Dental Implants

Where it may be suitable

• Adults missing one or a few teeth whose general health allows surgery and healing
• Enough bone height and width to hold the implant; where there is not, bone grafting or a sinus lift may be considered
• Healthy gums, or gum treatment already completed
• People who do not want their neighbouring teeth ground down
• People who cannot manage or do not want a removable partial denture

What is associated with higher risk

The figures below are pooled results of observational studies; they show association, not proven causation.

• Smoking. A 2020 review compared people who smoked more than 20 cigarettes a day with non-smokers. They had about 2.5 times the risk of implant loss per implant¹; per patient, the risk was about 4 times higher¹. In that review the risk rose with the number of cigarettes, and no level of smoking was shown to be free of extra risk. For early implant loss in smokers, a review of 32 studies gave an odds ratio of 2.59 per implant². It comes from the 21 groups of patients analysed per implant. An odds ratio compares odds, not risks, so this does not mean that the absolute risk is 2.6 times higher.
• A history of periodontitis (gum disease that has damaged the bone around the teeth). Across 14 prospective studies, implants were lost at about 1.75 times the rate³ seen in people without that history. After fast-progressing disease the rate was about 6 times higher³. These are hazard ratios, not absolute risks. Peri-implantitis (inflammation around the implant with bone loss) was about 3 times more likely³. These were treated patients; implants are not placed while the disease is active.
• Clenching or grinding. Across 27 studies, people judged likely to clench or grind their teeth were compared with people who do not. The odds of implant loss were about 2.2 times higher⁴ in the first group (an odds ratio). These studies did not test whether a night guard prevents that.
• Diabetes. The findings are mixed. Two of three reviews found no significant difference in implant loss: a nine-study review of type 2 diabetes⁵ and an older review⁶. The third, covering 89 publications, reported a higher odds ratio⁷ for implant loss. All three found more bone loss around implants in people with diabetes. That is why blood-sugar control and regular reviews matter.
• Bone-strengthening medicines (bisphosphonates, denosumab). The risk depends on why the medicine is taken, and on its dose, route and duration. Whether it is given by drip, by injection or by mouth does not on its own decide it. In people on high-dose antiresorptive treatment for cancer, elective implant surgery is usually avoided. That group includes bisphosphonates given by drip and denosumab given by injection under the skin. The decision is made together with your oncology and oral surgery teams. Do not stop a medicine without asking the doctor who prescribed it. Doses used for osteoporosis, whether tablets, infusions or injections, are assessed separately. With these medicines the main concern is medication-related death of jaw bone (osteonecrosis), an area of jawbone that dies and may not heal. Separately, a 21-study review looked at people taking bisphosphonates as one group, not by the reason they took them. In it, implant loss was about 1.7 times more likely per implant⁸. Jaw osteonecrosis was about 3.5 times more likely per patient⁸. The per-patient analysis of implant loss found no significant difference. These figures are for bisphosphonates and cannot be applied to denosumab; the certainty of the evidence is very low. Tell us about every medicine you take.
• Radiotherapy to the head and neck. Implants are lost more often in irradiated bone. After extractions and implant surgery there is a risk of wounds that do not heal and of bone death (osteoradionecrosis). We ask about the field and dose of your radiotherapy, and planning is done with your oncology team.

Where another step comes first

• A tooth that can be saved. Whether the tooth can be kept is assessed first. If root canal treatment, gum treatment or a crown could keep it, that comes first. Before you agree to an extraction, ask about the tooth's outlook and the ways of replacing it, an implant among them.
• Active infection, untreated gum disease, uncontrolled medical conditions. These are dealt with first.
• Not enough bone. For one or a few missing teeth, bone grafting or a sinus lift may be considered; both lengthen treatment and carry their own risks. In some cases short implants are an alternative; the options without a graft are compared on the bone grafting page. Zygomatic implants are not the subject of this page. They are a separate method, considered for people with no teeth in an upper jaw whose bone has been severely lost.
• A jaw that is still growing. In young patients, implants wait until growth is complete.

Suitability is decided by an examination, a 3D scan and your medical history. A plan based on photographs or a panoramic X-ray is not final; it is a preliminary assessment.

There is more than one way to deal with a missing tooth, or one that cannot be saved. The list starts with the option that removes the least tissue.

