Questions and answers
Short, direct answers to more than 80 questions patients ask most often in consultations, by message and online: implants, bone loss, short implants, sinus lift, teeth grinding, loose teeth, gum disease, and implants in conditions such as diabetes. The answers are general information; the right approach for you is decided after examination and 3D imaging (CBCT).
Yes, in most cases. Bone loss does not make an implant impossible; it changes the length, diameter and placement method of the implant. The available bone is first measured to the millimetre on CBCT. In suitable cases, planning can be done with short or narrow-diameter implants that fit the existing bone, without the need for extensive bone grafting. Where very little bone remains, a graft or bone augmentation may be needed.
Usually there is. This sentence most often means there is not enough bone for a standard-length implant (10 mm or longer); the bone may be sufficient for 4–8 mm short implants, narrow-diameter implants and crestal (closed) sinus lift. If you already have a scan taken elsewhere, it can be sent for a preliminary assessment before your examination.
In suitable cases, yes. This is the core idea of minimally invasive implantology: using the existing bone as efficiently as possible instead of adding bone. Short implants, crestal (internal / closed) sinus lift in the upper back jaw, and narrow-diameter implants make this possible. In the 2018 and 2024 reviews of the European Federation of Periodontology, short implants are listed as an accepted alternative to long implants combined with bone augmentation. Whether a graft can be avoided completely is determined on CBCT.
It means placing implants with as little surgery as possible: where feasible without opening a flap or with a small flap, keeping bone grafting to a minimum, using short or narrow implants, and planning with computer guidance. The aim is less swelling, faster healing and fewer surgical sessions. This approach is the clinical focus of Dr. Rouzbeh Fazeli.
Often it is still possible, but the method changes. Even when 5–6 mm of vertical bone height remains, a short implant or crestal sinus lift can be planned. In very advanced resorption, the options are short implants, tilted implants, All-on-4-type planning or bone augmentation. This decision is made only after CBCT measurement and an examination.
A dental implant is a titanium (or zirconia) screw placed in the jawbone in place of the root of a lost tooth; a crown, bridge or denture is then made on top of it. It is placed under local anesthesia, a healing period follows while it fuses with the bone (osseointegration), and the restoration is attached afterwards. Placement takes 20–40 minutes in most cases.
In long-term studies, the 10-year survival of implants is around 95%; with regular maintenance they can be used for life. The main factors that determine their lifespan are gum health, oral hygiene, smoking, teeth clenching and regular check-ups. The crown or denture on top may need to be renewed over the years because of wear.
For a single implant, 2–4 months in most cases: placement, the healing period for fusion with the bone, and then the crown. Placing the implant in the same session as the extraction (immediate implant) and, in suitable cases, a temporary tooth on the same day (immediate loading) shorten the process. In cases that need a bone graft, the time can extend to 6–9 months; the aim of minimally invasive planning is to avoid this extra time.
If the neighboring teeth are healthy, an implant is usually preferred, because a bridge requires the neighboring teeth to be cut down and an implant slows bone loss in the extraction site. A bridge is a reasonable option when the neighboring teeth already have large fillings or crowns, or in anatomies where an implant is not possible. The decision is made at the examination, based on the condition of the teeth and bone.
There are three timings: in the same session as the extraction (immediate), 6–8 weeks later once the soft tissue has healed (early), and 3–4 months later once the bone has healed (late). In sites without infection and with an adequate bone wall, immediate or early placement may be preferred; this shortens the total time and reduces bone loss. The choice is made with CBCT and an examination.
There is no "rejection" in the sense of an organ transplant; implant loss is usually due to infection, insufficient stability, excessive load or healing problems. Titanium allergy is extremely rare. In patients with a known metal sensitivity, zirconia (metal-free) implants are an option; the situation is assessed at the examination.
