Implants for Several Missing Teeth

Where implants may be suitable

• Adults with two or more missing teeth, or teeth that cannot be saved, whose general health allows surgery and healing
• Remaining teeth that are healthy, or have been treated, so the plan can be built around them
• Enough bone height and width for the implants, or bone that can be added (see "Assessment" below)
• Gum disease treated and under control, with regular care to keep it that way
• People who want fixed teeth without grinding down healthy neighbouring teeth for a bridge
• People who can clean around implants, and under a bridge, every day

When another option may make more sense

• Teeth that can be saved. If root canal treatment, gum treatment or a crown could keep a tooth, that is assessed first. Before you agree to an extraction, ask about each tooth's outlook.
• Neighbouring teeth that already need crowns. If the teeth at each end of a short gap have large fillings or need crowns anyway, a conventional bridge may be worth discussing.
• Only back teeth (molars) missing. If your front teeth and premolars are in place, you may manage without replacing the molars. A review of adults in this situation, called a shortened dental arch, found it encouraging for function, satisfaction and cost-effectiveness¹. Whether this suits you depends on your remaining teeth.
• Cleaning you cannot keep up. If the area under a bridge cannot be cleaned, the risk of inflammation around the implants rises². A removable partial denture may then suit better.
• Active gum disease, infection or an uncontrolled medical condition. These are dealt with first.
• A jaw that is still growing. Implants usually wait until growth is complete. If you are asking for someone under 18, ask us first whether and when we would treat them.

What is associated with higher risk

The figures below are pooled results of published observational studies, not our own records. They show association, not proven causation.

• Smoking. People who smoked more than 20 cigarettes a day had about 2.5 times the risk of implant loss per implant³ compared with non-smokers. In that review the risk rose with the number of cigarettes, and no level of smoking was shown to be free of extra risk.
• A history of periodontitis (gum disease that has damaged the bone around the teeth). This matters here because, in a review of why adults' teeth are taken out, decay and periodontitis were the most common reasons⁴. Across 14 prospective studies, implants were lost at about 1.75 times the rate⁵ seen in people without a history of periodontitis. This is a hazard ratio, which compares rates over time; it is not an absolute risk. These were treated patients; implants are not placed while the disease is active.
• Clenching or grinding. Across 27 studies, people judged likely to clench or grind had about 2.2 times the odds of implant loss⁶ (an odds ratio). Like the hazard ratio above, it is not an absolute risk. These studies did not test whether a night guard prevents implant loss.
• Diabetes, blood-thinning medicines, bone-strengthening medicines and radiotherapy to the head and neck. Each needs a careful look at your medical history, and sometimes planning with your own doctors. With blood-thinning medicines, Scottish guidance for dentists counts surgery that raises a flap of gum as a higher bleeding risk⁷ than a simple extraction. The evidence on the others is set out on the dental implants overview. Do not stop any medicine without asking the doctor who prescribed it.

Suitability is decided by an examination, a 3D scan and your medical history. A plan based on photographs or a panoramic X-ray is not final; it is a preliminary assessment.

Where the gaps are shapes the choices. Each gap is planned on its own, so one plan may combine more than one option.

Two or more teeth missing side by side

A gap of several teeth can be filled with an implant for each tooth. Or a bridge can be fixed on implants placed under some of the missing teeth. If there are sound teeth at both ends, a conventional bridge fixed to them is another option. One NHS hospital leaflet notes that usually only one or two teeth can be replaced⁸ on a bridge fixed to neighbouring teeth. A removable partial denture is a further option.

Gaps in different places

One gap might suit an implant and another a conventional or resin-bonded bridge. A partial denture can replace teeth in several gaps with one piece, without surgery.

