Types of Dental Implants

The types of dental implants define different ways that allow us to find the most accurate and healthiest solution for you when replacing your missing teeth. Everyone’s oral structure, bone condition, and aesthetic expectations are different; therefore, it is not possible to talk about a “one-size-fits-all” implant treatment. Grouping implants according to where they are placed in the jawbone, what material they are made of, or how their surgical processes work is the first and most important step in creating the most ideal personalized treatment plan for you.

Where Are Implant Types Placed in the Bone?

The most fundamental factor that determines how an implant treatment will proceed is the current condition of your jawbone. How voluminous and how strong your bone is directly determines where and how the implant will be placed. This decision affects the difficulty of the operation, the duration of the treatment, and most importantly the success and longevity of your implant.

• Endosteal (In-Bone) Implants: This is the most frequently used, most reliable implant type today with the highest success rate. As the name suggests, these implants are placed directly into a socket prepared within the jawbone. The success of this method is based on a wonderful biological process we call “osseointegration.” In this process, the titanium surface of the implant and your living bone tissue gradually integrate with each other, becoming almost a single inseparable unit. Thanks to their root-shaped designs, they mechanically grip the bone tightly the moment they are placed. This initial grip keeps the implant stable without movement throughout the healing period required for complete fusion with the bone. The only requirement for placing in-bone implants is the presence of healthy jawbone of sufficient height and width to fully envelop the implant like a sleeve.
• Subperiosteal (On-Bone) Implants: Sometimes, especially in areas that have been toothless for many years, the jawbone resorbs so much that there is not enough volume to place an in-bone implant. In such cases, on-bone implants come into play. In this technique, a custom metal framework is designed for you using your three-dimensional tomography data. With a surgical procedure, the gum is lifted and this framework is seated directly onto the surface of your jawbone. Small posts extending from the framework to the outside of the gum support your prosthesis to be made. Although once considered a more complex method, today’s computer-aided design and manufacturing (CAD/CAM) technologies make it possible to produce extremely precise frameworks that fit the bone perfectly. In this way, it has become a modern solution that offers the opportunity to achieve fixed teeth without the need for major surgical procedures such as adding bone grafts.
• Zygomatic Implants: This is a special solution developed for very challenging cases in the upper jaw—especially in the posterior regions—where the bone has almost completely resorbed and the sinus cavities have descended. These special implants, which are much longer than standard implants, are passed through the upper jawbone and anchored into a very hard and dense bone called the cheekbone (zygoma). The greatest advantage of this method is that it eliminates the need for major bone augmentation operations with long healing periods, such as “sinus lifting.” Thus, it is a highly successful and reliable treatment option that can offer even patients considered to have no bone left in the upper jaw the chance to have a fixed temporary prosthesis often on the very same day as surgery.

What Materials Are Implant Types Made Of?

The choice of material from which the implant is made is a critical decision that directly affects the success and longevity of the treatment. Many factors such as biocompatibility, strength, and aesthetics are considered in this selection.

Titanium Implants: Titanium and its alloys have been considered the “gold standard” of implant treatment for decades. They fully deserve this title with their clinically proven outstanding success rates and unique properties. Titanium is a very strong and fracture-resistant yet quite light metal. Its resistance to corrosion is excellent. However, the most important feature that makes it indispensable is its perfect biological harmony with the body. When titanium comes into contact with air or body fluids, it instantly forms a thin, stable, and chemically inert titanium dioxide (TiO₂) layer on its surface. This protective layer prevents the metal from being perceived as a foreign substance by the body and allows bone cells to adhere directly to the surface of the implant and grow, integrating with it. This unique union—“osseointegration”—forms the basis of the success of titanium implants.

Some prominent features of titanium are:

• High mechanical strength
• Excellent biocompatibility
• Decades of proven clinical success
• Superior resistance to corrosion
• Flexible prosthetic options

Ceramic (Zirconia) Implants: Developed to meet the increasing demand of patients seeking “metal-free” and “holistic” treatments and for situations where aesthetics are very important, zirconia implants are the strongest alternative to titanium. These implants are actually produced from a high-tech ceramic called zirconium dioxide (ZrO₂). Zirconia is a biocompatible material that does not corrode in the body and does not release metal ions. Thanks to this property, it is the ideal solution for patients with metal sensitivities or allergies. Its most distinctive advantage is its white color, which closely resembles natural tooth enamel. Especially in the anterior region and in patients with thin gums, it completely eliminates potential aesthetic problems that may be caused by the gray shade of titanium reflecting through the gum. In addition, scientific studies show that zirconia surfaces accumulate less bacterial plaque compared to titanium. This can significantly contribute to preserving the health of the gum tissue around the implant in the long term.

