Full-Mouth Dental Implants

If teeth remain in the jaw, keeping them is a fifth route, and the list starts with it. The other four are for a jaw with no teeth left, or with teeth that cannot be saved.

• Keeping the remaining teeth. If teeth in the jaw can be saved, keeping them is also a route. Gum treatment, root canal treatment and a partial denture are smaller steps than extracting every tooth. Extracting all the teeth cannot be undone, so the first question is always "do they really all need to come out?"
• A removable full denture. It needs no implant surgery. If teeth have to be extracted first, those extractions cannot be undone. It rests on the gums and, in the upper jaw, on the palate. Getting used to it takes time, chewing force is limited and the jaw bone continues to shrink. On the other hand, it can be made now and is easy to replace.
• An implant-retained removable denture. It clips onto implants: often two in the lower jaw, usually at least four in the upper. You take it out to clean it. Grip is clearly better than with a full denture. In the lower jaw it can often be done with fewer implants. The number of implants and the extent of surgery depend on the jaw and the denture design. Because you can take it out, cleaning is easier than with a fixed bridge for most patients.
• A fixed bridge on four or six implants. You cannot take this bridge out; your dentist can. Where the anatomy allows, the back implants are placed at an angle. The details are on the All-on-4 and All-on-6 pages.
• Several short bridges on more implants. If there is enough bone, more implants can be placed and two or three separate fixed bridges made for the jaw. Some problems can then be dealt with in one section only, although others can still need treatment across the jaw. On the other hand, more implants mean more surgery, and a graft may be needed.

Not all five routes are possible for every patient. If you have been offered only one, ask why the others were ruled out.

If you answer these questions for yourself before the examination, it becomes easier to judge the plan you are offered.

1. Is taking a denture out of your mouth acceptable to you? If it is, an implant-retained removable denture can mean fewer implants and less surgery, especially in the lower jaw. It is also easier to clean for most patients. If it is not, a fixed bridge is discussed.
2. What is the state of the bone? This is decided on a 3D scan. If there is bone at the front, a fixed bridge on angled implants may be possible. If the bone has shrunk severely, a graft, a sinus lift or zygomatic implants may be considered.
3. Will you be able to do the cleaning? Cleaning under a fixed bridge is demanding, and you need to be shown how. Manual dexterity, eyesight and regular reviews decide a lot here.
4. What is in the opposing jaw? Natural teeth, a denture or a bridge in the other jaw changes the design and the load.
5. Do you clench or grind your teeth? If you do, the bridge material and a night guard become part of the plan.
6. Are there teeth that could be saved? If so, ask for the reason for each extraction in writing, such as a root fracture, decay that cannot be repaired or advanced bone loss.

Being told "let's take them all out and make it fixed" is not a reason on its own. In the same way, "it won't work for you" should come with its reasoning. The reverse also holds: extracting healthy teeth because a patient asks is not a medical reason. Teeth that can be kept may help protect the bone. If what you want is a change in appearance, that may be possible without extractions.

When an implant solution is considered

• No teeth left in a jaw, or the remaining teeth cannot be saved (advanced decay, root fractures, advanced gum disease)
• People who cannot use a removable full denture, have problems with its grip or have a strong gag reflex
• General health that allows surgery and healing
• People who can keep up daily cleaning and regular reviews

What is associated with higher risk

The figures below are pooled results of observational studies. They show an association, not proven cause and effect.

• Smoking. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant as in non-smokers¹. Per patient it was about 4 times as likely. For early loss, a pooled analysis of 32 studies gave an odds ratio of 2.59 per implant². An odds ratio compares odds, not risk, so this does not mean 2.6 times as likely. No safe number of cigarettes has been shown.
• A history of gum disease. Across 14 prospective studies, the rate of implant loss was about 1.75 times higher³; after fast-progressing disease it was about 6 times higher. These are hazard ratios, not absolute risks. 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. In the first group, the odds of implant loss were about 2.2 times higher⁴ (an odds ratio). These studies did not test whether a night guard prevents loss.
• 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. The type 2 review based its reassuring conclusion on strictly maintained oral hygiene. Blood sugar control, daily cleaning and regular reviews therefore matter.
• Bone-strengthening medicines (bisphosphonates, denosumab). The risk depends on why, at what dose and for how long the medicine is taken. 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 team; do not stop a medicine without asking your doctor. Doses used for osteoporosis are assessed separately. In a 21-study review, implant loss in people taking bisphosphonates was about 1.7 times more likely per implant⁸. Jaw osteonecrosis (death of an area of jaw bone) was about 3.5 times more likely per patient. The per-patient analysis of implant loss found no significant difference. These figures are for bisphosphonates and cannot be generalised to denosumab; the certainty of the evidence is very low.
• Radiotherapy to the head and neck. Implants are lost more often in irradiated bone. There is a risk of wounds that do not heal and of bone death (osteoradionecrosis). Planning is done together with your oncology team.