Back teeth missing at the end of the row

If there is no tooth behind the gap, a conventional bridge has nothing to rest on at that end. A bridge on natural teeth held from one side only (a cantilever bridge) is possible in some cases. In a 2007 review, about 80 in 100 of these were still in place after ten years⁹. For bridges supported at both ends the figure was about 89⁹. The review gave no figures for resin-bonded bridges. We could not check whether these figures were counted per bridge or per patient. The review's authors regard the cantilever design as a second option. So at the end of the row, the choice is often between implants, a partial denture and leaving the gap. Upper back teeth sit below the sinus, and lower back teeth above a nerve; both affect implant planning (see "Assessment" below).

Front teeth

If front teeth are among those missing, the gum and the bone decide how natural the result looks. Not all of that can be controlled. The single-tooth implant page explains this for one front tooth. Ask how the result is likely to look in your mouth before you agree to a plan.

For two or more missing teeth there is no rule of one implant per tooth. The plan depends on how many teeth are missing and where, the bone, the sinus and the nerve, your bite and your habits.

• An implant for each missing tooth. Each tooth has its own implant and crown. The crowns are not joined, so you can clean between them with floss or interdental brushes. A problem with one crown can often be dealt with on its own. It needs enough bone and room for every implant, so it can mean more surgery.
• A bridge on implants. Fewer implants carry a bridge that spans the gap. This can avoid placing an implant where the bone is thin or close to the sinus or the nerve. You clean under the bridge every day with bridge floss, interdental brushes or a water flosser. If one implant fails, the whole bridge may have to be remade.
• A bridge joined to a natural tooth and an implant. This is possible in some cases. In the 2007 review, about 78 in 100 of these were still in place after ten years⁹. For bridges on implants alone it was about 87⁹. We could not check whether these figures were counted per bridge or per patient. The review's authors regard this design as a second option.

What the evidence says

A review of 74 articles, most published between 1995 and 2003, compared these designs in people missing some of their teeth. After more than six years, about 98 in 100 implants under implant bridges and about 96 in 100 single implants¹⁰ were still in place. For implants under bridges joined to natural teeth the figure was about 91¹⁰. None of these differences was statistically significant, which does not show that the designs are equal. The authors found the evidence too thin for firm guidelines. Only two of the 74 articles were randomised trials. So the figures compare different groups of patients and gaps, not the same gap treated both ways, and cannot tell you which design suits yours.

How many implants?

The studies we use give no number of implants for a given gap, and this page gives none. The number is decided from the 3D scan, the bone, the length of the gap and your bite. One NHS hospital leaflet, written for its own patients, notes that fewer implants usually mean more biting and chewing force through the implants⁸. It adds that this can potentially lead to more frequent complications of both the bridges and the implants. More implants, on the other hand, mean more surgery and may need a graft.

Your written plan states the number of implants, where they go and why. If two clinics propose different numbers, ask each of them to explain, and ask a dentist in the UK for an independent opinion.

If most of the teeth in a jaw are missing or failing, the choices change. The full-mouth dental implants page compares implant-retained dentures, fixed bridges on four or six implants and several shorter bridges on more implants.

Implants are not the only way to replace several missing teeth. All of these options are also available from dentists in the UK, and a UK dentist can give you an independent opinion before you decide.

