Dental Implants: Treatment Steps, Suitability and Aftercare

A dental implant is a small screw placed in the jawbone to replace the root of a lost tooth; together with the crown or denture fitted to it, it aims to restore both the appearance and the function of the missing tooth. This page explains who implants may suit, the stages treatment goes through and what to look after afterwards. At our polyclinic in Çankaya, Ankara, every implant plan is based on an individual examination and imaging results.

What is a dental implant and how does it work?

A tooth has two parts: the crown you can see in the mouth and the root that sits inside the bone. When a tooth is extracted or lost, both parts go. Options such as bridges and removable dentures replace only the visible part. An implant replaces the root as well.

Implants are usually made from titanium or titanium alloys. Titanium is well tolerated by the body, and over time bone cells attach to the implant surface and hold it firmly. This bonding process is called osseointegration. Once it is complete, the implant can transfer chewing forces to the bone in much the same way as a natural tooth root.

An implant restoration usually has three components:

• Implant body (fixture): the screw-shaped artificial root placed in the bone.
• Abutment: the connecting piece between the implant and the tooth that sits over it.
• Restoration: a crown for a single tooth, a bridge for several teeth, or an implant-supported denture for a whole jaw.

Who are implants suitable for?

Implants can be planned for a wide range of situations, from a single missing tooth to a jaw with no teeth at all. Suitability depends on the condition of the bone and on general health rather than on age. Implants are not placed before jaw growth is complete, however, so in teenagers the end of growth is usually awaited.

An implant is often one of the options considered in the following situations:

• A single tooth is missing and the teeth on either side are healthy. A bridge would require those healthy teeth to be reduced, whereas an implant is placed without touching the neighbouring teeth.
• Several back teeth are missing and there is no tooth behind the gap to support a bridge.
• A removable denture moves around or causes discomfort when speaking or eating.
• All the teeth in a jaw have been lost and a more stable hold for a full denture is wanted.

If you would like to see how the options for missing teeth compare with one another, our article on implants, bridges and dentures for missing teeth sets them out side by side.

When is extra care needed in planning?

Implants are not equally suitable for everyone. The situations below do not rule treatment out on their own, but they may call for further assessment, preparation or cooperation between doctors:

• Uncontrolled diabetes: if blood sugar is not well managed, wound healing and bone integration can be affected. In well-controlled diabetes, implants can be planned in most cases.
• Smoking: smoking slows healing of the tissues around the implant and increases the long-term risk of inflammation around it.
• Untreated gum disease: active periodontal disease is treated first.
• Insufficient bone: bone may have shrunk where a tooth has been missing for a long time. Additional procedures such as bone grafting or a sinus lift may then be discussed.
• Certain medicines: some drugs used for osteoporosis, blood thinners and treatments that suppress the immune system must always be reported to your dentist.
• A history of radiotherapy to the head and neck and pregnancy are also assessed separately; elective surgical procedures are generally postponed during pregnancy.

Sharing a complete list of the medicines you take and the illnesses you have had at the first appointment is an essential part of planning treatment safely.

How does implant treatment progress, step by step?

Implant treatment is not completed in a single appointment. It is spread over several stages, and each stage is shaped by the results of the one before.

1. Examination and consultation: the mouth is examined, and the area of the missing tooth, the neighbouring teeth, the gums and the bite are assessed. Your general medical history is taken.
2. Imaging: a panoramic X-ray gives an overview. In most cases a three-dimensional CT scan (cone beam CT) is requested to measure the height and width of the bone and its distance from structures such as nerves and the sinus.
3. Treatment plan: the number of implants, their positions, whether additional bone procedures are needed and the type of restoration are planned. At this stage you are told about the expected duration and the number of visits.
4. Preparatory treatment: if needed, decay treatment, scaling, gum treatment or extractions are carried out at this stage.
5. Implant placement: under local anaesthetic the gum is opened, a site is prepared in the bone and the implant is placed. For a single implant the procedure usually takes 30 to 60 minutes; it takes longer with several implants or with additional bone work.
6. Healing and integration: for the implant to bond with the bone, a wait of about 2–3 months in the lower jaw and 3–6 months in the upper jaw is usual. If bone has been added, this period may be longer. In the front of the mouth a temporary tooth can be worn for appearance during this time.
7. Impressions and final restoration: once integration has been checked, impressions are taken and the colour and shape of the tooth are chosen. The crown, bridge or denture made in the laboratory is tried in and then fitted.
8. Follow-up: after the restoration is fitted, the bite is checked and regular review appointments are planned for the period that follows.

