Implant-Supported Prosthetics

An implant is an artificial root placed in the jawbone; the part you see, chew with and show when you smile is the prosthesis built on top of it. Once the implant has fused with the bone, a connecting piece called an abutment is attached to it, and a single crown, a bridge of several teeth or an entire arch is secured to these abutments.

We cover the surgical stage on the dental implants page, and the general comparison with other types of prosthesis on the dentures and prosthetic dentistry page. This page focuses on what comes afterwards: how the prosthesis is attached to the implant, what options there are for a jaw with no teeth, and which suits whom.

Screw-retained or cemented?

Crowns and bridges on implants are attached in one of two ways. Both have their place; the choice depends on the angle of the implant, the area of the mouth and how easy maintenance will be in the years ahead.

	Screw-retained	Cemented
How it is attached	A screw passing through the prosthesis fixes it to the implant; the screw channel is then sealed with filling material	The prosthesis is cemented onto an abutment that is screwed into the implant
Can it be removed?	The dentist can undo the screw and take the prosthesis off	Hard to remove; it often has to be cut off
Excess cement under the gum	No cement is used, so this risk does not exist	Cement squeezed out under the gum can cause inflammation if it is not cleaned away
Appearance	On front teeth, the position of the screw channel can limit the aesthetics	The surface is unbroken

In the long run, being able to remove the prosthesis is very valuable: if a piece of ceramic chips, or the area around the implant needs cleaning, a screw-retained prosthesis can be taken off and put back. That is why, where the case allows it, screw retention is often the first choice. When cementing is chosen, removing every trace of excess cement from under the gum becomes the most important step of the job.

What are the options for a jaw with no teeth?

When no teeth are left in a jaw, the number of implants and the type of prosthesis are planned together. There are four main routes:

• Attachment-retained denture: Small, press-stud-like attachments are fitted onto the implants, and plastic inserts inside the denture clip onto them. In the lower jaw two implants are often enough; in the upper jaw four are usually planned. You put the denture in and take it out yourself.
• Bar-retained denture: The implants are joined by a metal bar and the denture sits on this bar. Retention is stronger, but the denture needs more room, and cleaning underneath the bar takes care.
• Fixed hybrid prosthesis: A full-arch bridge, usually screwed onto four to six implants, with a pink section that replaces the lost gum and bone volume. You cannot take it out; the dentist removes it at check-ups. All-on-4 is the most widely known example of this group.
• Full-arch ceramic bridge: Where bone loss is limited, a fixed bridge made on a larger number of implants, without a pink section.

We compare the four- and six-implant fixed options in detail on the All-on-4 and All-on-6 page.

Removable or fixed: which suits whom?

A fixed prosthesis feels “like my own teeth”, and it is most patients' first preference. But it is not always the better option. When a lot of bone has been lost, what is missing is not just the teeth but also the tissue that supports the lips and cheeks from the inside. The flange of a removable denture gives that support back easily; providing the same support with a fixed bridge may need a design that is hard to clean underneath. With a fixed prosthesis in the upper jaw, some patients also notice air escaping when they speak during the first weeks.

For patients who find fine cleaning work difficult with their hands, or whose care may later depend on someone else's help, a denture that can be taken out and brushed over the sink is often the safer choice. We make the decision with you at the examination, looking at facial support, the amount of bone and your daily cleaning habits.

What is it made of?

Single crowns and short bridges are mostly made of zirconia or porcelain fused to metal. For fixed full-arch prostheses there are two main approaches. Acrylic teeth set on a metal or titanium framework are more flexible and easier to repair; on the other hand, the teeth wear over the years and need renewing. Monolithic (single-piece) zirconia is highly resistant to wear and staining, but it is difficult to repair if it fractures, and the condition of the teeth in the opposing jaw has to be taken into account when planning.

Maintenance: what really decides how long it lasts?

An implant cannot decay, but the gum and bone around it can become inflamed. This condition is called peri-implantitis, and it is one of the most common reasons implants are lost. Unlike problems around a natural tooth, it can progress for a long time without symptoms.

• Clean underneath fixed bridges every day with interdental brushes, bridge floss or a water flosser.
• Take removable dentures out every evening and brush them; clean around the attachments in your mouth separately as well.
• The plastic inserts inside the denture wear over time and the grip weakens. They are replaced at check-ups; this is planned maintenance, not a fault.
• If a tooth feels loose or you notice a “click”, do not wait — see us, or a dentist near you if you are not in İzmir. A loosened screw that is tightened early stays a small problem; left too long, the screw can break.
• If you clench your teeth at night, a night guard protects both the prosthesis and the implants.

Process and timeline

The permanent prosthesis is usually made once the implants have fused with the bone, that is, a few months after placement. In full-arch cases with suitable bone, a temporary fixed prosthesis can be fitted on the same day as the implants or within a few days; the permanent one still follows once healing is complete.

1. Impressions: The position of the implants in your mouth is transferred with special impression components or a digital scan.
2. Framework try-in: On a full arch we check that the framework seats on every implant without any tension. Skipping this step increases the risk of loosening screws and fractures.
3. Tooth try-in: Shade, length and bite are tried out in the mouth.
4. Fitting: The prosthesis is fitted, the screws are tightened and the bite is adjusted.

Two or three appointments are usually enough for a single crown; a full arch may need four to six. The cost depends on the number of implants, the type of connection and the material; you receive a written, itemised quote after the examination at our clinic in İzmir.