When a fixed bridge may not suit

• People who cannot keep up daily cleaning. If the area under the bridge cannot be cleaned, the risk of inflammation around the implants rises. For these patients a removable solution may be safer.
• Expectations about lip support. Where the bone has shrunk severely, a fixed bridge may not support the lip and cheek as well as a removable denture. This is discussed before a decision is made.
• Active infection, untreated gum disease, uncontrolled medical conditions. These are dealt with first.
• 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.

Bone is the most common obstacle in a jaw with no teeth. The options differ in the extent of surgery, their risks and their duration. A graft or a sinus lift lengthens treatment. In suitable patients, angled or zygomatic implants can shorten it compared with grafting; zygomatic implants carry their own risks, set out below.

• Angled implants. The back implants are placed at a slant to keep clear of the sinus (upper jaw) or the nerve canal (lower jaw). The consensus report of the International Team for Implantology (ITI) states that, where conditions are suitable, implants can be deliberately placed at an angle⁹. In many patients this can reduce the need for a graft.
• Bone grafting and sinus lift. A review pooled 11 prospective studies with at least five years of follow-up. Its patients had 6 mm of bone height or less, and their sinus floor was raised through a side window (the lateral approach). Implant loss was 0.43 per cent per implant per year¹⁰. This result cannot be applied to methods that work through the top of the ridge. Vertical bone augmentation, on the other hand, is not a small extra step. In a Cochrane review, complications were more frequent than with short implants: an odds ratio of 4.97 per patient¹¹. The 95 per cent confidence interval was 1.10 to 22.40. This does not mean that the absolute risk is five times higher. The difference in implant loss was not significant. The details are on the bone grafting page.
• Short implants. The same Cochrane review states that in a shrunken lower jaw, short implants appear to be a better option¹¹ than vertical bone grafting. This rests on few studies, most at high risk of bias; whether short implants suit a full-arch design is assessed separately.
• Zygomatic implants. When the upper jaw bone is not enough for standard implants, implants anchored in the cheekbone can be used. A Cochrane review describes the procedure as technically demanding¹² and notes that it may be associated with serious complications. One small trial compared them with implants placed after bone grafting. Zygomatic implants led to fewer implant losses but more complications¹²; the two results belong together. Among complications in the surrounding tissues, inflammation of the sinus is reported most often¹³. Infection comes next, then an opening between the mouth and the sinus. It is not a routine option; it is explained at the consultation.

Imaging alone does not decide which route suits you. Your dentist assesses the examination, the 3D scan, your medical history and a denture plan prepared in advance together, and discusses the options with you. If a graft or a sinus lift is done, treatment takes longer.

The sequence below is shared by the fixed bridge and the implant-retained denture; the details vary with the route chosen. Times vary from patient to patient, and your plan is given in writing. How the stages fit around travel is covered in "If you are coming from abroad" below. If you would like sedation, the details are on the anaesthesia and sedation page. When the denture or bridge is complete, measurements around the implants and an X-ray are taken as a baseline¹⁴, as the consensus report asks.

Risks

• Steps that cannot be undone. An extracted tooth does not come back. Extracting all the teeth while some could have been saved cannot be put right later. Removing part of the jaw bone, where that is planned, cannot be reversed either. That is why getting a second opinion is reasonable.
• Implant loss. In a 55-study review, about 2 to 3 in 100 implants¹⁵ were lost at five years and beyond. With a fixed bridge, losing one implant can affect the whole bridge; with short bridges, some problems can be dealt with in one section only. That difference has not been measured; it is clinical reasoning.
• Inflammation around implants. Peri-implant mucositis is inflammation of the soft tissue around an implant. Peri-implantitis is that inflammation with loss of the supporting bone. An umbrella review of reviews on full-arch bridges reports peri-implantitis at 4 to 18 per cent¹⁶. These rates are as given in the review abstracts; whether they count patients or implants could not be verified in the full text. In implant patients in general, a 57-study review found it in about 20 in 100 patients¹⁷. The rate depends on the definition used and the time in function.
• Bone loss. At five years the 55-study review reports an average bone loss of 1.28 mm per implant with four implants and 0.94 mm with six¹⁵. These are averages; they do not mean that this much loss is harmless for your own implants. Loss that continues, especially with inflammation, is checked against your baseline record¹⁴. "No bone loss" is not true.
• Technical problems with the bridge. Reviews report screw loosening at 5 to 15 per cent and framework fracture under 5 per cent¹⁶. Chipping of veneered zirconia is reported at 15 to 35 per cent. These rates are as given in the review abstracts; the follow-up period and the denominators could not be verified in the full text. In these reviews, bridges of solid (monolithic) zirconia chipped less than veneered zirconia, and monolithic and screw-retained designs had fewer technical problems.
• Surgical risks. Bleeding, swelling, bruising and infection. In the lower jaw, the nerve canal is close: the lip and chin may feel numb for a while and, rarely, permanently. In the upper jaw, the sinus membrane may tear, and sinusitis or an opening between the mouth and the sinus may follow. The 3D scan shows these structures, and the position and angle of each implant are planned to avoid them. Complications are still possible.
• Immediate loading. Provisional teeth on the same day or within a few days (immediate loading) can work well in selected patients. A review of 39 randomised trials found slightly lower implant survival¹⁸ with immediate loading; the Cochrane review¹⁹ found no convincing difference within one year. Placing an implant straight into the socket of an extracted tooth is a separate question. There, survival was lower than with implants placed in healed sockets: 95.2 versus 98.4 per cent²⁰. If your plan places implants on the day of the extractions, ask whether any will go straight into a socket.
• Speech, lip support and adaptation. Speech and chewing change in the first weeks. A fixed bridge may not support the lip as well as a removable denture.