Titanium implants have more than 50 years of data and are the standard option in most cases. Zirconia implants contain no metal and do not show a gray shadow in the front area where the gum is thin; however, they have less long-term data and fewer two-piece design options. Zirconia is considered in selected cases with metal sensitivity or aesthetic requirements.
The procedure is painless under local anesthesia. Mild to moderate pain and swelling for 1–3 days afterwards is normal; it is noticeably less with flapless and closed techniques. Most patients are comfortable with simple painkillers. Severe pain, or pain lasting longer than a week, needs to be checked.
For the first 24 hours, cold and soft foods; avoid hot and hard foods; for the first week, do not chew on the implant side. Smoking and alcohol are not recommended for at least two weeks because they delay healing. Oral hygiene is continued from the first day; the mouthwash and medications given by the dentist are used as prescribed.
One implant for every missing tooth is not necessary. A three-unit bridge can be made on two implants, and a full-arch fixed prosthesis on 4–6 implants. The number is determined by the amount of bone, the chewing force, the teeth in the opposing jaw and the prosthesis design. Short and tilted implants make it easier to reach these numbers when there is little bone.
CBCT and an intraoral scan are combined, and the position, angle and depth of the implant are planned on the computer; with a surgical guide produced from this plan, the implant can be placed without opening a flap. It offers a shorter surgery time, less swelling and a safer distance from structures such as the sinus and nerves. It is one of the core tools of minimally invasive implantology.
Yes. Titanium and zirconia implants are non-magnetic; they do not prevent an MRI scan and do not heat up. There may be a small artifact around the implant in the image; it is enough to tell the radiologist that you have an implant.
Mobility of the implant, pain on biting, persistent swelling, bleeding or discharge in the gum, and bone loss around the implant on the X-ray are the main signs. Loss in the first months is usually due to a problem with fusion, while loss years later is due to peri-implantitis or excessive load. Most problems can be treated when noticed early; this is why regular check-ups are important.
Brushing twice a day like a natural tooth, an interdental brush or floss around the implant, and professional cleaning and a check-up every 6–12 months. A night guard is used in patients who clench their teeth. Regular maintenance is the most important factor in keeping an implant trouble-free for many years.
A dental implant that is generally 8 mm or shorter is called a short implant; types of 4–6 mm are also called extra-short implants. They make it possible to place implants in the upper and lower back jaw, where bone height has decreased, without bone augmentation.
In published randomized studies, the survival of short implants for up to 5 years has been found to be similar to that of long implants placed with bone augmentation, with fewer surgical complications and less patient discomfort. In data of 10 years and more, higher losses have been reported in some short implant groups; this is why suitable case selection and regular follow-up are important.
Less surgery, a shorter total treatment time, staying away from anatomical structures such as the sinus and nerves, no risk of graft-related complications, and usually a lower cost. A second surgical site for harvesting bone graft is also not needed.
A short implant alone may not be enough in some situations, such as when bone width is also insufficient, bone quality is very low, or biting forces are very high. In these cases, splinting several implants together, combining with a narrow implant, or limited bone augmentation is planned.
Placement is usually done in a single session under local anesthesia. The restoration (crown) is placed after 2–4 months in most cases; in suitable cases, immediate loading may allow it earlier. With flapless placement, swelling and pain are usually limited to a few days.
These are implants with a diameter under 3.5 mm. In thin ridges where the bone width is insufficient for a standard implant, they can be used without the need for bone expansion surgery. Lower front teeth, upper lateral incisors and narrow spaces are typical areas of use. Together with the short implant, it is one of the two core tools for graft-free treatment in bone loss.
Yes. Short implants are used successfully in splinted crowns and bridges; for full-arch fixed prostheses, they are generally planned together with standard or tilted implants. Connecting several short implants together distributes the force and improves long-term success.
In the upper back jaw, when bone height is reduced because of the sinus cavity, a sinus lift raises the sinus floor to create room for an implant. It is planned when bone height is insufficient for an implant and a short implant alone does not look sufficient.