Reasons for preferring zirconia include the following.

• It contains no metal
• It has a natural tooth color
• Superior aesthetic results
• Low bacterial adhesion
• Ideal for those with metal allergies

What Is the Surgical Process in Implant Treatment Like?

The time from placing the implant to attaching the prosthesis may vary depending on the surgical method used. When making this decision, we consider the quality of your bone and the degree of initial tightness at the moment the implant is placed.

• Two-Stage Surgery (Closed Technique): This is the traditional method and is considered the safest. In the first surgical procedure, the implant is placed into the bone and covered with a small cover screw. Then the gum is sutured to completely cover the implant. Thus, the implant is left to heal under the protection of the gum, away from external factors and chewing forces. We prefer this method especially when bone quality is weak, when bone augmentation is performed, or when the implant’s initial stability is not ideal. After a few months of osseointegration, we expose the implant with a second, much simpler surgical procedure by making a tiny incision in the gum. Afterwards, we place a healing abutment to shape the gum and proceed to the prosthetic phase.
• Single-Stage Surgery (Open Technique): In this method, after the implant is placed, it is not covered by the gum. Instead, a longer healing abutment that extends out through the gum is attached directly onto the implant. Thus, the implant remains visible in the mouth during the healing period. The biggest advantage of this technique is that it eliminates the need for a second surgical procedure. This both shortens the overall treatment time and means a more comfortable process for the patient. However, two basic conditions are required to apply this method: very good bone quality and the implant being placed with very strong initial stability.

What Are the Structural Types of Implants?

Implants basically have two different structures depending on how the prosthesis to be attached is connected to them. This structural difference directly affects flexibility in the prosthetic phase of treatment and potential repair needs in the future.

• Two-Piece Implants: This design is used in the vast majority of implant treatments today. The system consists of two main parts: the implant body (fixture) placed into the bone and an intermediate part called the abutment, which is usually connected to this body with a tiny screw. The crown, bridge, or denture-like prosthesis you will see is attached onto this abutment. The biggest advantage of this design is the flexibility it provides in prosthesis fabrication. For example, even if the implant is placed into the bone at a slight angle, this can be easily corrected by using specially designed angled abutments, allowing a prosthesis that is both aesthetically and functionally flawless. The ability to manage the surgical and prosthetic stages independently also offers the clinician great convenience and control.
• One-Piece Implants: In this design, the implant body and the abutment are manufactured as a single piece at the factory. In other words, when the implant is placed into the bone, the part on which the prosthesis will be attached is simultaneously present outside the gum. The most important advantage of this structure is that it eliminates the junction between the implant and the abutment. Since this junction can be a potential site of bacterial leakage, this risk is theoretically lower in one-piece systems. In addition, a technical problem that can rarely be seen in two-piece systems—loosening of the abutment screw—does not occur in this system. However, the prosthetic flexibility of this design is much more limited. Because the position and angle of the abutment are fixed, the implant must be surgically placed in a perfect position. Otherwise, making a prosthesis on it can become quite difficult.

What Implant Solutions Exist for Completely Edentulous Mouths?

For our patients who have lost all their teeth, implant technology offers wonderful solutions that restore quality of life. We can plan these solutions as fixed or removable prostheses depending on the patient’s preference, expectations, and budget.

• Fixed Prostheses: These prostheses are permanently screwed or cemented onto the implants and can only be removed by the clinician. They offer comfort and ease of use almost like your own natural teeth.
• Prostheses That Replace Only the Tooth: In this option, only the crown (visible) parts of the lost teeth are replicated. The goal is to achieve the appearance of a natural tooth emerging from healthy gums. It is the most aesthetic option, but for it to be applicable, bone and gum levels must be ideal.
• Prostheses That Replace the Tooth and Gum: In this solution, commonly known as a “hybrid prosthesis,” both the missing teeth and the jawbone and gum tissue that have resorbed over time are compensated for. Pink porcelain or acrylic is used in the parts of the prosthesis that simulate gum appearance. In this way, even in cases with severe bone loss, natural tooth lengths and lost lip support are restored to achieve an aesthetic smile.
• Removable Prostheses (Implant-Supported Prostheses): These prostheses are supported by implants but can be easily inserted and removed by the patient for cleaning. They are much more stable and comfortable than conventional complete dentures.
• Fully Implant-Supported Prostheses: This prosthesis receives all chewing forces directly from the implants and does not load the palate and gum at all. This design requires the placement of a sufficient number of implants in the correct positions to bear the entire chewing load.
• Implant- and Tissue-Supported Prostheses: In this option, while the prosthesis receives retention and some support from the implants, part of the chewing force is also transmitted to the patient’s palate and gum tissue. It is a more economical solution preferred when fewer implants are placed or when the bone condition does not allow an ideal implant distribution.