• Leaving some gaps. Not every missing tooth has to be replaced. A review of 83 articles found that having about 20 teeth, front teeth included, was associated with adequate chewing¹¹ for most people. Those teeth formed about 9 to 10 pairs of upper and lower teeth meeting when biting¹¹. People varied a great deal. The trade-off is that the teeth beside and opposite a gap can move. In one UK study of back teeth that had lost the tooth opposite them, 92 in 100 had moved towards the gap¹². The bone in the gap also shrinks after the extraction (see "Assessment" below).
• A resin-bonded (adhesive) bridge. A false tooth held by a thin wing bonded to the inner surface of a neighbouring tooth. That tooth needs little or no drilling, and no surgery is needed. One NHS hospital leaflet on sinus lifts lists bridges glued directly onto the neighbouring tooth or teeth⁸ among the alternatives. Depending on your bite, it suits some single-tooth gaps, so it may fill one of several gaps. It can come loose and may need to be bonded again. The reviews we use give no survival figure for it.
• A conventional bridge. The teeth at each end of the gap are reduced and crowned, and the bridge is fixed to them. No surgery is needed and the treatment is short. The tooth tissue removed does not grow back, and the bridge needs sound teeth at both ends. The dental bridges page explains the designs.
• A removable partial denture. A plate carrying the missing teeth, held by clasps on your own teeth. It needs no surgery and little or no grinding, and one denture can fill several gaps. You take it out to clean it. As the gums and jawbone shrink or change over time, it may become loose¹³ and need adjusting. In a review of 46 studies, about 95 in 100 partial dentures with cast clasps were still in use after five years¹⁴. Cast clasps are metal arms that hold the denture on your own teeth. The teeth a denture holds on to had a higher chance of being taken out¹⁴ over time. That is an association, not proof that the denture caused it. Studies of partial dentures did not consistently report better quality of life or satisfaction¹⁵.
• Implants, with separate crowns or a bridge. The neighbouring teeth are not ground down to support them. They need surgery, a healing period and usually at least two visits to Antalya.

Bridges on implants and conventional bridges: how do they compare?

There are almost no head-to-head trials. The figures below come from separate groups of studies, mostly published before 2007, and are not our own results.

• In a 2007 review, about 89 in 100 conventional bridges and about 87 in 100 bridges on implants⁹ were still in place after ten years. We could not check whether these figures were counted per bridge or per patient.
• The problems differ. Within five years, about 39 in 100 patients with bridges on implants had a complication⁹, against about 16 in 100 with conventional bridges. With conventional bridges the problems were mainly decay and loss of vitality (the nerve inside the tooth dying) in the supporting teeth. Implant reconstructions had significantly more technical complications⁹.

So neither is better for everyone. If the teeth at each end of a gap already need crowns, a conventional bridge may make sense. If they are healthy, implants avoid grinding them down. If you have been offered only one option, ask why the others were ruled out.

Before implants are planned, the dentist examines the gaps, your remaining teeth, your gums and your bite, and takes your medical history. X-rays and a 3D scan (cone beam CT) show the bone, and where the nerve canal and the sinus lie. Recommendations on 3D scans in implant dentistry say a scan could be justified for diagnosis and planning before surgery¹⁶. A 3D scan gives a higher radiation dose than a panoramic X-ray. The recommendations ask for the dose to be kept as low as is diagnostically acceptable¹⁶. They also say ordinary dental X-rays remain the main tool for checking implants afterwards. So a dentist in the UK who agrees to review your implants can use standard X-rays.

Bone

Bone shrinks after teeth are taken out, and the amount varies with the type of tooth¹⁷. We have found no good research showing that implants for several missing teeth prevent this shrinkage. Where there is too little bone, bone grafting may be considered; it lengthens treatment and carries its own risks. Adding bone height is not a small extra step. A Cochrane review found complications common, especially with vertical grafting¹⁸, which adds height. It found that, in a shrunken lower jaw, short implants appear to be a better alternative to vertical grafting. Those conclusions rest on few trials, often at high risk of bias.

Upper back teeth and the sinus

In the upper jaw the back teeth sit below the sinus, an air space next to the nose. One NHS hospital leaflet notes that many people who have lost the back teeth in their upper jaw do not have enough bone⁸ for implants. A sinus lift raises the lining of the sinus and adds bone below it, before or at the same time as the implants. A review of 11 studies looked at people with 6 millimetres of bone or less. They had a sinus lift through an opening in the side of the upper jaw. Over at least five years, implants were lost at 0.43 per cent per implant per year¹⁹. The same leaflet lists alternatives that may avoid a sinus lift: shorter implants, angled implants, or fewer implants placed further forward. Each has its own trade-offs.

Lower back teeth and the nerve

In the lower jaw a nerve runs through the bone below the back teeth. The 3D scan shows how much bone lies above it. Where there is little, shorter implants or a graft may be considered.