Benefits

• Implant solutions can improve grip and chewing comfort. Sensation and use are not the same as natural teeth; the result varies by person and design.
• An international consensus report of implant dentists recommends implant prostheses to help preserve the jaw bone and the chewing muscles²¹. That is a consensus view, not a measured effect, and some bone loss around implants is still expected (see "Bone loss" above).
• With a fixed bridge the palate stays uncovered; for many patients this matters for taste and speech.
• Where the anatomy allows, angled back implants can reduce the need for a graft and shorten treatment.
• An implant-retained removable denture can give a clear gain in grip with fewer implants, especially in the lower jaw. Because you can take it out, cleaning is easier for most patients.

The first days

• Swelling and bruising usually increase over the first 48 to 72 hours, then settle. Use cold packs and the medicines prescribed.
• Eat soft, lukewarm food in the first weeks. While the provisional denture or bridge is in place, do not chew hard or sticky food; this protects healing.
• 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 escort²². It also says that treatment under sedation must not be provided if an escort cannot be assured. 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 impairs healing. At the very least, do not smoke during the healing period.
• If you had a sinus lift, do not blow your nose or drink through a straw, and if you sneeze, keep your mouth open. These rules reduce pressure changes on the sinus membrane. Follow the written instructions you are given.

Flying

A 2023 narrative review suggests waiting at least 72 hours²³ after implant placement before flying. After a sinus lift it suggests at least two, and ideally six, weeks. 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. They offer the intervals as a starting point for the dentist's decision, not as clearance to fly. Your plan is built around them.

Daily care

• With a fixed bridge: clean under the bridge every day with bridge floss, interdental brushes or a water flosser. Your dentist shows you which works in your mouth.
• With a removable denture: take the denture out and clean it with the cleaner your dentist recommends. Clean the implant heads and the clip parts separately. Ask whether to leave it out at night. The clip parts are renewed over time.
• Brush twice a day with a soft brush, paying particular attention to the line where the gum meets the bridge or denture. Use fluoride toothpaste on a fixed bridge and on any natural teeth; a removable denture is cleaned as above.
• If you clench, a night guard may be advised. It has not been shown to prevent implant loss; its purpose is to protect the bridge or denture from the forces of clenching.
• Reviews. The consensus report asks for an X-ray and pocket measurements to be taken as a baseline¹⁴ when the bridge or denture is complete. The European Federation of Periodontology guideline calls for a structured supportive care programme²⁴. The UK's NICE guideline on dental recall covers check-ups in general, not implants. It asks for the interval between reviews to be set for each patient²⁵. It is based on a risk assessment and discussed with the patient.

The rates below are from published studies, not from our own records, and they are not promises. They are pooled estimates, calculated with statistical models from studies with different follow-up periods. What happens in your case depends on your bone, your habits and your care.

