Implant-Supported Prostheses in İzmir: Crowns, Bridges, All-on-4/6 and OverdenturesImplant-Supported Prostheses in İzmir: Crowns, Bridges, All-on-4/6 and Overdentures 

A dental implant is a small screw-shaped post, usually made of titanium or zirconia, that replaces the root of a missing tooth. It is placed surgically and, over a healing period, bonds with the surrounding bone (osseointegration). What you actually see and chew with is the prosthesis connected on top: a single crown, a bridge spanning several teeth, or a full-arch restoration replacing all the teeth in one jaw.

Think of the implant as the foundation and the prosthesis as the building. Appearance, speech, chewing efficiency, ease of cleaning and the way biting forces reach the bone all depend largely on how the prosthesis is designed. That is why implant restorations sit at the heart of prosthodontics, the dental specialty dedicated to replacing and restoring teeth.

Adults who have lost one tooth, several teeth, or all of their teeth, including people who struggle with a loose conventional denture, may be candidates. Suitability varies from person to person and is confirmed only after a thorough examination.

• Bone volume and quality: assessed with 3D imaging (CBCT). Where bone is limited, grafting or a different prosthetic design may be considered.
• Gum health: any gum disease around remaining teeth is usually treated before implants are placed.
• General health: uncontrolled diabetes, smoking, previous head and neck radiotherapy and certain bone medications (such as antiresorptive drugs) can affect the plan; your dentist may liaise with your doctor.
• Clenching and grinding: bruxism directly influences the design and choice of materials.
• Your expectations: whether you prefer fixed or removable teeth, your aesthetic goals and your cleaning habits all shape the plan.

Single implant crown

A missing tooth is replaced by an abutment (connector) and a crown on one implant. A key advantage is that neighbouring teeth do not need to be prepared. At the front of the mouth, matching the gum line to the adjacent teeth and choosing the right crown material are crucial; materials are covered in more detail on our crowns and veneers page.

Implant-supported bridge

When several neighbouring teeth are missing, a bridge supported by two or more implants can replace them without needing an implant for every tooth. Designing the underside of the bridge so that it can be cleaned properly is essential for long-term gum health.

Full-arch fixed teeth: All-on-4, All-on-6 and hybrid bridges

In a jaw with no teeth, or with teeth that cannot be saved, a one-piece fixed bridge can be attached to four or more implants. In the All-on-4 concept, the two front implants are usually upright and the two back implants are tilted; in suitable cases this allows longer implants while avoiding the sinus or nerve. Where bone allows, six or more implants spread the load over a wider area.

A hybrid bridge is a full-arch prosthesis screwed onto the implants that you cannot remove yourself. Traditionally it combines a rigid framework with acrylic or composite teeth and pink gum-coloured material; monolithic zirconia is another option today. In selected cases, if the implants are stable enough at the time of surgery, a fixed temporary bridge can be fitted shortly afterwards (“immediate loading”). This decision depends on measurements taken during surgery and is not possible for everyone. The definitive bridge is made once healing is complete.

Overdenture (implant-retained removable denture)

An overdenture is a full denture that clips onto attachments or a bar on typically two to four implants, and which you take out for cleaning. It is particularly helpful for a loose lower denture, improving retention with relatively few implants. It may also be preferred when significant bone loss means the lips and cheeks need extra support.

For a toothless jaw there are two broad paths: a fixed full-arch bridge (hybrid) or a removable overdenture. Neither is right for everyone. Many people find that fixed teeth feel closer to their own; an overdenture usually needs fewer implants, is easier to clean and can give more support to the face where a lot of bone has been lost.

• Amount of bone loss: if it is extensive, a fixed bridge carrying only teeth may not support the lips and cheeks adequately.
• Smile line: whether the junction between the bridge and your gum shows when you smile sets the aesthetic limits of a fixed design.
• Cleaning ability: for people with limited dexterity, a removable prosthesis can be easier to keep clean.
• Bite and forces: the opposing teeth and any clenching habit influence the number of implants and the material used.

Implant crowns and bridges can be connected in two ways: with a small screw (screw-retained) or bonded onto an abutment with dental cement (cement-retained). Current literature reports good outcomes for both in appropriate cases. The choice depends on implant angle, the aesthetic zone, the size of the restoration and how likely future maintenance is.