Because the process involves several appointments spread over months, you will need to be available for these visits in Ankara from placement through to the final restoration and the first reviews. If you live abroad or are in the city for a limited time, it is worth discussing the timetable at the first examination.

Are same-day implants and immediate loading possible?

In some cases an implant can be placed in the same session as the extraction; this is known as immediate implant placement. In selected cases where the bone is adequate, the area is free of infection and the implant has strong initial stability, a temporary tooth can also be fitted to the implant within a short time. This approach is not suitable for every patient or every area of the mouth, however. The decision is based on the examination and CT findings.

How long does treatment take in total?

The total length of treatment varies from person to person. If the bone is adequate and no additional procedure is needed, the time from implant placement to fitting the permanent tooth is usually between 3 and 6 months. When bone grafting or a sinus lift is carried out, the total can extend to 6 to 9 months, sometimes longer. This waiting period is part of the treatment: overloading the implant before integration is complete increases the risk of failure.

Time spent in the dental chair amounts to only a few appointments in total. In the months in between, you carry on with daily life as normal.

What does it feel like during and after the procedure?

The implant is placed under local anaesthetic. Because the area is numb, most patients feel pressure and vibration during the procedure rather than sharp pain. Once the anaesthetic wears off, mild pain, swelling and sometimes bruising may appear over the next few days. These are generally most noticeable in the first 48–72 hours, then ease gradually, and in most cases they are controlled with the painkillers your dentist recommends.

The main points to follow in the first days are:

• Applying something cold to the outside of the face at intervals in the first hours helps reduce swelling.
• On the first day, avoid rinsing vigorously, spitting and drinking through a straw.
• Hot drinks and hard or crunchy foods should be avoided for the first few days; lukewarm, soft foods are more suitable.
• Smoking slows healing; stopping altogether is advisable, or at least for the healing period.
• Do not stop cleaning your mouth: brush the other teeth as usual and clean the implant area as your dentist instructs.
• Take any prescribed medicines at the recommended dose and for the recommended length of time.

If pain increases after a few days, or you notice significant bleeding, a fever or growing swelling, you should contact the polyclinic.

Possible risks and complications

Implants are a treatment with well-documented long-term results in the scientific literature. Even so, like any surgical procedure they carry some risks, and knowing about them is part of making an informed decision:

• Failure to integrate: in a small number of cases the implant does not bond with the bone and has to be removed. Once the area has healed, a new implant can often be planned.
• Infection: infection can develop at the surgical site; following hygiene instructions and attending reviews reduces the risk.
• Nerve involvement: in areas of the lower jaw close to the nerve, temporary or, rarely, permanent numbness can occur. Measuring with a CT scan is intended to reduce this risk.
• Relationship to the sinus: in the back of the upper jaw, the closeness of the implant to the sinus is taken into account in planning.
• Peri-implantitis: inflammation of the gum and bone around the implant. It progresses much like gum disease and can lead to bone loss. It is one of the most common long-term problems and is closely linked to cleaning habits.
• Mechanical problems: a screw can loosen or the porcelain on a crown can chip over time; these problems can usually be repaired.

Advantages and limitations of implants

What kind of tooth is fitted to the implant?

The final stage of implant treatment is the restoration, and this is what determines the visible result. When a single tooth is missing, one crown is usually fitted to the implant. Zirconia or porcelain fused to metal can be used for the crown; in the front of the mouth, where appearance matters more, ceramics that let light through well are often chosen. For a detailed look at the differences between materials, see our page on zirconia crowns.

If several adjacent teeth are missing, a bridge can be made on two implants instead of placing a separate implant for each tooth. In jaws with no teeth, either a fixed bridge on implants or a removable denture that clips onto the implants with press-stud (locator) attachments or a bar can be planned. Which one is chosen depends on the amount of bone, the number of implants, your cleaning habits and your expectations.

