Multiple Dental Implants Turkey

You don't need one implant for every missing tooth. Simple enough to say. In a real mouth it gets messier, because the gaps are scattered about and each has its own back story.

So here's an example. It's invented, but it's close to the kind of multiple dental implants case that comes up regularly.

A man in his early fifties sends in a panoramic X-ray. Both molars on his lower left are gone. On the upper right he's lost a premolar and the molar behind it. One lower front tooth is missing, and an old three-unit bridge on the upper left has started to feel loose. He counts six problem teeth and assumes he'll need six implants.

Maybe. Here's how each area might be thought through.

Lower left: two molars side by side

Two molars missing side by side? In decent bone, the usual fix is one implant per molar, each with its own crown. Brushing and flossing work just as they did before. Chip one and only that one gets replaced.

The thing to watch is the nerve. It sits in a channel in the lower jaw, right under these teeth. Years without molars can leave only a thin layer of bone on top. If the back site comes up short on the scan, you're normally looking at a shorter implant or a graft first.

Upper right: same count, different problem

Two missing teeth again, but the obstacle here is the sinus rather than a nerve. The bone under the upper molar is often too thin for a standard implant, and a sinus lift, done at the same appointment where possible, can create the height it needs. The premolar site in front of it is frequently fine as it is.

Two neighbouring implant crowns can be made separately or joined together. Joining them (splinting) shares the load a little, which helps when one implant is shorter than ideal. The price you pay is in cleaning. Floss won't pass between two crowns that are joined, so it has to be threaded underneath instead, or you use a small interdental brush from the side. It adds a minute or so to your evening routine. And if one of the pair chips badly, the lab will generally have to make both again.

Lower front: one small gap

This is really a single-tooth case sitting inside a bigger plan, and space may decide it. Lower front teeth are slim, and when one goes, its neighbours lean into the space. Once the gap shrinks past a certain point, there's no safe room for an implant between the roots. A small bonded bridge, or moving the teeth with a brace, may suit better. Single sites like this are covered in more detail on the single dental implant page.

Upper left: the old bridge

Old bridges usually fail at the teeth holding them up, through decay under the crowns or a cracked root. Once the bridge is off and those teeth have been assessed, one might be worth keeping and the other not. If both have to go, they can be removed on the first trip to Istanbul, and that area becomes three missing teeth in a row. Most often that gap gets a bridge on two implants, with an implant under each end tooth and the middle one hanging between.

One thing most dentists won't do is fix a new bridge to a natural tooth on one side and an implant on the other. A natural tooth sits in a ligament that lets it move very slightly when you bite. An implant is locked into bone and doesn't budge. Tie them together and one ends up doing more of the work than it should.

How many implants for several missing teeth?

Counted properly, with both bridge teeth included, this patient could have as many as eight teeth to replace. On paper that might be carried by six or seven implants, or fewer if the lower front gap is better closed another way. Some of this can't be decided until we see a CBCT scan. Treat any plan drawn up from an X-ray as provisional. The 3D images can change it. And if it turns out an implant isn't needed, that's a site you don't have to heal or look after.

One long appointment or several, and the recovery

Implants in different parts of the mouth needn't all go in on one day. Doing it all at once means you heal once and spend fewer days away, which is why most travelling patients go that way. The flip side is a long session and soreness in several places, so for a few days neither side is great for chewing.

Or the work can be split, often a side or a jaw per visit. Some people simply can't face a long appointment. A graft that needs months to settle forces a split in any case. You'll take longer overall, possibly with one more flight. The surgeon will propose an order from your scan. Want one side left alone so you can eat comfortably? Tell us. It's usually possible.

What's the first week like? Sore in patches, mostly. You'll chew on whichever side hurts less and live on soft food for a bit: eggs, soup, yoghurt, that kind of thing. Swelling peaks around day two or three. The final crowns don't go on straight away. They're fitted on a second visit, a few months later, when the bone has grown firmly around the implants.

Two front teeth, one implant?

Front teeth have a rule of their own. With two upper front teeth missing next to each other, lots of surgeons avoid putting two implants side by side. The problem is the little triangle of gum between teeth. Between two implants it tends to shrink, and you're left with a dark gap when you smile. Often it looks better with one implant and a false tooth hanging off it, or two implants with a bridge tooth in the middle. It's a judgement made case by case, but it's one of the places where fewer implants can mean a better-looking result as well as a cheaper one.

The teeth you keep

In a multiple implant case, the natural teeth that remain matter as much as the new ones. They'll be sharing the bite with the implants for years, so decay, failing fillings or gum problems are best dealt with before or alongside placement, as the pathway above describes.

There's also a difference in how the two feel under pressure. A natural tooth sits in a ligament packed with nerve endings that sense how hard you're biting. An implant doesn't have one. You can still feel pressure through the jaw, just less precisely, and that's partly why grinders are usually told to wear a night guard once the final teeth are fitted.

When the final crowns go in, the dentist checks your bite with thin coloured paper. Implant crowns are often left touching very slightly less than the teeth next to them. Your own teeth sink a fraction when you bite; implants don't. A lighter contact stops the implants taking more than their share.

Your own teeth will keep moving very slowly for the rest of your life, and they wear a little too. Implants stay put. Small bite adjustments every few years are part of the deal, nothing to worry about.

Checking results: before and after photos, X-rays and reviews

With implants dotted round the mouth, before and after photos of multiple dental implants are harder to judge than you'd think. A big smile shot shows the front and not much else. Ask for photos of the back teeth as well, and the X-ray if they're willing. Look at the gum between crowns that sit side by side: filled in, or a dark gap? Reviews help too. The best are from people a year or so after treatment who can tell you how everything feels when they eat.

When several implants stop being the right plan

There's a stage where patching things up stops making sense. Holding on to five or six struggling teeth with implants squeezed between them can cost more over time than a full arch. It's usually obvious when you're there. The teeth you'd keep are loose, or mostly filling, or keep flaring up with gum disease. Sooner or later one fails, and then the whole plan around it needs redoing. At that point we'd be talking about full mouth dental implants, and about whether All-on-4 or All-on-6 fits your bone. Nobody should make that call for you from a first X-ray. If you already suspect you're close to it, though, say so when you send your details, because it changes how the plan is put together.

Multiple dental implants cost in Turkey, and choosing a system

The price list above shows how much implant systems vary. With one implant, going for a more expensive system adds a few hundred euros. With six, that same difference applies to every one of them. That's a real decision, and it deserves more thought than price.

For anyone travelling for treatment, there's another side to it. Screws occasionally loosen, crowns can chip, and years from now something may need adjusting, most likely by a dentist near where you live. They'll need parts and tools that fit your implants. The more widely used systems are easier to service in most countries; a less common one can mean your dentist has to order components or refer you elsewhere. Before choosing, it's worth asking your own dentist which systems they work with. It's also generally better to keep to one system throughout the mouth rather than mixing two to save money on some sites. Mixing is possible, but it doubles the range of parts and tools anyone looking after your implants will need.

People often ask how much they'd save. Several implants at a private practice in Britain, Ireland or America usually add up to a lot more than multiple dental implants in Turkey, and with six or seven implants the gap gets big quickly. That's the reason most of our multiple implant patients fly in. Just make sure the quote you're comparing lists every implant by system, plus the abutments and crowns, and says whether any graft or sinus lift is included.

Whichever you pick, keep the paperwork. The system and batch of every implant we place are recorded in writing. Ask for the diameter and length of each one too, and file it with your other medical records. Ten years from now, it could save a dentist a lot of guesswork and save you a fair amount of money.