Gums

The gums need to be healthy before surgery, so gum disease is treated first. The teeth you keep matter too. A review looked at people treated for periodontitis who stayed in professional maintenance for at least five years. They lost on average about 0.1 teeth per patient each year²⁰, and most lost none. Regular gum care protects the teeth you have as well as the implants.

Bite and the remaining teeth

When teeth have been missing for a while, the neighbouring teeth can tilt into the gaps. Opposing teeth can move towards them (see "Other options" above). This is planned for before the implants. If you clench or grind, this is taken into account in the design, and a night guard may be advised.

Treatment has two main stages, the surgery and the final crowns or bridge, with healing in between. The number of visits and the length of each depend on you and your plan; both are written in the plan. How the stages fit into visits to Antalya is explained under "Visits to Antalya, and the time between them" below. When the restoration is complete, probing measurements around each implant and an X-ray are taken as a baseline record²¹, as the consensus report recommends.

With several teeth missing, what you wear while the implants heal affects eating, speaking and how you look at home. You and your dentist choose one of these:

• The gaps are left empty. Some people choose this for back teeth that do not show.
• A removable temporary partial denture. A plate carrying the missing teeth. You take it out to clean it, and it is adjusted so that it does not press on the healing areas.
• A bonded temporary bridge. Where a short gap suits it, a temporary bridge attached to the neighbouring teeth.
• Temporary teeth on the implants. This is done only in selected patients, if the implants hold firmly enough in the bone at placement (primary stability). You are told what you can and cannot bite with them.

The last option is not for everyone. Ask the dentist to explain its risks for you, and whether it is in your plan. A Cochrane review of 26 randomised trials found no convincing difference²² within one year between loading implants immediately and waiting. Most of its trials were at high or unclear risk of bias. Another review of 39 randomised trials reported slightly lower implant survival²³ with immediate loading. The decision depends on how firmly the implants hold during surgery, and on you.

This is what you will live with at home in the UK between visits, so have it written in your treatment plan before you book.

Implant systems differ in surface, screw design and parts, and the 2017 consensus report noted that there is no generic implant²¹. A bridge on implants is either screwed onto them or cemented. A 2012 review found no clear difference in five-year survival²⁴ between cemented and screw-retained bridges on implants. Its authors noted that screw-retained work is easier to remove, so complications can be treated more easily. Cement left under the gum is a possible risk indicator²⁵ for inflammation around implants. Ask which your plan uses, and why.

When you receive a quote, ask for these in writing:

• Which implant system is planned, how many implants, and in which diameter and length?
• Will you have separate crowns or a bridge, and will it be screwed or cemented?
• Are the connecting parts (abutments) from the same system?
• Will a dentist in the UK be able to obtain these parts years from now?
• Will I be given an implant card or a similar record, showing the batch (lot) number?

A brand name alone does not decide the result. We give you the system planned for you, in writing, in your treatment plan.

Risks

The figures below come from published studies, not from our own records.