In a crestal (internal, osteotome) closed sinus lift, the sinus floor is raised a few millimetres through the implant site itself; no window is opened on the cheek side, the implant is placed in the same session, and there is little swelling. In an open (lateral window) sinus lift, a window is opened in the bone from the cheek side and more graft is placed; it gains more bone but is a larger surgery. If the remaining bone height is 4–5 mm or more, the closed method is generally preferred.
In suitable cases, yes. If 5–6 mm of bone remains, a short implant may be considered; with 4–5 mm, a short implant together with a crestal sinus lift may be considered; both avoid opening a window on the cheek side. If the bone is below 3–4 mm, an open sinus lift may be required.
In crestal sinus lift, it is a device that applies controlled magnetic impulses to the osteotomes instead of a hand mallet. Dr. Rouzbeh Fazeli's randomized controlled specialty thesis at Ege University examined this topic: discomfort during surgery was found to be significantly lower with the magnetic mallet. The results were presented at the 2019 EAO Congress and published in Clinical Oral Implants Research.
When the upper jaw bone is severely resorbed, zygomatic implants are special implants, 30–55 mm long, anchored in the cheekbone (zygoma) instead of the jaw. They are placed passing alongside or through the sinus and require advanced surgical experience.
In many cases, yes. In upper jaws where a zygomatic implant is said to be required, when the remaining bone is carefully measured on CBCT, a solution can often be found within the jaw bone using short implants, crestal sinus lift and tilted-implant planning. Zygomatic implants are not recommended at this clinic; these cases are planned with short implants and minimally invasive surgery. Suitability is determined after an examination and CBCT.
According to consensus reports, the most common complication is sinusitis; soft tissue recession, oral–sinus communication and difficulties in prosthesis design are also reported. Because the long implant reaches the cheekbone, managing complications is also harder. These risks are not present with short implants that stay within the jaw bone.
In patients who have lost all their teeth or are about to, 4 implants (6 if needed) are placed in one jaw and a fixed prosthesis is made on top. The rear implants are placed at an angle to avoid the sinus and nerve, and in most cases no bone graft is needed. In suitable cases, temporary fixed teeth can be placed on the same day.
In most cases, no. The existing bone is used with tilted implants, short implants and crestal sinus lift. Bone augmentation is planned only when the remaining bone is not enough even for these.
In suitable cases, yes: extraction, implant placement and a temporary fixed prosthesis can be done on the same day (immediate loading). The condition is that the implants achieve sufficient primary stability; this is assessed in advance from bone quality and the scan. The permanent prosthesis is usually made after 3–6 months.
A periodontist is a dentist who, after dental school, completes 3 years of specialty training and specializes in gum disease, the bone that supports teeth, and the tissues around implants. In Turkey, a significant share of implant surgery is performed by periodontists. Dr. Rouzbeh Fazeli completed his periodontology specialty at Ege University in 2019.
The gum disease is brought under control first, and then the implant is placed. Untreated periodontitis markedly increases the risk of inflammation around the implant (peri-implantitis). For this reason, implant planning is carried out together with periodontal treatment.
It is inflammation of the gum and bone around an implant that leads to bone loss. In the early stage it can be treated with cleaning and medication, and in the advanced stage with surgical cleaning and regenerative (bone-rebuilding) methods. Where the implant cannot be saved, it is removed; once the bone has healed, a short implant can be placed in the same area in suitable cases.
Yes. The exposed root surface can be covered with a microsurgical technique using a connective tissue graft taken from the palate and a repositioned gum flap. Dr. Rouzbeh Fazeli's case series on this topic was presented at the EuroPerio9 congress in Amsterdam in 2018.
Bleeding when brushing, red and swollen gums, bad breath, gum recession, teeth that look longer, gaps opening between the teeth and, in advanced stages, mobility. Because gum disease usually progresses without pain, bone loss may already have begun by the time symptoms are noticed; bleeding alone is a reason for an examination.
