All-on 6 Dental Implant in Turkey

Presented by modern dentistry, all-on-6 implant systems are applied globally and are the most frequently used treatment methods by specialist dentist in Turkey. Along with the usage of high-quality dental implants and prosthetic materials, experienced dentists and dental laboratories equipped with up-to-date technology apply all-on-six treatment with high satisfaction results to our local and guest patients from abroad.

Especially in European and American continental countries, high dentistry and laboratory prices are causing dental treatments to have high prices. Along with using global and high-quality materials, dentistry, and laboratory expenses are more affordable in Turkey, enabling dental treatments to be carried out more budget-friendly. Because of the prosthetic structure treatment approach, all-on-6 implants can be applied in a more budget-friendly manner in Turkey.

At the same time, the temporary fixed prosthesis system provided by all-on-6 systems after the surgical procedure enabled the systems to be applied rather frequently in Turkey, where health tourism is intense. In our clinic, our dentists, with more than 25 years of experience, offer our precious patients all-on-6 treatment methods from the perspective of personal aesthetics and smile design. In addition, we, as experts, are witnessing that you achieve your health and happy smiles with a rather enjoyable experience with the treatment we apply under the historical and enchanting atmosphere of the cultural heritage city of Istanbul.

The all-on-6 treatment concept is available for cases with no teeth on the upper or lower jaw. The foremost condition for implant application is that the implant candidate area must have sufficient bone capacity.

Together with that, the patient's general health condition is required to be suitable. The foremost health conditions to be taken into consideration in case of systemic diseases:

• Blood thinners;

Blood thinners are anticoagulant and antiplatelet medicines used for cardiovascular diseases and to prevent the formation of blood clots. Although the usage of such medications is recommended to be discontinued before the dental implant applications involving oral surgery, the right approach is to monitor the patient's blood picture and general health condition by a cardiologist before the oral surgical procedures. During minor surgical dentistry procedures (dental implant, tooth extraction, endodontic surgery, gum surgery, etc.), intense bleeding is not expected. In addition, to ensure doctor and patient comfort during surgical procedures, we recommend that blood thinners be discontinued by checking the International Normalized Ratio (INR) values in the blood. For moderate oral surgical procedures, an INR value between 2-3 is a safe value during the surgical procedure. The 2016 Clinical Practice Statement of the American Academy of Oral Medicine organization stated that moderate invasive oral surgery (defined as "uncomplicated tooth extraction") is safe with an INR value of 3,5. If the surgical procedure planned is advanced invasive surgery, an INR value must be ≤2 for advanced surgical procedures. All-on-6 procedures can be considered advanced oral surgical procedures, including multiple tooth extractions alongside implant applications. As a result, in all-on-6 treatment approaches, an INR value must be ≤2 for the safety of the procedure.

• Diabetes How many cardiovascular, general surgery, and medical-surgical procedures can be performed on diabetic patients, and dental/oral surgical procedures can also be performed? Here, the most critical issue is keeping Diabetes under control. Therefore, before All-on-6 dental implant applications, conducting a Hemoglobin A1C (HbA1C) test is important, as it shows the average blood sugar (glucose) level in the last two or three months. To perform oral surgical procedures safely, the HbA1C blood value is expected to be 64 mmol/mol (8%) ≤ n. Patients with HbA1C values higher than the reference range may experience delayed recovery and an increased risk of infection. The usage of biphosphonate and similar medicine. Physiologically, two mechanisms in the bone function at the same time. Bone construction (osteoblastic activity) and bone destruction (osteoclastic activity).

• Bisphosphonate;

Bisphosphonate and a drug group with similar effects inhibit the bone destruction mechanism; in other words, prevent it, and bone construction continues. In this situation, the balance of the bone mechanism turns in favor of bone construction, and during drug use, continuous bone construction continues. As a result of intense osteoblastic activity, recovery of a surgical wound will turn into a risky situation. This disorder in bone recovery causes necrotic tissues to form in the bone, and these necrotic areas that cause intraosseous infection must be cleaned. These intraosseous lesions are generally known as MRONJ (Medication-related Osteonecrosis of the Jaw). β-CTx values are measured in the blood of patients using this group of drugs to evaluate the risk of developing MRONJ. If the β-CTx value is <100 pg/ml, risk/safety values are stated for oral surgery procedures.

• Smoking;

Smoking is one of the most important elements that negatively affect oral hygiene. Like how it causes gingivitis followed by bone destruction around the natural teeth, bad oral hygiene causes bone destruction caused by plaque buildup in soft and hard tissues around the dental implants. Together with this, scientific research has shown that implant loss rates in patients who smoke are 2.14 times higher than in patients who do not smoke. Smoking is an important element that threatens the long-term success and usage of dental implants. However, Smoking is an important bad habit that impairs healing and prevents tissue formation not only in implant surgical procedures but also in bone graft applications.

• Alcohol consumption.

Alcohol is known to cause tissue-specific changes in healthy tissue protein metabolism. Alcohol consumption affects the immune system and changes the structure of proteins that help the tissue recover. As a result, the recovery period is disrupted. As all-on-6 treatment approaches are included in oral surgery procedures, alcohol consumption has a significant negative impact on tissue healing after such surgery.

Generally, the all-on-6 treatments are completed in 2 sessions. For each session, 5-7 workdays will be sufficient. If the bone capacity is insufficient, the number of sessions may increase to 3.

In all-on-6 systems, no extra or advanced surgical procedures are generally needed. Advanced surgical procedures are necessary when the bone capacity is insufficient. Due to the pressure in the upper jaw (pneumatization), the maxillary sinus floor is prone to expand to the area where the tooth extraction was performed.

Expansion of the maxillary sinus makes implant installation in the posterior region of the upper jaw rather difficult. In this case, a tangential implant is placed in the upper jaw posterior region to the sinus floor to avoid the maxillary sinus. This slope is consciously created by the doctor. If implant installation is not desired this way, with the surgical procedure called maxillary sinus lifting, a bone powder graft is placed in the posterior region of the upper jaw, and the implant candidate area is made suitable in terms of bone capacity.

The situation is different in the lower jaw. The anterior region, generally called the symphysis and includes the canine teeth, is suitable for implant application. Although rare, situations where it is impossible to place an implant in the symphysis area are due to insufficient bone thickness. In this case, to increase the bone thickness, an autogenous block bone graft or Guided Bone Regeneration is applied. Along with this, there is a double-sided anatomical structure that defines the borders of the symphysis area: Mental foramen. This structure is the opening where the alveolar inferior nerve, which runs in the posterior region of the lower jaw, integrates with the soft tissue from the bone tissue. The decrease and insufficiency of bone height from the mental foramen point to the posterior region of the lower jaw have a negative impact on implant application in these areas. In all-on-6 procedures, posterior group implants are placed sloped to avoid damaging the mental foramen and get the most efficient support from the available bone capacity. This slope is consciously created by the doctor. However, if a choice is to be made to increase the amount of insufficient bone in the posterior region, procedures such as;

• Guided Bone Regeneration (GBR)

• Autogenous Bone Graft

• Alveolar Distraction Osteogenesis can be applied.