• Implant loss. A review of 32 studies looked at bridges on implants. Of every 100 implants under them, about 96 were still in place after five years and about 93 after ten²⁶. It is not always possible to place a new implant where one was lost. Under a bridge, losing one implant can affect the whole bridge.
• Problems with the bridge. In the same review, about a third of patients had some complication within five years²⁶. The most common was fracture of the veneering material, such as chipped porcelain, at 13.5 per cent²⁶. Peri-implantitis and other soft-tissue problems followed at 8.5 per cent²⁶. Loss of the filling over a screw hole was 5.4 per cent, and loose screws 5.3 per cent²⁶. Regular reviews are needed to find these problems.
• Inflammation around the implants. Peri-implant mucositis is inflammation of the soft tissue around an implant. Peri-implantitis is that inflammation together with loss of the supporting bone. Its treatment may need surgery, and if it is not controlled, further bone loss can lead to losing the implant. A 57-study review reported peri-implantitis in about 20 in 100 patients and about 12 in 100 implants²⁷. An older 11-study review found mucositis in about 43 in 100 patients²⁸. The rates vary widely with the definition used.
• Surgical risks. Bleeding, swelling, bruising and infection can occur. In the lower jaw, a nerve runs close to where back implants are placed, so the lip, chin or tongue can go numb. It is usually temporary; rarely, it does not go away. The root of a neighbouring tooth can be damaged while an implant site is prepared. In the back of the upper jaw the sinus is close. The sinus lining can tear, sinusitis can develop, or an opening can form between the mouth and the sinus. A 3D scan and careful planning reduce these risks; they do not remove them.
• A graft or a sinus lift. Each adds its own risks and lengthens treatment; they are set out on the bone grafting and sinus lift pages.
• Limits of appearance. At the front of the mouth, the gum, the bone and your smile line decide the result. The gum can recede over time, and the metal edge of an implant can then show.

Benefits

• When implants alone carry the crowns or bridge, the neighbouring teeth are not ground down to hold them.
• The teeth are fixed: you do not take them out, and there are no clasps. A screw can still loosen or porcelain chip, as the figures above show. They do not feel or work exactly like natural teeth.
• A bridge on implants can replace several teeth with fewer implants than missing teeth.

The first days

• Swelling and bruising usually increase over the first 48 to 72 hours, then settle. Use cold packs and the medicines prescribed.
• Choose soft, lukewarm food for the first days, and do not chew on the surgical sites.
• Do not stop cleaning your mouth. Clean the surgical areas the way your dentist shows you, and the rest as usual.
• If you had a sinus lift, follow the written instructions you are given. One NHS hospital leaflet advises not blowing your nose for two weeks⁸ after the procedure.
• If you had sedation, do not drive or operate machinery for as long as the sedation team tells you. Whether you need an escort depends on the method. For adults, every form of sedation other than inhalation sedation requires a responsible adult as an escort²⁹ under the UK standards for dental sedation. Without an escort, treatment under sedation is not given. If you are travelling alone, ask before you book how this works for you. Before you leave the clinic after surgery, you and your escort should have written aftercare instructions. You should also know how to reach the clinic, including out of hours.
• Smoking is associated with poorer healing and with implant loss (see "Who it suits, and who it does not" above). At the very least, do not smoke during the healing period.

Daily care

• Brush twice a day with a soft brush and fluoride toothpaste. Pay particular attention to the line where the implants meet the gum.
• Clean between the teeth, and under any bridge, every day with interdental brushes, bridge floss or a water flosser. Your dentist shows you which works in your mouth.
• Look after the teeth you still have. Keeping them healthy is part of keeping the plan working.
• If you clench, a night guard may be advised to protect the crowns or bridge. It has not been shown to prevent implant loss, and we hold no study showing how well it protects them.
• Reviews. Follow-up for implants is different from a general dental check-up. The consensus report recommends that an X-ray and probing measurements be taken as a baseline²¹ when the restoration is complete. The European Federation of Periodontology guideline calls for a structured supportive care programme³⁰ once implants are in use. The NICE guideline on dental recall covers check-ups in general, not implants. It asks for the interval between reviews to be set for each patient³¹, based on a risk assessment and discussed with the patient. If your reviews will be with a dentist in the UK, give them your baseline record.

The rates below are not promises, and they come from published studies, not from our own records. They are pooled estimates from studies with different lengths of follow-up. What happens in your case depends on your bone, your gum health, your habits and your care. Different reviews give somewhat different figures, because they include different studies and follow people for different lengths of time.

