Dental Implants

A dental implant is a titanium screw that replaces the root of a missing tooth. It is placed into the jawbone, the bone grows against it over several months, and a crown, bridge or denture is then attached to it. An implant is not a tooth; it is the replacement for the part of the tooth nobody ever sees.

That distinction matters more than it sounds. A tooth root does not only hold the tooth in place — it carries chewing forces into the jawbone and keeps that bone renewing itself. When a tooth is removed, the stimulus disappears and the bone begins to resorb measurably within the first year. A bridge or a removable denture does not stop that, because both transfer force to the neighbouring teeth or to the gum rather than to the bone.

An implant is the only option that carries load directly into bone. That is why, even for a single missing tooth, preserving bone is as strong an argument as leaving the neighbouring teeth untouched. Over decades it is also what maintains the height of the lower third of the face.

The body of the implant is commercially pure titanium or a titanium alloy. Titanium is used not simply because it is strong, but because the oxide layer that forms spontaneously on its surface allows bone to attach directly to it. That process is called osseointegration, and the whole of implant dentistry rests on it.

Zirconia implants also exist and come up for patients who want a metal-free option. The long-term data behind them is far smaller than for titanium, and most are one-piece, which limits prosthetic flexibility. We assess them where the case calls for it, but titanium remains the standard choice.

There is no upper age limit for implants; the limits are set by bone and by health. We have placed implants in patients in their nineties and asked eighteen-year-olds to wait. Three things decide it: enough bone, gum health under control, and general health that does not obstruct healing.

Bone. Height and width are measured on a CBCT scan. Insufficient bone is not a refusal — it is a planning question: a graft, a sinus lift, or a shorter implant. Any quote issued without radiographs having been read is a guess.

Gums. Placing implants into active gum disease is building on ground that is not stable, and it raises the risk of peri-implantitis directly. Periodontal treatment therefore always comes first, and the surgical stage does not begin until it is complete.

Smoking. This is the strongest single modifiable cause of early implant failure. We do not refuse to treat smokers; we say plainly that success rates fall and that stopping during the healing period genuinely changes the odds.

Medical conditions. Uncontrolled diabetes delays healing; controlled diabetes is not an obstacle in most cases. Bone medications, a history of radiotherapy to the jaws and anticoagulant use all change the plan — none of them automatically rules implants out, but all of them must be known at the first consultation. Do not stop any medication on your own initiative.

Growth. Implants are not placed in the front of the jaw before facial growth is complete, because an implant does not move with the bone and is left behind over the years. That is the one genuine reason to wait in a young patient.

Implant planning rests entirely on three-dimensional imaging. A panoramic radiograph shows the height of the bone but not its width, and it does not give the exact position of the sinus floor or the inferior alveolar nerve. Every implant case here is planned digitally from a cone beam CT scan.

A CBCT produces a three-dimensional map of the jaws at a small fraction of the dose of a medical CT. On that map the position, angle, length and diameter of the implant are set against your actual anatomy. The nerve in the lower jaw and the sinus floor in the upper are known to the millimetre.

The scan is used for the prosthetic work as much as for the surgery. The implant position is planned around where the tooth needs to sit — not the other way round. An implant placed where there happened to be bone, but which no sensible tooth can be built on, is a technical success and a practical failure.

The same images are shown to you. At the consultation you see your own bone on the screen, and where a graft is needed you are shown why rather than told. The treatment plan is written after that conversation.

Where the case calls for it a surgical guide is produced: the digital impression from the intraoral scanner is merged with the CBCT and a guide is designed that reproduces the planned angle during surgery. It uses the same digital workflow as smile design.

We do not claim the scan shows everything. Bone quality — its density — is only known with certainty when the drill first engages. So the diameter written in the plan can change by one size at surgery. That is correct practice rather than a problem.

1. The area is anaesthetised and the field is draped sterile.
2. A small incision exposes the bone surface; in some cases a flapless technique is used instead.
3. The socket is prepared with drills that step up gradually to the planned diameter, under continuous irrigation so the bone does not overheat — one of the details that most affects early survival.
4. The implant is placed at a controlled torque and its primary stability is measured.
5. A healing abutment is fitted or the implant is submerged under the gum, and the site is sutured.

Placing a single implant is shorter and quieter than most patients expect. It is done under local anaesthetic, takes twenty to forty minutes on average, and is not painful during the procedure. Most people describe it as more comfortable than having a tooth taken out.

With several implants the appointment is longer but the structure is the same. For long sessions, or for patients with genuine anxiety, sedation is available — we have both sedation and general anaesthesia on site, with an anaesthetist present.

Where sedation is used the rules are firm: you fast beforehand, somebody accompanies you afterwards, and you must not drive, drink alcohol, operate machinery or make important decisions for a full twenty-four hours. Not the rest of the day — a full day.

The instructions for the first twenty-four hours are simple: do not touch the site with tongue or finger, do not rinse on the first day, use ice, and take the prescription as written. Swelling peaking on the second or third day is normal and settles afterwards.

Osseointegration — the implant bonding to bone — takes about three months in the lower jaw and three to six in the upper. That interval is set by the rate at which bone remodels, not by how fast a clinic works. No technique, no brand and no country shortens the biology.

The upper jaw takes longer because of bone density. The posterior mandible is dense cortical bone; the posterior maxilla is spongy and softer. Same implant, same surgeon, different interval.

You are not left without a tooth during that period. In the aesthetic zone there is always a temporary: an adhesive bridge, a removable temporary, or where the case allows a temporary crown on the implant itself. You do not leave here with a visible gap, and we write that into the plan rather than promise it verbally.