Common mistakes

• Waiting too long: after a tooth is extracted, the bone gradually shrinks. In an area that has been empty for years, the likelihood of needing an additional bone procedure for an implant increases.
• Giving an incomplete medical history: the medicines you take, especially blood thinners and bone medicines, directly affect the plan.
• Putting strain on the area during healing: chewing hard foods on the implant side can disturb the initial bond.
• Skipping reviews: peri-implantitis often causes no symptoms at first; regular reviews allow it to be spotted early.
• Assuming an implant needs no cleaning because it cannot decay: an implant does not get cavities, but the gum and bone around it can become diseased.
• Ignoring clenching and grinding: in people who clench their teeth at night the load on the restoration increases; a night guard is recommended where needed.

Long-term care after implant treatment

The most important factor in how long an implant lasts is the care it receives after it has been fitted. Brushing twice a day with a soft or medium brush is the basic step. To stop plaque building up where the implant crown meets the gum, interdental brushes, floss or a water flosser recommended by your dentist can be used. With full-jaw implant restorations, you will also be shown how to clean the area beneath the restoration.

Review appointments are usually more frequent in the first year and then planned every 6 or 12 months depending on your oral health. At these visits the gum around the implant, the bone level and the fit of the restoration are assessed, and professional cleaning is carried out if needed.

The health of your gums is directly linked to the health of the tissues around the implant. If you notice bleeding or recession of the gums, it is sensible to tell your dentist without waiting for your next review. Problems in your other teeth, such as decay or teeth that need root canal treatment, should not be neglected either; saving a tooth with root canal treatment is often a sounder approach than replacing it with an implant.

How orthodontics and implants relate

In some patients the gap left by a missing tooth narrows over time, or the neighbouring teeth tilt into the gap. The opposing tooth in the other jaw may also have over-erupted towards the space. In that case there may not be enough room left for an implant. Before placing an implant, it may be planned to move the teeth into a suitable position with orthodontic treatment. At our polyclinic, orthodontic and implant planning can be considered together, so such combined plans can be handled as one course of treatment.

Implant assessment at Yetkindent

Yetkindent Oral and Dental Health Polyclinic is located in YDA Center on Dumlupınar Boulevard (Eskişehir Road) in Çankaya, Ankara, near Çukurambar and Söğütözü. At the first appointment your mouth is examined, any existing X-rays you bring are reviewed and the necessary imaging is planned. Treatment options, the expected timeline and what will be needed from you during the process are explained clearly; the decision is yours.

You can contact the polyclinic to arrange an examination and assessment. Contact details and directions are on our contact page.

Frequently Asked Questions

Is there an age limit for dental implants?

There is no upper age limit; what matters is general health and bone structure. As a lower limit, jaw growth must be complete. This usually coincides with the end of adolescence, but it varies between individuals and is determined by the dentist's assessment.

How long does an implant last once it is fitted?

Implants that are well cared for and regularly reviewed can be used for many years in most cases, often for decades. The main factors affecting their lifespan are oral hygiene, smoking, clenching habits and general health. The crown fitted to the implant may wear over time and need replacing.

Will I feel pain during the procedure?

Because the procedure is carried out under local anaesthetic, most people feel pressure rather than pain during it. After the anaesthetic wears off, mild pain and swelling may occur for a few days; this is usually controlled with the painkillers your dentist recommends.

Can I still have an implant if I do not have enough bone?

Insufficient bone is not an obstacle on its own. In most cases a suitable site for an implant can be created with methods such as bone grafting, a sinus lift or choosing an implant of a different size. Which method is appropriate is determined with a CT scan.

I have diabetes. Can I have an implant?

In people whose diabetes is well controlled, implants can be planned in most cases. In uncontrolled diabetes, healing and integration may be affected, so bringing blood sugar under control first is recommended. Where necessary, the assessment is made together with your physician.

Will I be left without a tooth during healing?

In most cases, no. Particularly in the front of the mouth, a temporary tooth or temporary denture can be worn during integration. In suitable cases a temporary tooth can also be fitted to the implant within a short time. Which temporary solution is appropriate is decided at the examination.

Is an implant or a bridge more suitable for me?

Both have their place. If the neighbouring teeth are healthy, an implant closes the gap without reducing them; if those teeth already need crowns, a bridge can make sense. To see the options side by side, read our article on options for missing teeth; the final decision is made together after an examination.