Who Can Have Implant Treatment?

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Implant treatment can be applied to individuals whose general health status is suitable and whose jaw structure has sufficient bone density.

Those with Missing Teeth: Single tooth, multiple missing teeth, or completely edentulous patients.
Those with Sufficient Bone Volume: The jawbone should be of sufficient density and height to support the implant. If the bone volume is insufficient, it can be supported with additional surgical procedures.
Those with Good Oral and Dental Health: Those who do not have gum disease or those who have been treated.
Those with Good General Health: Individuals with chronic diseases such as diabetes and hypertension under control.
Those Who Want Aesthetic and Functional Improvement: Patients who want to eliminate aesthetic concerns or improve their chewing functions.
Those with Low Cigarette Use: Smoking can negatively affect the healing process, but the success rate is high in patients who do not smoke or can reduce their cigarette consumption.

Who Cannot Have Implant Treatment?

Suitability for implant treatment is determined with a detailed clinical examination, panoramic X-ray, and tomography evaluation. In doubtful cases, consultation can be made with a multidisciplinary approach (internal medicine, endocrinology, etc.).

Uncontrolled Chronic Diseases:
- Diabetes: Uncontrolled diabetes can delay bone healing.
- Cardiovascular Diseases: May not be recommended in high-risk patients.
Patients with Immune System Problems:
- Those Receiving Cancer Treatment: Bone tissue may weaken after chemotherapy or radiation therapy.
- Those with Immunodeficiency: The healing process can be risky.
Those with Severe Bone Loss: Implants cannot be placed unless the bone volume is increased with bone grafts or other supportive surgeries.
Excessive Smoking and Alcohol Consumption: Smoking and alcohol can negatively affect the osseointegration (fusion with bone) of the implant.
Serious Psychological Problems: Surgical procedures may not be applicable in individuals with dental phobia or who cannot adapt to treatment.
Patients Under 18 Years of Age: Implant application is not recommended in individuals whose bone development is not completed.
Pregnant Women: Implant treatment during pregnancy is usually postponed until after birth.
Briefly, Situations Where Implants Cannot Be Made;
Some heart diseases
Having problems with blood clotting
Rheumatic diseases
Uncontrolled diabetes
Some problems in the jawbone anatomy
The patient having a health problem that may prevent surgical intervention
Having undergone chemotherapy or radiotherapy treatment recently

What Is The Most Suıtable Age Range For Implant Treatment?

Especially in children with early tooth loss and incomplete growth and development, implants cannot be considered immediately for missing teeth. The patient’s growth and development period is determined with some parameters such as hand-wrist radiography, and the treatment is continued. In general, the most suitable age range for implant treatment is between 18-65. In this age range, the jawbone is usually of sufficient density and thickness for implant placement. However, this is not a definite limit.

So why is this age range preferred?

Jawbone Development: Before the age of 18, the jawbone has not yet fully developed, so the chance of long-term success of the implant is lower. When bone development is complete, the implant is placed more securely.
Bone Density: Bone density may decrease with age. For this reason, additional treatments may be needed in older people with bone weakness. However, thanks to today’s technologies, implant treatment can be successfully applied in people with bone weakness.
The Importance of Age in Implant Treatment: Age is not the only determining factor in implant treatment. Other important factors are:
- General Health Status: Healthy individuals without chronic diseases are more suitable candidates for implants.
- Oral Hygiene: Good oral hygiene is very important for the longevity of the implant.
- Jawbone Structure: Jawbone structure is one of the most important factors affecting whether the implant will be successful. If the bone structure is sufficient, implants can be made at older ages.
Implant Treatment in the Elderly: Implant treatment can also be performed in elderly individuals if their general health is good and the jawbone is of sufficient density. However, conditions such as bone resorption can affect implant success. Therefore, a detailed evaluation should be made before implant placement in elderly patients.
Implant Treatment in Young People: Implant treatment is generally not recommended in individuals under the age of 18 because jawbone development continues. However, implant treatment can be applied to young people in some special cases and if deemed appropriate by the physician.

Patients With Insufficient Bone Support In Implant Treatment

Additional procedures may be required in patients with insufficient bone support.

