Dental implants in Turkey: a plan that starts with the bone.

A dental implant is a small screw made of a biocompatible material that is surgically placed in the jawbone to mimic the root of a lost tooth. It is usually made of titanium. Over time the bone attaches to the surface of the screw and the implant becomes strong enough to carry a fixed tooth.

An implant is not a single piece but a three-layer system:

• Implant body: the screw that sits inside the bone and cannot be seen
• Abutment: the connector between the screw and the restoration
• Restoration: the crown, bridge or denture you see in your mouth

On our dental treatments page we summarised how implants compare with other options. This guide goes into the side that is talked about less: bone, grafting, waiting times and the timing of two trips.

Adults whose jaw has finished growing, whose gums are healthy and who have enough bone to support an implant are good candidates. The lower age limit is generally taken as 18; there is no upper limit. What decides is not your age on paper but your general health and oral hygiene.

Cleveland Clinic's patient information on implants says that an implant should be postponed, and the underlying problem treated first, in the following situations:

• Untreated gum disease or widespread tooth decay
• Uncontrolled diabetes
• Conditions and certain medicines that affect bone metabolism
• Advanced jawbone loss (which a graft can overcome)

Whether there is enough bone is shown by imaging, not by an examination: a panoramic X-ray gives the first impression and a 3D CT scan confirms the decision. The surgeon looks at three things on these images: the height, width and density of the bone. An implant only lasts if it can be surrounded by bone on all sides.

Once a tooth is removed, the bone in that area slowly shrinks because it no longer carries any load. So the longer the gap has been there, the more likely it is that bone has been lost. The scan also measures these neighbouring structures:

• Upper back teeth: the distance between the floor of the sinus and the top of the bone
• Lower back teeth: the position of the nerve canal that supplies feeling to the lip and chin
• Front teeth: the thin bone wall and gum level, which determine the aesthetic result

For a remote preliminary assessment, a panoramic X-ray is usually enough; the CT scan is taken at the start of the first trip and the final plan is confirmed that day.

If there is not enough bone to surround the implant on every side, it is first built up with a graft. A bone graft is a scaffold material placed in the deficient area, which the body gradually turns into its own bone. In the upper back teeth, if the bone is very close to the sinus, the sinus floor is raised and the space beneath it filled with graft; this is called a sinus lift.

Cleveland Clinic's bone graft page lists four sources of graft material:

• The patient's own bone
• Human bone from a licensed tissue bank
• Animal-derived bone
• Synthetic bone made in a laboratory

According to the same source, a graft takes at least three months to mature; for large grafts this can rise to 9–12 months. For small defects, the graft and the implant can be placed in the same session. For larger defects, the graft heals on its own first and the screw is placed in a separate session; this difference directly changes how many trips you need.

How many implants you need is decided not by the number of missing teeth but by the load to be carried and how the bone is distributed. You do not need one screw for every missing tooth; a few implants can support a bridge spanning the gap or a whole-jaw prosthesis.

The classic alternative for a single gap is to file down the two neighbouring teeth to anchor a bridge. An implant leaves those healthy teeth alone and, because it passes chewing forces to the bone, slows bone loss. On the other hand, it needs surgery and the timeline is measured in months. For crown materials, see our comparison of zirconia and veneers .

1. Preliminary assessment with an X-ray. Your panoramic X-ray, intraoral photos and medical history are reviewed; you receive an initial view on the number of implants, the likelihood of a graft and the number of trips.
2. Examination and 3D planning. On arrival in Turkey a CT scan is taken, the bone is measured and the position and angle of the implants are planned. We describe the overall flow of the trip on our treatment process page.
3. Surgical placement. The area is numbed with local anaesthetic; sedation can be added on request. The gum is opened, a socket is prepared in the bone, the implant is placed and the gum is stitched.
4. Healing period. You return home. Over these months the bone attaches to the surface of the screw; all that is asked of you is to keep the area clean and not put strain on it.
5. Abutment and impressions. On the second trip the top of the implant is uncovered, the abutment is fitted and impressions are taken for the permanent tooth. This appointment usually takes about an hour.
6. Permanent teeth and follow-up. After a try-in, the crown or bridge is fixed in place and your bite is checked. In the years that follow, check-ups continue with your own dentist.

Fusion, or osseointegration, takes 3–6 months in most patients and can extend to 9 months depending on bone quality and healing speed. During this time bone cells grow onto the rough surface of the screw and lock it in place; you do not feel anything from the outside.