• The implants under a bridge. In the 32-study review, of every 100 implants, about 96 were still in place after five years and about 93 after ten²⁶.
• The bridge itself. In the same review, about 95 in 100 bridges on implants were in use after five years and about 80 after ten²⁶. Leaving out bridges with a gold-acrylic veneer, about 96 in 100 metal-ceramic bridges were in use at five years and about 94 at ten²⁶. The rate for the implants is not the same as the rate for the bridge on top of them.
• Separate implants. For an implant and crown per tooth, the figures are on the single-tooth implant page.
• No one can promise a lifetime result. The reviews we use give five- and ten-year estimates, and none of them promises a lifetime result.
• Being in place is not the same as being trouble-free. Chipped porcelain and loose screws need repairs, and a bridge may have to be remade. Ask beforehand whether these are included in your plan, and who will do them once you are back in the UK.

We have found no good research comparing implant treatment squeezed into a few days with treatment spread over months; we say so plainly. The nearest evidence, the Cochrane review of loading times²², followed patients for a year at most, so it cannot settle the question. The timing first has to meet clinical requirements: how firmly the implants hold and how you heal. Beyond that, judge it on practical grounds. How is healing checked? Who do you contact if something goes wrong? What aftercare does the plan include?

First visit: examination and surgery

On the first visit you have the examination and 3D scan, and usually the implant surgery, with any extractions that are needed. Some people need extractions, gum treatment, a graft or a sinus lift as a separate first step. That step must heal before the implants go in, which can mean an extra visit. How many days each visit needs depends on your plan, and is stated in writing before you book travel. A 2023 narrative review suggests waiting at least 72 hours³² after implant placement before flying. After a sinus lift it suggests at least two, and ideally six, weeks³². These intervals assume no pain, swelling or bleeding at the treated site³². If your plan includes a sinus lift, ask whether that means a longer stay or a separate visit. The authors say the research is limited and comes mostly from military aviation. Treat these intervals as a starting point for a conversation with the dentist who treated you, not as clearance.

You can say no, or ask to stop, at any stage, including after the examination. Ask before you travel what you would pay if the examination shows that implants do not suit you.

At home: healing before the final teeth

The implants need time to fuse with the bone before the final crowns or bridge are made. How long depends on the bone, the implants' positions, any graft and how you heal; you are told your own period after the examination. For orientation, the Cochrane review calls teeth fitted more than two months after placement²² conventional loading. Do not shorten the healing period to fit travel plans. Ask how healing will be checked before you book the second visit, and what happens if it is not complete.

The NHS website for England advises you to discuss your plans with a GP³³ before making any final decisions about travel or medical arrangements. The GDC says it is always a good idea to speak to your own dentist³⁴ before treatment abroad. They may be able to advise you from your dental history. Ask them now whether they will see you between the visits and afterwards. If you do not have a regular dentist, find one in the UK, NHS or private, before you travel. A check with a dentist in the UK between the visits can be written into your plan. If so, ask for the records of the first visit before you fly home, so that dentist can see what was done.

Second visit: the crowns or bridge

Once healing is confirmed, an impression or digital scan is taken and the crowns or bridge are made and fitted. The bite is adjusted, and you are shown how to clean around the implants. Some plans need a further visit, for example when a try-in shows that a change is needed. You leave with your records and a written review interval.

Once you are back in the UK, the first person to see a problem may be a dentist near you rather than us. Plan for that before you travel. The British Dental Association advises patients to get advice on what to do if problems occur after they return³⁵.

• A loose screw, chipped porcelain, or a crown or bridge that comes loose. These are the usual technical problems (see "Risks and benefits" above). Contact us through the route in your plan, and see a dentist near you with your records. Whether the repair is done in the UK or on another visit to Antalya depends on the problem.
• Inflammation around an implant. Bleeding, swelling or pus around an implant needs assessment soon. See a dentist near you with your baseline record, and tell us.
• An implant that fails. It is not always possible to place a new implant in the same place. Under a bridge, the bridge may have to be remade or replaced by another design. Further surgery, a bone graft or a partial denture may be needed instead, and that may mean another visit to Antalya.
• Who pays. Our written remake terms state who pays for further treatment and travel (see "Is the work guaranteed?" below).
• Reviews. Reviews can be done in Antalya or, where your plan says so, with a dentist in the UK. Ask who will do yours and who pays for them.