In some cases a temporary tooth can be fitted on the day the implant is placed. That is immediate loading, and it depends on a single measurement: whether primary stability at placement is sufficient. Where it is, we do it. Where it is not, the correct decision is a healing abutment — and that cannot honestly be promised before surgery.

The site must not be overloaded while it heals. Immediately loaded temporaries are not bitten with, hard food is kept away from the area, and the soft diet period is observed. A proportion of early failures happen exactly here.

Review appointments are the invisible but decisive part of this period: suture removal, a two-week check and a check at the end of integration are all in the plan.

Once the implant has integrated the second stage begins: making the tooth that goes on it. There are three separate parts here — the implant, the abutment that connects to it, and the crown on top. How those three join decides both the appearance and the lifespan of the result.

Crown material is chosen by position. Strength dominates at the back; translucency and naturalness at the front. The choice between zirconia crowns and glass ceramic follows from the tooth and your bite. Choosing one material for a whole mouth is easy and usually wrong.

Whether the restoration is screw-retained or cemented is not a question we ask patients, but it affects the outcome. A screw-retained restoration is retrievable; with a cemented one, excess cement left beneath the gum becomes the cause of inflammation years later. We use a screw-retained design wherever the case allows.

The system we place is recorded in your file by manufacturer, diameter and length, and you are given an implant passport. If another dentist needs to order a component in ten years, they will not have to guess. That document matters more than the brand name on it.

Insufficient bone does not mean implants are impossible; it means the plan is longer. Where teeth have been missing for years the bone has resorbed, and the volume the implant needs is rebuilt first.

Graft material does not become bone. This is a common misunderstanding. A graft acts as a scaffold that holds the space; your own bone grows into and through it over the following months. Slow-resorbing minerals remain as a stable framework within the new bone.

A sinus lift applies to the posterior upper jaw. The roots of the upper molars sit directly beneath the maxillary sinus, an air-filled cavity inside the upper jawbone. When the teeth are removed the cavity expands downwards and there is no height left for an implant. The sinus membrane is lifted and graft is placed beneath it.

There are two approaches. Where residual height allows, a crestal technique places graft and implant at the same appointment. Where it does not, a lateral window is used and the graft consolidates for roughly six to nine months before the implant goes in.

Patients having a lateral window are told clearly about flying: air travel is not advised for around two weeks, because pressure changes act on a membrane that has just been repaired. That is a reason to build the fortnight into the plan, not a reason to have the treatment elsewhere.

Small grafts — the gap around an immediate implant, a thin outer wall — add nothing to the length of treatment and are done at the same appointment. Block grafts and large sinus grafts mean a second stage, and we say so at the consultation rather than on the day of surgery.

Modern implants show survival above ninety-five per cent at ten years, and that figure is supported by large clinical series. But survival and success are not the same thing: an implant still being in the mouth is one measure; the bone and gum around it being healthy is another. We follow the second.

What loses implants in the long run is not fracture but inflammation of the tissue around them. While it is confined to the gum — peri-implant mucositis — it is reversible. Once bone has been lost — peri-implantitis — it can usually be stabilised, but the lost bone does not come back. That is the real reason the early review appointments matter.

The implant itself cannot decay. That is an advantage and it is also misleading: a natural tooth gives early warning through pain and sensitivity, and an implant gives none. A problem can progress with nothing felt at all. Six-monthly checks are therefore not optional for an implant patient.

The lifespan of the restoration is separate from that of the implant. A crown can chip, a screw can loosen, retentive components wear. These are maintenance items rather than failures, and they should be stated at the outset.

If you grind, a night guard is the cheapest and most decisive part of this picture. Ceramic works every night under a load it was not designed for, and an implant has no nerve reflex to limit that force. The guard is made during the same course of treatment as the restoration.

Like every treatment carried out here, the implant and the prosthetic work on it carry a lifetime guarantee on materials and workmanship. What the guarantee covers and what falls outside it — accidental damage, neglect, missed recommended check-ups — is set out plainly and in writing.

Implant treatment is almost always in two stages with an integration period between them. For patients travelling from another city or country, the useful question is not the total elapsed time but the number of visits.

You do not need to be in İstanbul during the interval. Reviews can be done from photographs, and a check-up note from your own dentist is equally acceptable. Our clinic is in Bağcılar, about forty minutes from İstanbul Airport, and transfers are arranged directly by the clinic rather than through an agency.

For patients travelling within the city the picture is simpler: the same stages as individual appointments. Bağcılar is easy to reach from anywhere on the metro or metrobüs network, and evening appointments are available.

We do not shorten the plan by shortening integration. The only thing we compress is the waiting between stages: because the laboratory is in the building, the interval between an impression and a try-in is measured in days rather than weeks.

There are three routes for a missing tooth and which one is right varies from mouth to mouth. An implant is not the best option in every case — but it is usually the option that can be defended with the most reasons.

A bridge is a sensible choice where the neighbouring teeth already need crowning; cutting down sound teeth simply because there is a gap is a permanent cost. The bridge option is set out in detail on its own page.

A removable denture is a legitimate solution where surgery is not possible or not wanted, and its comfort improves markedly when it is supported by two implants. The denture options page explains how that is built.

Doing nothing is also a decision and it has consequences: the opposing tooth over-erupts into the space, the neighbours tilt, and chewing shifts away from that side. We say this to show that the decision is not free, not to frighten anybody.

At the consultation you are told not only which option is recommended but why. The difference between those two is visible immediately when you read the treatment plan.