Because the upper jawbone is more porous than the lower, surgeons usually allow a longer waiting time in the upper jaw. The American Dental Association's patient website also describes treatment in three stages : placing the implant, the bone growing around it, and fitting the artificial tooth.

No, in most cases you will not. Especially at the front, the surgeon prepares a temporary solution that fills the gap until fusion is complete. Which one is chosen depends on how firmly the implant sits in the bone on the day it is placed.

• Temporary removable denture: puts no load on the screw; the most cautious option
• Temporary tooth bonded to the neighbouring teeth: an aesthetic interim solution for a single gap
• Temporary crown on the implant: fitted the same day or within a few days if the screw is firm enough

In the first week the aim is to protect the blood clot and stitches; in the years that follow, it is to keep the gum around the implant healthy. An implant cannot decay, but the bone and gum that hold it can become inflamed, so cleaning is the key to a long life.

• On the first day, avoid hot food and drinks, straws and spitting
• Eat soft, lukewarm food for a few days and chew on the other side
• Until the stitches are out, clean the area gently with a soft brush without pressing
• Once the permanent tooth is fitted, use interdental brushes or a water flosser
• Have a check-up X-ray and a professional clean at least once a year

A loose implant, bleeding or swollen gums, fever and discharge from the area are signs you should report without waiting.

Dental implants are one of the few treatments that cannot be finished in a single trip: surgery is done on the first visit, there is a 3–6-month healing period in between, and the permanent teeth are fitted on the second visit. What sets the timetable is not the flight but how fast your bone heals.

• First trip: CT scan, extraction and grafting if needed, surgery. The stitch check is done before you leave the country.
• The months in between: you send a check-up X-ray taken in your own city; the second date is confirmed based on it.
• Second trip: impressions, try-in and fixing the permanent teeth; it takes a few days because of laboratory time.
• Flight: if you have had a sinus lift, have your return date approved by the surgeon.

Accommodation and transfers are planned separately for each trip. For patients whose graft is done in a separate session, the number of trips can rise to three.

Neda Deniz holds the Turkish Ministry of Health International Health Tourism Authorisation Certificate (AK-1032) and is an intermediary agency, not a clinic. Dental implant surgery and the prosthetic stage are carried out by our partner specialist surgeons in the relevant clinics. The doctor we work with in dental treatments is Oral, Dental and Maxillofacial Surgery Specialist Dr. Taylan Akça. Which doctor you proceed with becomes clear after the preliminary assessment. When choosing, ask who will do the surgery and who will make the crowns, which implant brand will be used and whether that brand has service support in your country.

Turkish regulations do not allow price advertising for healthcare services, and the cost of dental implants depends less on the number of screws than on what has to be done around them. On the NHS, implants are only offered in limited cases, which is why many people compare private options at home and abroad. When two quotes for the same number of implants differ, the difference usually comes from these items:

• Implant system: brand, surface technology and the manufacturer's documentation
• Bone procedures: graft, sinus lift, membrane material
• Restoration: crown material, single tooth or bridge
• Imaging and temporary teeth
• Accommodation and transfers for both trips

In experienced hands the complication rate is low, but an implant is surgery and it is not risk-free. Some problems appear in the first weeks, others years later.

• Failure to fuse: the screw does not attach to the bone and has to be removed; smoking and uncontrolled diabetes raise the risk
• Infection: pain, swelling and discharge at the surgical site
• Nerve involvement: numbness of the lip and chin in the lower jaw; this is why a CT scan matters in planning
• Peri-implantitis: gum and bone loss around the implant caused by plaque build-up over the years
• Mechanical problems: a loose screw, a cracked or chipped crown

In Turkey, the professional framework for dentistry is set by the Turkish Dental Association . Let us be just as clear about expectations: a dental implant is not identical to a natural tooth, it needs looking after, and the crown on it will one day need replacing.

If you are also considering another procedure on the same trip or later on, these guides take the same approach:

• Hair transplant guide — choosing a method and planning the grafts
• Rhinoplasty guide — open and closed technique
• Facelift guide — four techniques and recovery
• Breast reduction guide — scar types and breastfeeding

The decision about dental implants is not made by the screw brand but by three questions: Is my bone enough, or do I need a graft first? Can I plan the months in between and a second trip? Who will do my check-ups once I am home? If these three answers are clear, the rest is technical.

If you are not sure, getting an assessment first does not commit you to anything. Send us your panoramic X-ray and your questions; our partner doctors will review them and we will explain clearly how many trips you need and what steps lie ahead. If implants are not the right option for you, we will tell you that too.