The most common cause is inflammation (gingivitis) due to plaque and tartar building up along the gum margin. With professional cleaning and correct brushing, most bleeding stops within 1–2 weeks. Bleeding that does not stop suggests periodontitis, pregnancy, blood thinner use or certain systemic diseases, and needs an examination.
The main causes are hard brushing and incorrect technique, gum disease, a thin gum type, teeth clenching, crowded teeth, after orthodontic treatment and pulling from lip and cheek attachments. Recession exposes the root surface; it causes sensitivity, root decay and aesthetic concern.
Receded gum does not grow back on its own, but it can be covered surgically. The most predictable method is a coronally advanced gum flap with a connective tissue graft taken from the palate; in suitable cases a tunnel technique or microsurgery is used. In mild recession, removing the cause (brushing technique, night guard) is enough to stop progression. Dr. Rouzbeh Fazeli's case series on this topic was presented at the EuroPerio9 (2018) congress.
The exposed root surface causes sensitivity to cold and sweet. Desensitizing toothpastes and fluoride and bonding agents applied by the dentist are the first step; the permanent solution is to surgically bring the gum back over the root.
Tartar and inflamed tissue under the gum are cleaned with hand instruments and ultrasonic devices under local anesthesia (scaling and root planing, or deep cleaning). Thanks to the anesthesia the procedure is painless; mild sensitivity for a few days afterwards is possible. It is usually completed in 1–2 sessions and rechecked after 6–8 weeks.
Flap surgery is needed when pockets deeper than 5 mm remain after scaling and root planing, when there are intrabony defects, or when the spaces between teeth cannot be reached. In suitable defects, the lost support can be partly regained with bone regeneration (bone graft and membrane). Surgery is done under local anesthesia and usually one area at a time.
The bacteria that cause periodontitis can be shared within a family through saliva, but the disease develops not from bacteria alone but with the person's immune response, smoking, diabetes and genetic predisposition. People with a family history of early tooth loss should be checked more often.
Yes, the most common oral cause of persistent bad breath is gum disease and the bacterial coating on the tongue. With tartar cleaning, gum treatment and tongue cleaning, the odor goes away in most patients. If the odor does not go away, sinus, stomach and metabolic causes are also investigated.
The inflammation slowly dissolves the bone that holds the tooth; teeth become loose and are eventually lost. Untreated periodontitis also makes diabetes control harder and has been associated with cardiovascular disease. Treatment is simple and effective in the early stage; in the advanced stage, tooth loss and the need for implants may be unavoidable.
Bruxism is clenching and grinding of the teeth, usually during sleep and without being aware of it. Its signs are jaw and temple pain in the morning, tooth wear and fractures, cold sensitivity, headaches and noises in the jaw joint. Stress, sleep disorders and some medications can trigger it. It is diagnosed at the examination from the wear surfaces on the teeth and muscle tenderness.
Clenching does not cause gum disease on its own, but in teeth that have gum disease it speeds up bone loss and increases tooth mobility. It also raises the risk of fracture in crowns, fillings and implant restorations. This is why bruxism is always taken into account in periodontal treatment and implant planning.
The first step is protecting the teeth and the joint with a night guard (occlusal splint). If muscle pain is marked, botulinum toxin injection into the masseter muscle, stress management and sleep routine can be added to the treatment. Worn teeth can be rebuilt with crowns or fillings. Bruxism itself may not disappear completely; the aim is to prevent damage.
Yes, but the planning is different. Bruxism increases mechanical problems such as loosening of the prosthesis screw and porcelain fracture rather than implant loss. In these patients, a larger number of splinted (connected) implants, a more durable prosthetic material, avoiding short cantilevers and a night guard once the prosthesis is finished are recommended. The same principles apply to short implants.