Full-arch bridges are generally screw-retained, because being able to remove them makes professional cleaning, screw checks and repairs much simpler. When a cemented design is chosen, the cement margin is kept at a cleanable level and a controlled cementation technique is used.

Modern implant treatment is planned backwards. First the ideal position, size and bite of the future teeth are worked out (a digital set-up or wax-up); then the implants are planned where they can support those teeth well. This is called prosthetically driven planning. When implants are placed simply wherever bone happens to be, the final restoration can end up awkwardly angled, hard to clean or less natural-looking.

• Your bite (occlusion), vertical dimension and the condition of the opposing teeth
• Smile line, lip support and facial proportions
• The vertical and horizontal space available for the prosthesis
• Signs of clenching and jaw joint (TMJ) problems
• How the prosthesis will be cleaned at home and in the clinic

Placing implants is a surgical stage carried out by the surgical team. Throughout, the prosthodontist works alongside periodontist Dr. Rouzbeh Fazeli to assess gum and bone health, the need for any bone or soft-tissue procedures, and implant positions. Tools such as 3D imaging, intraoral scanning and surgical guides are explained on our digital dentistry page.

A natural tooth is attached to bone by the periodontal ligament, a fibrous layer that acts like a tiny shock absorber. Implants have no such layer, so chewing forces pass straight into the bone. The bite design, cusp steepness, cantilever length, and the number and spread of implants therefore determine how load reaches the bone.

The crown-to-implant ratio compares the height of the restoration above the bone with the length of the implant inside the bone. In the upper back jaw, bone often shrinks after tooth loss and the sinus can expand, so shorter implants and taller crowns may be needed, increasing the ratio. Its relationship with bone loss around implants has been studied with differing results, and it is usually considered together with bite forces, clenching, prosthesis design and oral hygiene.

Dr. Maryam Fazeli's specialty thesis addresses exactly this question: *“Radiographic Evaluation of Bone Loss in Implant-Supported Prostheses with Different Crown/Implant Ratios Placed in the Maxillary Posterior Region.”* The study focuses on assessing bone levels around implants on radiographs in upper back-jaw restorations with different crown-to-implant ratios. More details are on the academic work page.

Implants cannot decay, but the gum and bone around them react to plaque just as they do around natural teeth. Daily care usually involves a soft toothbrush, interdental brushes sized for the implant spaces, and a water flosser or special floss under full-arch bridges. Overdentures are taken out and cleaned every night; their retentive inserts wear over time and need replacing periodically.

Review intervals depend on your individual risk; many patients are seen every three to six months. Visits typically include gum measurements, plaque control, checking screw tightness and the bite, with X-rays at appropriate intervals. Screw-retained full-arch bridges can be removed by the dentist for a thorough professional clean when needed. If you live abroad, it helps to discuss a follow-up plan, including what can be done locally, before treatment begins; our trip planning guide covers this.

• Bleeding, swelling or discharge around an implant
• A loose, clicking or moving restoration
• A chipped or cracked tooth on the prosthesis
• A bad taste or smell around an implant

Peri-implant mucositis is inflammation of the gum around an implant without bone loss, and is often reversible with appropriate treatment. Peri-implantitis is inflammation that has spread to the supporting bone and is more complex to treat. Picking up early signs at regular reviews is therefore important.

Risk factors reported in studies include a history of gum disease (periodontitis), smoking, poor plaque control, uncontrolled diabetes, cement left under the gum and missing regular reviews. A cleanable prosthesis design and joint follow-up with a periodontist are central to keeping the tissues around implants healthy.

There is no single figure; the implant and the prosthesis need to be considered separately. Long-term studies report that, with regular maintenance, the large majority of implants continue to function for many years. Prosthetic components such as acrylic teeth, retentive inserts and screws can wear and may need maintenance, repair or replacement. Clenching, oral hygiene, general health and attending reviews all have a direct effect.

For implant restorations at the front of the mouth, aesthetic planning follows the same principles as smile design. To discuss your options, you can request an appointment via our contact page.