1- Bone Graft (Grafting)

In patients who do not have bone tissue of the required height and width for implant surgery, sufficient bone level can be achieved by applying special bone grafts. These grafts can be artificial or natural grafts. With these procedures, controlled and shaped crests will be obtained by using titanium meshes. In addition, the patient will be more comfortable during the healing process.

2- Osteosplit Application: (Horizontal Augmentation) (Expansion in the horizontal direction)

If the bone width where the implant will be placed is insufficient, the bone width is increased with some special burs. It is opened and stretched bucco-lingually with special burs from the middle of the crest, and the crest becomes wider. The block space opened from the middle is also closed with bone powder. Or, with block bone grafts, bone is taken from another part of the body and attached to both sides of the thin area with fixation screws, the inner part is grafted again and waited. Then, implants are easily placed in the newly formed bone tissue. Of course, these procedures mean both extra time and extra cost. Therefore, it will be advantageous for the patient in every respect to have implant treatment without waiting too long after tooth extraction.

3- Sinus Lifting

Anatomically, in short, we can describe the Maxillary Sinus as air spaces located on the right and left side of the upper jaw and connected to the nose. Especially after the loss of teeth in this area, which starts from the root tips of the upper jaw posterior teeth, the sinus floor sags due to the expansion of these spaces under the influence of air pressure over time, and as a result of bone loss, implant treatment becomes impossible without advanced surgical procedures. The advanced surgical procedure that makes implant application possible in these areas is called Sinus Lifting. With this procedure, the sinus floor is surgically raised and sufficient bone support is provided for the implant with extra bone grafts placed in the area of the raised sinus floor. Implant application can be applied together with the sinus lift procedure, and in some cases, it can also be applied 6 months after the sinus lift procedure. It should not be forgotten that the healing process will be longer in cases in this situation. For this reason, it is important for patients who have lost teeth to compensate for tooth loss as soon as possible in terms of operation cost, procedure success, and healing time.

PRF and PRP Applications: Healing is accelerated with the clotting cells of the blood.

What Are The Possible Complications After Implant Placement?

Complications that may occur after dental implant placement may occur early (shortly after surgery) or late (months or years later). These complications vary depending on the surgical procedure, healing process, or patient’s oral hygiene. Dental implants are generally a reliable treatment method, but complications can occur as with any surgical procedure. If not detected and treated early, it can progress to implant loss. Regular checkups and good oral hygiene are critical to preventing these complications. It is recommended that you consult your dentist if you have any problems.

1- Early Complications

Pain and Swelling: Pain and swelling due to surgical trauma, tissue damage, or edema are among the situations that may be encountered. It is controlled with ice application, painkillers and anti-inflammatory drugs.
Bleeding (Postoperative Bleeding): Leakage bleeding may occur due to trauma in the gums and vessels. Pressure is applied with gauze to control the bleeding. Surgical intervention may be required in excessive bleeding.
Infection (Peri-implant Mucositis): It manifests itself with symptoms of swelling, redness, discharge, and pain. Not paying attention to oral hygiene, smoking, or the surgical area not being sterile can cause infection. Infection control is achieved by antibiotic treatment and oral care with antiseptic solutions.
Sinus Perforation: Sinus perforation occurs if the sinus cavity is damaged while placing an implant in the upper jaw. Discharge from the nose, infection, or pain symptoms are observed. Small perforations heal on their own, but surgical repair is required in large lesions.
Nerve Damage: Nerve damage may develop as a result of placing the implant too close to the nerve in the lower jaw. Symptoms of numbness, tingling, or loss of sensation are observed. Mild cases may heal over time. In severe cases, the implant may need to be removed.