In adults, the most common cause of tooth mobility is bone loss from advanced gum disease (periodontitis). Other causes are trauma, excessive chewing force or teeth clenching, an infection at the root tip and, rarely, bone cysts. A loose tooth does not always have to be extracted; depending on the cause, it can be saved with periodontal treatment, a splint or balancing of the forces.
Often, yes. If the bone loss is not advanced, the tooth can be kept for many years with gum treatment and by connecting the teeth together (periodontal splint). If most of the bone around the tooth has been lost, the tooth is severely mobile and it keeps forming abscesses, extraction followed by an implant is planned. The decision is made with an X-ray and a periodontal examination.
It is the connection of loose teeth to one another from their inner surfaces with fiber- or metal-reinforced composite. It distributes the chewing force across several teeth, lets the patient chew comfortably and helps gum treatment heal better. It is not visible on the front teeth; it is applied in a single session without cutting the teeth and can be renewed if needed.
A hard or semi-hard splint, custom-made from an impression, is worn on the upper or lower teeth during sleep. It protects the teeth from wear and crowns and implants from fracture, and relaxes the jaw muscles. It is cleaned by brushing daily and renewed every 1–3 years depending on wear. A dentist-made one should be preferred over ready-made, heat-moldable splints.
Yes, if blood sugar is under control. In controlled diabetes (generally HbA1c below 7–8%), implant success rates are close to those of healthy individuals. Uncontrolled diabetes delays healing and increases the risk of infection and peri-implantitis; in that case, blood sugar is regulated first. Because gum disease is more common in people with diabetes, periodontal check-ups are scheduled more frequently.
HbA1c, which reflects the average of the last 3 months, and fasting blood glucose are requested; if needed, the plan is made together with the internist. On the day of the procedure, it is important to take your medications and not to skip breakfast. Healing check-ups after surgery are scheduled slightly more often.
In patients taking oral bisphosphonates (for example alendronate) for osteoporosis, implants can generally be placed; the risk of osteonecrosis of the jaw (MRONJ) is low, but it rises when the duration of use exceeds 3–4 years and especially if cortisone is also being used. Implant surgery is generally not recommended in patients receiving high-dose intravenous bisphosphonates or denosumab for cancer treatment. The decision is made together with the prescribing physician, based on the type, dose and duration of the drug; if a decision to proceed is made, minimally invasive, flapless techniques are preferred.
Yes. Osteoporosis on its own is not an obstacle to implants; bone quality in the jaw may be lower, so the implant design and healing period are adjusted accordingly. What needs the most attention are bisphosphonate- or denosumab-type medications used for osteoporosis; their type and duration are asked about before planning.
In most cases, yes. Implants can generally be placed without stopping aspirin, clopidogrel or newer blood thinners (such as apixaban and rivaroxaban), using local measures to control bleeding; in those taking warfarin, the INR value is checked. Whether a medication is stopped is decided only by your cardiologist. In patients with a history of heart valve disease or a stent, antibiotic prophylaxis is given if needed.
Non-essential surgical procedures, including implants, are postponed until after birth, in order to avoid X-rays and certain medications. Urgent gum problems and tartar cleaning, on the other hand, can be done safely, especially in the second trimester. Gum bleeding is common in pregnancy and should be treated.
There is no upper age limit; at 70, 80 and older, implants can be placed safely if general health allows, and they noticeably improve nutrition and quality of life. The lower limit is completion of jaw growth: generally 17–18 years in girls and 18–20 in boys. Medications used at an advanced age and bone quality are taken into account in planning.
Yes. Smoking roughly doubles the risk of implant loss and increases the risk of peri-implantitis even more; the effect is especially marked in the upper jaw and in cases with a bone graft. Not smoking for at least 1 week before and 2–4 weeks after the procedure is recommended, and quitting if possible. Implants can be placed in smokers, but more frequent check-ups are needed.
After chemotherapy is completed and blood values return to normal, an implant is generally possible. In patients who have had radiotherapy to the head and neck area, the risk is higher because blood circulation in the jawbone is reduced; when the dose exceeds 50 Gy, special precautions are needed and the decision is made together with the oncology team.