What the NHS does and does not do

NHS guidance for dentists in England and Wales says a patient treated abroad is dealt with like any patient previously treated by another provider. If you are accepted for NHS care, treatment that is clinically necessary within NHS services is provided, with your consent. But where another provider did the original work, further treatment within two months and free repair or replacement do not apply³⁶. That guidance does not say an implant, crown or bridge will be repaired or replaced on the NHS. It covers England and Wales. Scotland and Northern Ireland have their own NHS rules, and we hold no record for them. The NHS also states that it is not liable for negligence or failure of treatment³³ you receive abroad.

Insurance

The NHS warns that most travel insurance policies will not cover you for planned treatment abroad³³, so you may need specialist cover. Ask your insurer, in writing, before you book.

The UK General Dental Council lists thirteen questions³⁴ to ask before dental treatment abroad, and the NHS has its own checklist. Below are the ones that matter most for implants replacing several teeth, each with our answer. Where our answer is a commitment rather than something you can check today, it says so. Ask us the full list, and ask for the answers in writing.

Who will treat me, and how can I check their registration?

Before you commit, we name in writing the dentist who will place your implants. If someone else will fit the crowns or bridge, or do a graft or sinus lift, we name them too. In Turkey a dentist in private practice must register with the local dental chamber³⁷ within a month of starting, and cannot practise privately without it. The Turkish Dental Association's website offers a search of registered dentists by name and province³⁸. Ask us for the treating dentist's registration details. Registration in Turkey is separate from the UK register: the GDC states that only people registered with it can legally practise dentistry in the UK³⁹.

How often do you do this, and what are your complication rates?

The GDC suggests asking how many times the procedure has been carried out, and the success, complication and infection rates³⁴. The figures on this page come from published reviews, not from our own patient records. We publish no implant figures of our own yet, so ask us for them, how complications were defined and over what period.

Is the clinic licensed and regulated?

In Turkey a dental clinic cannot open without a licence or treat patients without an operating permit. It is inspected at least once a year⁴⁰. To treat international patients, a facility also needs an authorisation certificate from the Ministry of Health⁴¹. The Ministry publishes a register of authorised facilities⁴² that you can check yourself. We give you our authorisation details before you commit. A licence or authorisation is a legal minimum, not a statement about the result of your treatment. The GDC itself cannot guarantee that a regulator like it exists in another country³⁴.

Will I get the plan in writing?

Yes. The GDC says you should be assessed by a qualified dentist before being given a treatment plan and cost estimate³⁴. Your written plan states the number of implants and where they go, and whether you will have separate crowns or a bridge, with the reasons. It names the implant system, any graft or sinus lift, the temporary teeth and the alternatives considered, and how many visits are needed. It also states what the plan covers and does not cover. A plan made from photographs or X-rays you send is preliminary. It is confirmed after the examination and 3D scan, and we tell you before anything in it changes. You can take the written plan to a dentist in the UK for an independent opinion before you commit.

Is the work guaranteed?

The GDC suggests asking whether the work is guaranteed and for how long³⁴. It also suggests asking whether further treatment is included if there are complications, and who pays for extra flights, hotel and remedial work³⁴. The GDC sets no minimum period itself. Before you commit, we give you our complication route and remake terms in writing. They state what is covered, for how long and what is excluded, for the implants and for the crowns or bridge separately. They also state what you must do to keep the cover, such as attending reviews, and who pays for further treatment and travel. Read that document before you decide, rather than relying on the word "guarantee" on any web page.

Am I insured if something goes wrong?

The GDC lists insurance among its questions. In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre⁴¹. That does not by itself tell you whether your implant surgery is covered, so ask which procedures in your plan fall under it. Ask us in writing whether the clinic or the treating dentist holds insurance for complications or errors. Travel insurance is covered in the section on problems after you are home, above.