• Doing nothing. For a single missing back tooth, this is a reasonable option for some people. The trade-off: over time the teeth either side of the gap can drift, and the opposing tooth can over-erupt. The bone in the gap also shrinks. Discuss this option with your dentist too.
• Saving the tooth. If the tooth is still there, ask first whether root canal treatment, gum treatment, a repair or a crown could keep it. Keeping your own tooth usually preserves the most natural tissue.
• A removable partial denture. It is used for people who do not want surgery, or for whom surgery is not suitable. It is not a second-class solution; it is an option with its own indications. You take it out to clean it, and getting used to it takes time.
• A resin-bonded (adhesive) bridge. For suitable single-tooth gaps, a bridge with a wing bonded to the back of the neighbouring tooth can be used. It needs very little or no grinding of that tooth, and no surgery. It does not suit every gap or every bite; it can come loose and may need re-bonding.
• A conventional tooth-supported bridge. The teeth either side of the gap are reduced and a bridge is made over them. If those teeth are healthy, the tissue removed does not grow back. On the other hand, no surgery is needed and the treatment is short.
• An implant crown or bridge. The neighbouring teeth are not ground down to support it. It needs surgery and a healing period. Where several teeth are missing, not every gap needs its own implant; a bridge can be made on a few implants.

Which option suits you depends on where the gap is, the state of the neighbouring teeth, the bone, your bite and your habits. If you have been offered only one option, ask why the others were ruled out.

Implant treatment has two main stages, the surgery and the crown or bridge, with healing in between. The number of visits and the length of each depend on you and your plan; both should be written in the plan. Travel is covered in 'If you are coming from abroad' below, and sedation on the anaesthesia and sedation page. When the restoration is complete, probing measurements around the implant and an X-ray are taken as a baseline record⁹. The 2017 international consensus report on diseases around implants recommends this.

This matters day to day, and the answer is not the same for everyone. One of these is chosen for the waiting period:

• The gap is left empty. Some people choose this for back teeth that do not show.
• A removable temporary denture. A small removable piece is made for one or a few teeth. You take it out, and it is adjusted so that it does not press on the healing area.
• A bonded temporary bridge. Where suitable, a thin temporary bridge attached to the neighbouring teeth can be used.
• A temporary tooth on the implant. This is done only in selected patients, if the implant holds firmly enough in the bone at placement (primary stability).

The last option is not for everyone; its risks, and whether it is in your plan, should be discussed separately. A Cochrane review of 26 randomised trials found no convincing difference¹⁰ within one year between loading an implant immediately and waiting. Most of its trials were at high or unclear risk of bias. Another review of 39 randomised trials reported slightly lower implant survival¹¹ with immediate loading. The decision depends on how firmly the implant holds during surgery, and on you.

Which of these you will have, and whether it is included in your plan, should be written in your treatment plan. If it is not, ask for it in writing. If a fixed temporary tooth is planned, ask what you will have instead if the implant is not stable enough at surgery. Ask too whether that changes the cost or the trips. If you are travelling, this is what you will live with at home between trips, so settle it before you book.

There are many different implant systems. Surface treatment, screw design, the range of parts and the availability of the parts that go on top differ from system to system. The 2017 consensus report, which defined the diseases around implants, also noted that there is no generic implant⁹. There are numerous implant designs, with different surfaces. As well as the brand name, ask whether the parts of that system can still be obtained years from now.

When you receive a quote, ask for these in writing:

• Which system is planned, and in which diameter and length?
• Is the part that goes on top (the abutment) from the same system?
• Will a dentist in my own country be able to obtain these parts years from now?
• Will I be given an implant card or a similar record?
• If the plan offers an 'upgraded' option, what changes, and why is it needed?

A brand name alone does not decide the result. Published survival rates are not the results of one brand, clinic or dentist either; they are averages pooled from different countries and different patient groups. We give you the systems we use, and the one planned for you, in writing in your treatment plan.

Risks

The figures below come from published studies, not from our own records.

• Implant loss. A review of 46 studies looked at implants carrying a single crown. Of every 100, about 97 were still in the mouth after five years and about 95 after ten¹². The rest were lost. The ten-year figure is an estimate from a statistical model. It is not always possible to place a new implant where one was lost; further surgery or a different restoration may be needed.
• Inflammation around the implant. Peri-implant mucositis is inflammation of the soft tissue around an implant. Peri-implantitis is that inflammation together with loss of the supporting bone. Its treatment may need surgery, and if it is not controlled, further bone loss can lead to losing the implant. A 57-study review reported peri-implantitis in about 20 in 100 patients and about 12 in 100 implants¹³. An older 11-study review found mucositis in about 43 in 100 patients¹⁴. The rates vary widely with the definition used.
• Technical and biological problems. The same review reported these cumulative five-year rates: screw loosening 8.8 percent, soft-tissue problems 7.1 percent and aesthetic complications 7.1 percent¹². Bone loss of more than 2 millimetres was 5.2 percent, the crown coming loose (loss of retention) 4.1 percent and chipped porcelain 3.5 percent¹². The review's published summary does not say, for most of these rates, whether they are counted per implant or per crown. A loose screw can be tightened and a damaged crown repaired or replaced; soft-tissue problems need assessment and treatment. Regular reviews are needed to find them.
• Surgical risks. Bleeding, swelling, bruising and infection can occur. In the lower jaw, nerves run close to where implants are placed, so the lip, chin or tongue can go numb. This is usually temporary; rarely, it does not go away. The root of a neighbouring tooth can be damaged while the implant site is prepared. In the back of the upper jaw the sinus is close. The sinus membrane can tear, sinusitis can develop, or an opening can form between the mouth and the sinus. A 3D scan and careful planning reduce these risks; they do not remove them.
• An implant placed at the same session as the extraction. A review pooling studies with different follow-up and patient selection found survival of 95.2 percent¹⁵ for implants placed straight into the extraction socket. For implants placed in healed bone it was 98.4 percent¹⁵ (per implant). This is a group average, not a personal probability for you. The review's authors ask for the method to be used with caution. The decision depends on the state of the tooth and the bone.
• Limits of appearance. At the front of the mouth, the shape of the gum, the lip line and the colour of the neighbouring teeth decide the result. The gum can recede over time, and the metal edge of the implant can then show. Your expectations are discussed before treatment.

