any concerns promptly. These appointments are an essential part of implant care.

Avoiding trauma to the site: Take care when brushing adjacent teeth and follow any specific instructions your dental team provides about protecting the healing area.

If you are thinking about implant treatment and would like to understand the full journey from assessment to final restoration, you may find it helpful to explore what to expect from the dental implant process.

Key Points to Remember

• Submerged healing (two-stage) involves covering the implant beneath the gum until osseointegration is complete, followed by a minor second procedure to expose it.
• Non-submerged healing (one-stage) keeps a healing abutment above the gum throughout integration, avoiding the need for a second exposure procedure.
• Both protocols are clinically validated and widely used — neither is universally superior to the other.
• The appropriate protocol is determined by individual clinical factors including bone quality, primary stability, and site-specific considerations.
• Osseointegration — the bonding of bone to the titanium implant — is central to both approaches and typically takes several months.
• Good oral hygiene, avoiding smoking, and attending all follow-up appointments are important regardless of which protocol is used.

Frequently Asked Questions

Is one healing protocol more successful than the other?

Neither the submerged nor the non-submerged protocol is considered universally superior. Both have extensive clinical evidence supporting their effectiveness. Long-term implant success rates are strongly influenced by factors such as patient health, bone quality, oral hygiene, and clinical expertise rather than the protocol choice alone. Your dental clinician will recommend the most appropriate approach based on your individual clinical assessment.

Will I need general anaesthesia for a second-stage procedure in submerged healing?

The second-stage exposure procedure in submerged healing is typically a minor surgical procedure carried out under local anaesthesia in a dental clinic setting. It is generally considered straightforward. General anaesthesia is not routinely required for this stage, though your clinician will discuss sedation options with you if you have concerns about anxiety or comfort.

How long does the healing period take for dental implants?

The osseointegration period — during which the implant bonds to the jawbone — typically takes between three and six months, though this varies depending on the individual, the implant site, bone quality, and whether any grafting was performed. Your clinician will monitor your progress through follow-up appointments and advise when it is appropriate to proceed to the restorative phase of treatment.

Can both protocols be used for implants that replace multiple teeth?

Yes. Both submerged and non-submerged protocols can be applied to single implants, implant-supported bridges, and full-arch implant restorations. The choice of protocol for each case depends on the specific clinical circumstances of each implant site. In some cases, different protocols may even be used for different implants within the same treatment plan. Your dental team will explain the rationale for any recommendations made during your treatment planning appointment.

What happens if osseointegration does not occur as expected?

While implant failure is uncommon, it can occur. Signs that integration may not be proceeding as expected include persistent discomfort, movement of the implant, or unusual soft tissue changes. If you notice any of these, contact your dental team promptly. Early assessment gives the best opportunity for the situation to be managed appropriately. Your clinician will explain the options available to you based on the clinical findings.

Does the protocol affect how the final tooth restoration will look?

Both protocols are designed to support natural-looking gum tissue formation around the final restoration. In aesthetically sensitive areas, clinicians pay particular attention to how the soft tissue profile develops — this can influence the choice of protocol and the design of the healing abutment used. Your restorative dentist will work to achieve an outcome that looks and functions as naturally as possible, and will discuss aesthetic considerations with you during treatment planning. Explore our information on implant-supported restorations to learn more about the final stages of treatment.

Conclusion

Understanding the difference between submerged and non-submerged implant healing can help patients feel more informed and confident when discussing treatment options with their dental team. The submerged (two-stage) protocol involves complete coverage of the implant beneath the gum during osseointegration, with a minor second procedure to expose it later. The non-submerged (one-stage) protocol maintains a visible healing abutment above the gum throughout the integration period, avoiding an additional surgical stage.

Both approaches are clinically well-established. The decision between them is made on the basis of individual clinical factors — bone quality, primary implant stability, site anatomy, and patient health among them — rather than a universal preference for one over the other.

What matters most for implant success is that the chosen protocol is appropriate for the individual patient, that osseointegration is given the time and conditions it needs to proceed, and that the patient maintains good oral hygiene and attends all follow-up appointments throughout the process.

If you are considering dental implants or have questions about your current treatment journey, speaking with a qualified dental professional is always the right first step. Dental symptoms and treatment options should always be assessed individually during a clinical examination.

This article is intended for general educational purposes only and does not constitute personalised dental advice. Individual diagnosis and treatment recommendations require a clinical examination by a qualified dental professional.

Next Review Due: 10 July 2027