2- Late Complications

Osseointegration Failure (Non-Union with Bone): Occurs due to insufficient bone density, excessive loading, systemic problems, infection, or smoking. Symptoms include movement of the implant, pain, or tenderness. As a treatment, the implant is removed and can be placed again after bone grafting.
Peri-implantitis (Infection Around the Implant): Poor oral hygiene, smoking, and teeth grinding (bruxism) are among the causes of peri-implantitis. It manifests itself with gingival recession, inflammation, bleeding and bone loss. Antibiotic treatment, mechanical cleaning and surgical intervention may be required in advanced cases.
Loosening or Breaking of the Implant: The implant may loosen or break as a result of incorrect loading, imbalance of chewing forces, or impact. In such cases, it may be necessary to remove the implant and place a new one.
Prosthesis Fit Problems: Incorrect positioning of the prostheses (being excessively outward while trying to support the lip, or vice versa, being placed further inside), the patient’s lower jaw being excessively forward or backward, and the vertical dimension being high will cause the chewing forces to come to the prosthesis uncontrollably. As a result, the implants supporting the prosthesis will be negatively affected, and the patient will experience chewing difficulties, pain, or aesthetic problems. Fit problems can be resolved by readjusting or replacing the prosthesis. Similarly, in fixed restorations, if there is primary contact during eating or when the jaw moves to the right, left, and forward, this will also directly affect the implant negatively. Especially unbalanced lateral forces will cause melting of the bone around the implant and, in advanced cases, situations that lead to the loss of the implant.

3- Factors That May Lead to Implant Loss

Smoking: Impairs blood circulation and delays healing.
Diabetes and Chronic Diseases: Increases the risk of infection and slows down the healing process.
Poor Oral Hygiene: Causes bacterial accumulation and leads to the development of peri-implantitis.
Teeth Grinding and Clenching (Bruxism): Prevents bone fusion by putting excessive load on the implant.

4- Measures That Can Be Taken to Prevent Complications

Planning and Examination: Good surgical planning and the ability to perform it on a suitable patient are important. Especially in cases with edentulous ends or tooth extraction performed a long time ago and with serious vertical and horizontal bone loss in the jawbone, and if an implant is being considered in the area close to anatomical structures, three-dimensional imaging (tomography) should definitely be used. Planning on tomography before starting the surgical procedure will minimize complications.
Hygiene and Care: Regular oral care and the use of dental floss after implant placement are carefully explained to the patient.
Check-ups: Regular dental check-ups should be done for the first 6 months.
Diet: It is important to consume soft foods and avoid hard foods.
Avoiding Smoking and Alcohol Consumption: To speed up the healing process.

What Is Peri-Implantitis? Is It the Maın Factor In Implant Loss?

In cases where oral hygiene is insufficient, bacteria multiply on the implant surface and inflammation (peri-mucositis) begins in the soft tissue around the implant. If not treated, a picture (peri-implantitis) showing bone loss around the implant may be observed. When the bone around the implant completely loses its connection, mobility and then loss of the implant occurs.

Regular physician check-ups are essential to maintain the health of the tissues around the implant and to ensure the longevity of the implants. In particular, patients cannot understand the bone loss that¹begins in the bone tissue around the implant. Because in such a case, there is no mobility, that is, movement in the implant. Perhaps during this period, the patient may understand that something is wrong with bleeding, swelling in the soft tissues around the implant, bad breath and a bad taste in the mouth. But thanks to regular physician check-ups, peri-implantitis is tried to be treated before the destruction in the bone progresses. However, as long as the factor causing peri-implantitis continues in the mouth environment, the treatment result is failure. Despite paying attention to oral hygiene, if the patient has a systemic problem or a drug treatment that they have to take after implant-supported restorations and therefore may have a negative impact on the success of the implants. The patient having to undergo radiotherapy as a result of any cancer disease; starting to use Bifosphanate as a result of osteoporosis; Being a diabetic patient and not paying attention to their diet and blood sugar levels getting out of control, etc. are factors that negatively affect implant success in the long term.

Incorrect planning of the implant-supported prosthesis; Failure to completely clean the cements escaping to the subgingival area during the cementation of cemented crowns, non-hygienic construction of the implant-supported prosthesis that cannot be cleaned by the patient, incorrect occlusion, using the wrong material in the wrong area, etc. trigger peri-implantitis.

Treatment: The problematic area is fully seen by surgically lifting the flap. First of all, the bacteria on the implant surface due to bacterial entry are cleaned from the implant surface. The implant surface is acidified and/or cleaned with periodontal titanium curettes, and milled to smooth the implant surface. If there is a concave area around which bone graft will be placed; The treatment is completed by placing bone graft and membrane and connective tissue graft on it. If the problem is caused by the prosthesis made, the prosthesis must be changed and renewed by planning it correctly again.