An oral examination is performed and, if needed, a panoramic X-ray and a 3D scan (CBCT) are taken; bone height and width are measured to the millimetre. Then the options, duration and stages are discussed together. The treatment plan is not tied to a single implant brand; the system most suitable for the case is chosen.
A panoramic X-ray does not show the width of the bone or the exact position of the sinus and nerve. Because CBCT shows these to the millimetre, decisions about short implants, narrow implants and crestal sinus lift can be made safely only with CBCT. This measurement is the foundation of minimally invasive planning.
Yes. Your existing panoramic X-ray or CBCT file can be sent via WhatsApp or email; from these files, a preliminary opinion can be given on whether short implants or crestal sinus lift may be possible. A definitive plan still requires an examination.
For a single implant, 3 main visits are usually enough: planning, placement, and the prosthesis after 2–4 months. In full-arch treatments, with immediate loading the temporary fixed teeth are placed at the first visit and the permanent prosthesis is made after 3–6 months. For patients coming from other cities and from abroad, visits are planned around this schedule.
The procedure is done under local anesthesia and is generally painless. Discomfort after the procedure is markedly less with flapless and closed techniques; most patients manage with simple painkillers for a few days. Sedation is also possible for patients who want it.
Yes, but smoking increases the risk of implant loss and peri-implantitis. Cutting down as much as possible during healing, and quitting if possible, is recommended, and follow-up visits are planned more frequently.
First, a remote preliminary assessment is made using an existing X-ray or CBCT; the number of visits and the length of each are determined accordingly. Most implant treatments are completed in 2 visits: examination, planning and implant placement at the first visit (a temporary tooth in suitable cases), and the permanent prosthesis at the second visit 2–4 months later. Follow-up between visits is continued by message.
A guaranteed outcome cannot be given in medical procedures; every patient heals differently. The manufacturer's warranty of the implant brands used applies to the product. The clinic's approach is to stand by the patient in early problems and to protect long-term success with regular check-ups.
He is a specialist in periodontology working in İzmir who also performs dental implant surgery. He graduated from the Faculty of Dentistry at Ege University in 2015 and completed his periodontology specialty at the same faculty in 2019. His clinical focus is minimally invasive implantology in bone loss, short implants and crestal sinus lift. He is a founding partner of Nifa Dent and also sees patients at İzmirdent. He is a member of EAO, EFP, ITI and OSSEDER.
At two clinics: Nifa Dent Oral and Dental Health Polyclinic (Kazımdirik Mah. 372/32 Sk. No: 3, Bornova, İzmir) and İzmirdent Oral and Dental Health Polyclinic (Yunus Emre Mah., Şehit Pilot Volkan Koçyiğit Bulvarı No: 38, Karabağlar, İzmir). Nifa Dent International is the unit of Nifa Dent that serves international patients; it is the same clinic.
Turkish, English, Persian and Azerbaijani Turkish. For French-speaking patients, the clinic has a French-speaking coordinator.
First, a remote preliminary assessment is made from your existing X-ray or scan; then the number and length of visits are planned. Nifa Dent holds the Republic of Türkiye Ministry of Health International Health Tourism Authorization Certificate; the clinic coordinators help with accommodation and transport. Most implant treatments are completed in 2 visits.
The treatment plan is not tied to a single brand; a choice is made among international systems according to the needs of the case. Systems that offer short and narrow implant options are preferred. Dr. Fazeli is the Türkiye clinical trainer for the i-LiNQ implant system.
You can book via WhatsApp at +90 530 909 70 66 or through Nifa Dent's landline (0232) 202 00 55. For a preliminary assessment, your existing X-ray or scan can be sent to the same number.
The information on this page is for general information only and does not replace an examination. Which treatment is suitable is determined only after a clinical examination and imaging. No guarantee of results is given for any treatment.
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