Dental Implants

A dental implant is an artificial tooth root made of titanium that replaces the root of a lost tooth. It is shaped like a small screw and placed in the jawbone. Because titanium is compatible with the body, the bone gradually attaches to the surface of the implant and the implant becomes part of the bone. This bonding is called osseointegration. It is what makes an implant stable and what sets it apart from a removable denture.

Once healing is complete, a connecting part (abutment) is attached to the implant, and a crown, the visible part of the tooth, is placed on top. The result looks and works much like your own tooth.

Implants are used in many situations, from a single missing tooth to the loss of all teeth. For a single tooth, each implant carries one crown; when several teeth are missing, a few implants can support a bridge; when all teeth are missing, a fixed set of teeth can be made on a small number of implants (see All-on-4 and All-on-6 Implants).

What matters for an implant is not age but the condition of the bone and your general health. The basic requirements are:

• Jaw growth has finished (usually after the age of 18)
• There is enough bone to hold the implant, or the bone can be built up with additional procedures
• There is no active, untreated gum disease in the mouth
• You can keep up good oral hygiene during healing

Some conditions do not rule out implants, but need to be assessed before treatment:

• Uncontrolled diabetes
• Previous radiotherapy to the head and neck
• Certain medicines used for osteoporosis or cancer treatment (such as bisphosphonates)
• Blood-thinning medication and serious heart conditions
• Heavy smoking
• Pregnancy (planned surgery is usually postponed until after birth)

That is why it is important to tell us about all your medicines and past illnesses at your first examination. Where needed, we work together with your doctor.

Once a tooth is removed, the jawbone in that area no longer receives chewing forces. Bone renews itself through these forces; when they stop, it starts to lose volume. This loss is especially fast in the first months after an extraction.

Over time, the teeth on either side of the gap tilt into it, the opposing tooth grows towards the gap and the bite can change. The chewing load shifts to the other side. After a long wait, the bone may no longer be enough for an implant; treatment is still possible, but it takes longer because bone has to be rebuilt first. In short, an implant placed early is often simpler and quicker.

1. Examination and 3D CT scan. Your mouth is examined and your general health is discussed. A 3D CT scan measures the height, width and density of the bone, and shows the distance to the sinus in the upper jaw and to the nerve that supplies sensation to the lip in the lower jaw.
2. Planning. The length, diameter and angle of the implant are planned on the scan. Where needed, a surgical guide is prepared so that the implant is placed exactly as planned (see Guided Implant Surgery).
3. Placing the implant. The area is numbed with local anaesthesia; you feel no pain during the procedure, only pressure and vibration. A small opening is made in the gum, a site matching the implant is prepared in the bone and the implant is placed. For a single implant this usually takes 30–60 minutes.
4. Healing period. We wait for the bone to bond with the implant. The time depends on bone quality; it is usually shorter in the lower jaw and longer in the upper jaw. During this period, especially for front teeth, a temporary solution is planned so you are not left without a tooth.
5. Fitting the permanent tooth. Once healing is complete, an impression is taken (with an intraoral scanner or a conventional impression) and the abutment and a crown matched in colour and shape to the neighbouring teeth are fitted.

In most cases, yes. Where bone is insufficient, procedures to build up bone are carried out before the implant or in the same session. Which method is used is decided after the examination and CT scan.

Bone can be added using the patient's own bone or ready-made bone grafts. Depending on their source, grafts may be of bovine origin (xenograft), human origin (allograft) or synthetic (alloplastic). All of them provide a scaffold on which the body forms its own bone.

Sinus lift

In the back of the upper jaw, just above the molars, there is an air space called the maxillary sinus. After tooth loss this space can expand downwards, leaving too little bone height for an implant.

In a sinus lift, the thin membrane lining the floor of the sinus is carefully lifted and the space created underneath is filled with graft material. New bone forms in this area within a few months. If there is enough bone height, the procedure can be done in the same session as the implant; if not, the sinus is lifted first and the implant is placed at a later stage.

Dr. Seda Koçyiğit's doctoral thesis was on this subject: it compared the effectiveness of graft materials used in sinus grafting operations.

Block graft with the patient's own bone

Older tooth loss, trauma or congenital conditions can leave a larger bone defect. In this case, a piece of the patient's own bone is fixed to the deficient area. For small defects the bone is taken from inside the mouth (the chin or the back of the lower jaw). For very large defects it may need to be taken from the hip; this is done in hospital under general anaesthesia and requires a short hospital follow-up.

Nerve repositioning

The nerve that supplies sensation to the lower lip and chin runs inside the lower jaw. In the back of a lower jaw with advanced bone loss, this nerve may lie very close to where the implant needs to go. In that case the nerve is carefully freed from its canal and moved aside, and the implant is placed.

A known risk of this procedure is temporary or, rarely, permanent numbness of the lower lip and chin. For this reason it is rarely chosen; options such as short implants or grafting are considered first. In patients with advanced bone loss in the upper jaw, zygomatic implants may be discussed as an option that does not require grafting.

• Neighbouring teeth are not cut down. A bridge is supported by reducing the healthy teeth on either side of the gap; an implant does not need this.
• The bone continues to be preserved. Because an implant transfers chewing forces to the bone, bone loss in the area slows down. Bridges and dentures do not do this.
• It is fixed. There is no taking it in and out, no denture adhesive and no plate covering the palate; taste and speech are not affected.
• It lasts a long time, but needs care. Scientific studies generally report 10-year success rates above 90% for implants. This depends on oral hygiene, smoking, general health and regular check-ups.
• It takes longer and involves surgery. A bridge can be completed in a few weeks, whereas an implant needs a healing period. The initial cost is also usually higher.

Implant placement is a common procedure that goes smoothly for most patients; like any surgery, it still carries some risks:

• Swelling, bruising and tenderness in the first days (expected and temporary)
• Infection during healing
• The implant not bonding with the bone; in that case it is removed and can be placed again once the area has healed
• Changes in lip sensation when working near the nerve in the lower jaw, or sinus-related problems in the upper jaw
• Over the years, gum inflammation and bone loss around the implant (peri-implantitis); the most important prevention is regular cleaning and check-ups

Many of these risks are reduced by planning with a CT scan, pausing smoking and following the instructions during healing.

• First 48 hours. Mild swelling and aching are normal. Cold compresses and the recommended painkiller are usually enough. Avoid hot drinks, smoking and vigorous rinsing.
• First week. Choose soft, lukewarm foods and do not chew on the treated side. Stitches are removed on day 7–10.
• Healing period (2–6 months). Daily life goes on as normal. If you have a temporary tooth, avoid putting hard foods on it, and attend your check-ups.
• After the permanent tooth. Daily brushing, floss or interdental brushes, and at least one check-up with professional cleaning a year. This is what determines the lifespan of an implant more than anything else.