Benefits

• The neighbouring teeth are not ground down; no healthy tooth is reduced for a bridge.
• The implant passes chewing load to the bone. This does not fully prevent the bone loss that follows an extraction. Bone can also be lost around the implant over time or through disease.
• It is fixed: you do not take it out, and there are no denture clasps. A screw can still loosen or the crown come loose, as the figures above show. It does not feel or work exactly like a natural tooth.
• Where several teeth are missing, a bridge can be carried on fewer implants than there are missing teeth.

The first days

• Swelling and bruising usually increase over the first 48 to 72 hours, then settle. Use cold packs and the medicines prescribed.
• Choose soft, lukewarm food for the first days, and do not chew on the surgical site.
• Do not stop cleaning your mouth. Clean the surgical area the way your dentist shows you, and the rest of your mouth as usual.
• If you had sedation, do not drive or operate machinery for as long as the sedation team tells you. Whether you need an escort depends on the method. A UK national standard covers conscious sedation in dentistry. For adults, it says that every form of sedation other than inhalation sedation requires a responsible adult as an escort¹⁶. It also says that if an escort cannot be assured, treatment under sedation must not be provided. If you are travelling alone and want sedation, raise this before you book. Before you leave the clinic after surgery, you and your escort should have written aftercare instructions. You should also know how to reach the clinic, including out of hours.
• Smoking is associated with poorer healing. At the very least, do not smoke during the healing period.

Flying

A 2023 narrative review suggests waiting at least 72 hours¹⁷ after implant placement before flying. After a sinus lift it suggests at least two, and ideally six, weeks¹⁷. These intervals assume no pain, swelling or bleeding at the treated site. The authors say the research is limited and comes mostly from military aviation. Treat these intervals as a starting point for a conversation with the dentist who treated you, not as clearance. Your written plan proposes flight dates on this basis; confirm them with that dentist after the treatment.

Daily care

• Brush twice a day with a soft brush and fluoride toothpaste. Pay particular attention to the line where the implant meets the gum.
• Clean between the teeth every day with interdental brushes, floss or a water flosser. Your dentist shows you which works in your mouth.
• If you clench, a night guard may be advised to protect the crown or bridge. It has not been shown to prevent implant loss, and we have found no study showing how well it protects the restoration.
• Reviews. Follow-up for an implant is different from a general dental check-up. The consensus report recommends that an X-ray and probing measurements be taken as a baseline⁹ when the restoration is complete. The European Federation of Periodontology guideline calls for a structured supportive care programme¹⁸ once implants are in use. The UK's NICE guideline on dental recall recommends that the interval between reviews be set for each patient¹⁹. It is based on a risk assessment and discussed with the patient. That guideline covers check-ups in general, not implants. So there is no ready-made 'once a year' interval that suits everyone; yours may be shorter or different, depending on your risk.

The rates below are not promises. They are pooled estimates, calculated with statistical models from studies with different lengths of follow-up. What happens in your case depends on your bone, your gum health, your habits and your care.

• The implant itself. In the 46-study review, of every 100 implants, about 97 were still in the mouth after five years and about 95 after ten¹² (per implant).
• The crown on top. In the same review, of every 100 crowns, about 96 were in use after five years and about 89 after ten¹² (per crown). In an older review the figures were about 95 at five years and about 89 at ten²⁰. The rate for the implant is not the same as the rate for the tooth on top of it.
• No one can promise a lifetime result. The reviews we use give five- and ten-year estimates. The ten-year values are estimates from a statistical model, based on studies with a mean follow-up of at least five years. Longer-term reviews exist, but those we have checked cover different patient groups and restoration types, so their results are not carried over here. None of them promises a lifetime result.
• Being in place is not the same as being trouble-free. The rates above show only that the implant or the crown is still there. Regular cleaning and reviews are part of maintenance. A loose screw or chipped porcelain needs a repair, and replacing the whole crown counts as losing the restoration. Ask beforehand whether these are included in your plan.