What Is the All-on-4® Implant Concept and Who Is It For?

All-on-4® is a revolutionary treatment protocol that enables edentulous patients—especially those with significant jawbone resorption—to achieve fixed teeth in the fastest and most effective way. This concept offers a modern alternative to older approaches that require more implants and advanced surgical operations such as bone augmentation.

The basis of this concept relies on only four strategically placed implants to support a full-arch fixed prosthesis. In the anterior region, two implants are placed vertically in the area where the bone is generally denser and stronger. The two posterior implants are placed at an angle of up to 45 degrees to avoid anatomically sensitive areas—such as the sinus cavity in the upper jaw or the nerve canal in the lower jaw—and to engage more solid bone. Placing the implants at an angle in this way eliminates the need for bone grafting and, by distributing the prosthesis over a wider area, creates a biomechanically much more balanced and robust support. One of the most exciting advantages of the All-on-4® concept is that, when suitable surgical conditions are met, a fixed temporary prosthesis can be placed on the same day as the surgery. Thus, the patient can leave the clinic with teeth. Scientific studies have repeatedly proven that this concept is a highly reliable and predictable treatment with an implant success rate of over 95% in 10-year follow-ups.

The main features of the All-on-4® concept are:

• Four implants are used for a full arch.
• Eliminates the need for bone augmentation.
• The treatment period is quite short.
• Offers the possibility of fixed temporary teeth on the same day.
• Has a high long-term success rate.
• Is a cost-effective solution.

What Factors Affect the Success of an Implant Treatment?

For an implant treatment to serve you smoothly for many years, it is not enough to choose the right type of implant. It is an equation in which many factors come together, and each part must be meticulously managed.

Bone Quality and Quantity: The condition of the bone where the implant will be placed is perhaps the most important determinant of success. The density of the bone directly affects the degree of tightness at the moment the implant is first placed—i.e., “primary stability.” Based on the resistance felt during the drilling process, bone quality is classified between D1 (very hard) and D4 (very soft). Dense and hard bones offer the highest success rate, while spongy and soft bones (often found in the posterior upper jaw) may require more caution and special implant designs. Today, three-dimensional tomographies measure bone density numerically, providing us with very valuable information before surgery and allowing us to plan accordingly.

Digital Planning and Guided Surgery: Digital technologies have opened a new era in implant dentistry. We can now plan and implement our treatments much more precisely and safely. The process starts with a three-dimensional tomography (data showing your bone) and an intraoral digital scan (data showing your teeth and gums). These two images are combined in special software to create a one-to-one virtual 3D model of your mouth. On this virtual model, the ideal position, angle, and depth of the implant are planned millimetrically according to the requirements of the prosthesis to be made. Based on this plan, a custom surgical guide (stent) is produced for you with 3D printers. During the surgery, this guide is seated in your mouth, and the implants are placed into the bone exactly according to the plan through the guide’s sleeves. Guided surgery eliminates the margin of error, maximizes safety, and allows us to achieve flawless results especially in complex cases where multiple implants must be placed parallel to each other.

Long-Term Care and the Risk of “Peri-implantitis”: The fusion of the implant with the bone is only the beginning of the treatment. The real goal is to keep this implant healthy for a lifetime. The most insidious long-term enemy of implants is an inflammatory condition called “peri-implantitis.” This disease starts with inflammation of the gum around the implant (this stage is called “peri-implant mucositis”) and, if left untreated, gradually turns into a serious infection that causes resorption of the bone supporting the implant. In short, peri-implantitis is the gum disease of the implant and is the most common cause of late implant loss.

The most important risk factors for peri-implantitis are:

• Insufficient or incorrect oral hygiene
• Smoking
• Poorly controlled diabetes
• Having a history of severe gum disease (periodontitis)
• Skipping regular professional maintenance