Who do I contact after treatment?

Your written plan names the contact route for questions and problems once you are home, and your review interval. For urgent symptoms, get emergency care where you are first (see "When to contact a dentist" below).

What records will I take home?

The NHS lists exchanging medical records and arranging aftercare back home³³ among the things to consider. In Turkey you are entitled to an itemised bill, and on request to free copies of the records of materials, tests and imaging⁴¹. You may also examine your file and take a copy⁴³. At the end of treatment we give you your records in a form a UK dentist can use. They include the plan, X-rays and scan, each implant's system, diameter and length, the parts used, and the baseline measurements.

What if I am unhappy, and where can I complain?

We give you our written complaints procedure before treatment. A complaint goes to the clinic first; private dental polyclinics, centres and hospitals in Turkey must have a patient rights unit⁴⁰. If the clinic does not resolve it, you can apply in writing to the provincial health directorate's Patient Rights Board⁴³. The Board decides within thirty days, but it does not assess allegations of medical error. The dental chamber can also open disciplinary proceedings³⁷ against a dentist. Do not expect the UK regulator to settle it. The GDC states that it cannot resolve complaints or help with refunds³⁹; its investigations are about whether dental professionals are fit to practise.

Will the team speak English?

The GDC suggests asking whether the team speaks your language and, if not, whether a translator is provided³⁴. We confirm in writing, before you commit, who will explain the plan, the consent form and the aftercare instructions to you in English.

Do you treat under-18s?

Implants usually wait until the jaw has stopped growing. This page does not yet set out whether, or from what age, we treat patients under 18. If you are asking for a teenager, ask us before you travel, and talk to their own dentist too.

Warning signs, including for us

The NHS checklist names five signs to think twice about before booking. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare⁴⁴. Apply them to us too. If you feel pushed to decide quickly, wait.

After surgery, or at any time later, contact us and see a dentist near you in these cases.

• Pain or swelling increases after the third day, or bleeding does not stop
• A high temperature, or swelling of the face that keeps growing
• Numbness of the lip, tongue or chin lasts beyond the expected duration of the anaesthetic
• An implant, crown or bridge moves, a screw feels loose, or a piece cracks or breaks
• Bleeding, a bad smell, pus or receding gum around an implant
• Pain on biting, or the bite feels high
• Nasal discharge, a blocked nose or sinus pain on the side of an implant in the back of the upper jaw

Before you fly home. If any of these starts while you are still in Turkey, tell us before you travel.

Once you are home. Contact us through the route written in your plan. See a dentist near you as well if bleeding does not stop, numbness persists, pain or swelling keeps increasing, or an implant or bridge moves. Do not wait for our reply. In England, if you do not have a dentist or cannot get an emergency appointment, the NHS says to call 111 or use 111 online⁴⁵. Elsewhere in the UK, check the local arrangements.

Emergencies. In the UK, call 999 or go to A&E⁴⁵ if you have any of the signs below. Do not wait for our reply. In Turkey, call 112.

• It is hard to breathe, speak or swallow
• There is a lot of swelling in your mouth, or it is hard to open your mouth
• Your eye is swollen or painful, or your eyesight changes suddenly
• Your neck is swollen⁴⁶

This page carries no prices. The main things that shape a plan for several missing teeth are:

• How many teeth are missing and where; whether extractions are needed
• The number of implants, and whether you have separate crowns or a bridge
• Whether bone grafting or a sinus lift is needed
• The implant system and the connecting parts
• The material of the crowns or bridge, and whether it is screwed or cemented
• The temporary teeth used during healing
• Sedation; the number of visits and the review programme
• The remake terms if there is a complication

Ask for three things in writing. What does your plan include? Which items are left 'to be decided later'? Who pays for further treatment and extra travel if there is a complication? Add your own travel for every visit, and reviews with a dentist in the UK, to see the whole cost. If you are comparing with a UK quote, check the number of implants and the design in each. Then compare what each one includes, item by item.