The Dental Implant Process: Why Are Two Visits Needed?

An implant is a titanium screw placed in the jawbone in place of a tooth root. Titanium is a metal the body does not perceive as a foreign object and onto which bone cells can attach directly. In the weeks after placement, bone cells migrate to the implant surface and a living bond forms between the screw and the bone; this process is called osseointegration (fusion with the bone).

Fusion usually takes 2–3 months in the lower jaw and 3–4 months in the upper jaw, where the bone is less dense. If chewing load is placed on the implant during this period, micro-movements occur, soft tissue develops instead of bone, and the implant fails to hold. This is exactly why the second visit is deferred: the permanent tooth can bear load only after fusion is complete.

The first visit usually lasts 3–5 days. On the first day, a three-dimensional CT scan measures bone volume and the position of the sinuses and nerves; the diameter, length, and angle of the implant are planned on this image. Gum disease, teeth that need extraction, and cavities are also addressed during the same visit; an implant is not placed in an unhealthy mouth.

Placement is done under local anesthesia and usually takes no more than an hour for a single implant; sedation can be added for multiple implants or anxious patients. The gum is either closed over the implant or a healing cap is attached. Mild swelling and tenderness in the following days are normal; before your return flight, the dentist checks the sutures and wound healing and gives you written care instructions to follow at home.

For most patients, no. If a tooth is missing in the front, the gap is closed with a temporary tooth either bonded to the neighboring teeth or removable; this temporary is designed so that it places no load on the implant. If the bone is dense enough and the implant achieved sufficient stability at placement, in suitable cases a temporary crown with a reduced chewing surface can be fitted the same day (immediate loading).

In fully edentulous jaws, the All-on-4 concept takes this principle a step further: four implants placed at angles are joined together by a fixed temporary prosthesis, and the patient leaves the first visit with fixed teeth. Which option is possible becomes clear during surgery, based on bone quality and the implant's initial stability.

The job of the temporary tooth is not only cosmetic. By closing the gap, it prevents the neighboring teeth from tilting and the opposing tooth from over-erupting, it shapes the gum to the form of the permanent crown, and it keeps your speech and smile habits intact. Because the temporary is made of acrylic, it is not as durable as a permanent zirconia crown; you should avoid hard and sticky foods and inform the dentist if it breaks. A breakage does not harm the implant, but the repair should not be delayed so that the gum does not lose its shape.

If the tooth was extracted long ago, the jawbone in that area may have resorbed. When bone volume is insufficient, the site where the implant will anchor is prepared: the gap is filled with bone granules (a graft), or in the back of the upper jaw the sinus floor is lifted and bone is placed beneath it (a sinus lift).

If the deficiency is small, the graft is done in the same session as the implant and the overall timeline does not change. If the deficiency is significant, bone is built first, allowed to mature for 4–6 months, and the implant is placed in a second stage; in that case, treatment can extend to three visits. When the dentist foresees this on the initial CT scan, you can set up your travel plan correctly from the start.

The graft material may be the patient's own bone, processed animal-derived bone, or synthetic bone granules; the choice depends on the size of the deficiency and the dentist's preference. For a few weeks after a sinus lift, you need to avoid blowing your nose forcefully, holding your mouth closed when sneezing, and straining during pressure changes on a plane; for that reason, the waiting period the dentist sets before the return flight must be observed.

The fusion period is usually uneventful; the expected course is no pain and calm gums. Even so, remote follow-up is done through photos and short calls in the first week, at the first month, and in the week before your return. Redness, a bad odor, a loosened healing cap, or a broken temporary tooth are situations that must be reported to the dentist right away.

• Smoking: because it interferes with fusion, you will be asked to stop at least for the waiting period
• Oral hygiene: keep the implant area clean with a soft brush and the mouthwash your dentist recommends
• Chewing: avoid hard and sticky foods on the temporary tooth
• Diabetes and blood thinners: share your medications and blood sugar levels with the dentist

The second visit usually lasts 5–7 days. On the first day, fusion is confirmed with an X-ray and a manual check, the healing cap is removed, and a digital or conventional impression is taken. The impression goes to the laboratory; meanwhile, the tooth shade is selected to match the neighboring teeth and, if needed, a try-in of the metal framework or abutment is done.

The crown is most often made of zirconia; the bite and contact with the neighboring teeth are adjusted at the try-in, and the permanent tooth is delivered either screwed or cemented in place. Zirconia crowns planned for other teeth can also be completed during the same visit. The length of stay depends on the laboratory's production time and the number of try-ins required; for that reason, the dentist sets the date of the second visit during the first one.

An implant cannot decay; however, the gum and bone around it can become inflamed, just as with a natural tooth (peri-implantitis). The most common cause is plaque building up at the implant neck. Brushing twice a day, cleaning around the implant with an interdental brush or floss, and a dental check-up every six months are the basic conditions for the implant to remain problem-free for many years.

Patients from abroad can have their routine check-ups done by a dentist in their own country; the brand and dimensions of the implant used are provided in writing so that compatible parts can be found if needed. For patients who grind their teeth at night, a night guard is recommended to protect the crown and the implant. Problems such as a chipped crown or a loosened screw can usually be repaired without touching the implant itself.

The total timeline depends less on the number of implants than on bone quality, the need for grafting, and general health. Uncontrolled diabetes, active gum disease, the use of certain bone medications, a history of radiotherapy, and heavy smoking make fusion more difficult; in these cases, treatment is postponed or planned differently.

In young patients whose jaw growth is not yet complete, implants are deferred. Suitability is confirmed by the CT scan and oral examination performed during the first visit in Istanbul; a panoramic X-ray sent remotely is for preliminary planning only and does not replace the examination.