• Implants under a fixed bridge. In the 55-study review, about 97 to 98 in 100 implants¹⁵ were still in place at five years and beyond (per implant).
• The bridge itself. In an umbrella review of seven systematic reviews, bridge survival over 5 to 15 years was about 90 to 97 per cent¹⁶. That is as given in the review abstract; whether it counts bridges or patients could not be verified in the full text. A 2012 review looked at full-arch bridges on four to six implants. In the upper jaw, about 97 in 100 were in use at five years and 95 at ten²⁶. In the lower jaw the figures were 98 at five years and 96 at ten.
• Several short bridges: indirect data only. We have no pooled direct data for this route. The nearest data are for single crowns. In a 46-study review, about 97 in 100 implants carrying a single crown were in place at five years, and about 95 at ten²⁷. Of the crowns on them, about 96 in 100 were in use at five years and about 89 at ten. These figures cannot be carried over directly to short bridges or full-arch designs.
• Implant-retained removable dentures. The reviews cited on this page give no pooled survival figures for them, so this page gives none. The clip parts wear and are renewed, and the denture is relined over time; ask what your plan includes.
• Maintenance. Being in use does not mean no repair was needed. Regular cleaning and reviews are part of care. A loose screw or chipped porcelain needs extra repair. Some bridges have to be remade, which counts as losing the original bridge. Ask beforehand whether these are included in your plan.
• No one can promise a lifetime result. Follow-up in the reviews cited here goes up to 15 years. Longer studies of implants in general exist, but they cannot predict how long this particular bridge will last. An offer that promises a result for life is not based on evidence.

We have found no good research comparing full-mouth treatment squeezed into a few days with treatment spread over months. The nearest evidence, the Cochrane review of loading times¹⁹, followed patients for a year at most, so it cannot settle the question. The timing first has to meet clinical requirements: how firmly the implants hold 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

The way we plan full-mouth treatment, a healing period separates the surgery from the final bridge or denture. So the treatment does not fit into one trip. A graft or a sinus lift lengthens it further. 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, at home, you wear a provisional: a fixed provisional bridge in selected patients, or a removable temporary denture. Which one you will have is decided during surgery, so ask what happens in each case and whether both are included in your plan.

Between trips and after you go home

Between the stages, you can have a check with a dentist in your own country; if you do, we write it into the plan. Some dentists may not want to take on treatment that is in progress. So the plan also says where to turn if a problem arises in between. The Dutch dental association advises talking the plan through with your own dentist²⁸ before you go. It also suggests asking whether you can go to that dentist if something goes wrong²⁸. Ask your dentist at home, too, whether the treatment could be done where you live instead.

Once the bridge or denture is in use, the supportive care the European Federation of Periodontology calls for²⁴ will mostly happen near your home. Before you fly home, ask for your record: the implant system placed, with its diameter and length, your baseline X-ray and measurements, and your scan. The record should also name the parts the bridge or denture is attached to. A dentist at home needs it to look after the implants. Before you go, ask your dentist at home whether they can work with that implant system. 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 imaging²⁹. The regulation also requires a facility treating international patients to take out complication insurance for surgical and interventional procedures carried out in an operating theatre²⁹. That does not by itself tell you whether your implant surgery is covered, so ask which procedures in your plan fall under it.

Whether care at home is covered depends on the health service or your insurer in the country where you live. The same goes for repairs to a bridge or denture made abroad. Ask them before you travel, and get the answer in writing.

Questions to ask before you commit

Ask us all of the questions below before you agree to treatment, 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?

The rules for dentists differ between countries, so check the rules in your own country as well. The full list of questions to ask before treatment abroad, and how we answer each one, 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.

After surgery, or at any time while you use your bridge or denture, contact your dentist if you notice any of the following.

• Pain or swelling that increases after the third day, or bleeding that does not stop
• Numbness of the lip, tongue or chin that lasts beyond the expected duration of the anaesthetic
• The bridge or denture moves, a screw feels loose, or a piece cracks or breaks
• Bleeding, a bad smell, pus or receding gum around the bridge or denture
• Pain on biting, or a bite that feels high
• Nasal discharge, a blocked nose or sinus pain (upper jaw)
• A sore spot under a removable denture, or a sore that does not heal
• A high temperature or feeling unwell after surgery

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 bridge or denture moves, also see a dentist locally without waiting for our reply. If your plan names a dentist at home, contact them as well.

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, or swelling around the eye are serious signs. If you have any of them, do not wait for the clinic's reply. 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 factors in a plan are these:

• The route chosen: removable denture, implant-retained denture, fixed bridge or several short bridges
• The number of extractions, and any bone reshaping
• The number of implants, the system chosen and the connecting parts
• Whether a graft or a sinus lift is needed
• The provisional denture or bridge used during healing
• The material of the final bridge: monolithic zirconia, veneered zirconia or acrylic on titanium
• Sedation, the number of trips and the review programme
• The remake terms in case of complications

Ask in writing what your plan includes and which items are left for later. The plan should also state who pays for further treatment and extra travel if there is a complication. Two plans often do not describe the same scope: the number of implants, the material and the number of teeth can differ. Add travel and accommodation for each trip when you compare them. Before treatment we give you, in writing, the route to follow if there is a complication and our remake terms. You can ask us for that document before you decide.