We have found no good research comparing implant treatment squeezed into a few days with treatment spread over months. The nearest evidence, the Cochrane review of loading times¹⁰, followed patients for a year at most, so it cannot settle the question. The timing first has to meet clinical requirements: how firmly the implant holds and how you heal. Beyond that, judge it on practical grounds. How is healing checked? Who do you contact if something goes wrong? What aftercare is included in the plan?

Trips and days

An implant needs a healing period between the surgery and the final crown, so the treatment may not fit into one trip. Your plan states how many trips it needs, what is done on each, how many days each one takes and when you can fly. Have that in writing before you book travel. The intervals before flying are under 'After surgery and daily care' above.

Between trips and after you go home

We try to arrange a check with a dentist in your own country between the stages, and write it into the plan. This may not be possible everywhere, because some dentists may not want to take over treatment in progress. So the plan also says where to turn if a problem arises in between. If a check at home is planned, ask for the records of the first visit before you fly home. That dentist needs them to see what was done. The Dutch dental association suggests discussing your plan with your own dentist²¹ before you go. It also suggests asking whether you can go to them if something goes wrong.

Before you fly home, ask for your record: the implant system placed, with its diameter and length, and your X-rays and scan. Ask for your aftercare plan in writing too. A dentist at home needs them to look after the implant. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging²².

Problems after you return are usually first seen by a dentist where you live, and that dentist may not take over work done elsewhere. What a health service or an insurer covers after treatment abroad differs from country to country. Before you travel, ask the health service or your insurer in the country where you live. Ask what they would cover if the implant needs care at home.

Questions to ask before you commit

These are the questions we suggest you ask before treatment abroad. Ask us all of them, and ask for the answers in writing.

1. Who will carry out my treatment, and what are their qualifications?
2. How many times have you carried out this procedure; what are your success, complication and infection rates?
3. Are you regulated by a professional body and registered with it?
4. If there is a complication, are the remake and correction terms in writing, and for how long do they apply?
5. What aftercare do you provide, and who can I contact after the treatment?
6. What happens if I am unhappy with the results?
7. If there are complications, who pays for the further treatment, the extra flights and the hotel?
8. Do you have a complaints system, and can I see a copy?

We publish no implant figures of our own yet. Ask us for them, and ask how complications were defined and over what period.

Dental regulation differs between countries; check the rules in your own country as well. The full list of questions to ask before treatment abroad is on our page about dental treatment abroad. We give you the route to follow if there is a complication, and our remake terms, in writing before treatment. You can ask us for that document before you decide. You can take time to decide. You can say no, or ask to stop, at any stage, including after the examination. Ask before you travel what you would pay if the examination shows that an implant does not suit you. Having the treatment with a dentist where you live remains an option.

Contact your dentist after surgery, or at any time once the implant is in use, if you notice any of the following.

• Pain or swelling increases after the third day, or bleeding does not stop
• Numbness of the lip, tongue or chin lasts beyond the expected duration of the anaesthetic
• The implant or crown moves, a screw feels loose, or a piece cracks or breaks
• Bleeding, a bad smell, pus or receding gum around the implant
• A high temperature or feeling unwell after surgery
• Pain on biting, or the bite feels high
• Nasal discharge, a blocked nose or sinus pain on the side of an implant in the back of the upper jaw

Before you fly home. If any of these starts while you are still in Turkey, tell us before you travel.

Once you are home. Contact us through the route written in your plan. If numbness persists, pain or swelling keeps increasing, or the implant moves, also see a dentist locally without waiting for our reply. If your plan names a dentist at home, contact them as well.

Emergencies. Do not wait for the clinic's reply if breathing or swallowing becomes difficult. The same applies to rapidly spreading swelling of the face or neck, or swelling around the eye. Go to the nearest emergency department or call the emergency number where you are (112 if you are in Turkey).

This page carries no prices. The main things that shape a plan are:

• How many teeth are missing and where; whether extractions are needed
• Whether bone grafting or a sinus lift is needed
• The number of implants, the system chosen and the abutment that goes on it
• The material of the crown or bridge
• The temporary solution used during the waiting period
• Sedation; the number of trips and the review programme
• The remake terms if there is a complication

Ask for three things in writing. What does your plan include? Which items are left 'to be decided later'? Who pays for further treatment and extra travel if there is a complication? Two quotes for the same procedure may not describe the same scope. Add travel and accommodation for each trip when you compare them.