Stephan, born in 1974, arrived from Germany with teeth he could feel moving when he ate. Advanced periodontal disease had loosened them one by one. His back teeth barely functioned and his existing restorations no longer looked or worked the way they should. The answer at International Plus in Istanbul was a full mouth rehabilitation: 14 implants carrying a fixed Toronto Bridge in each jaw, 28 units in total. This case study follows the entire process, from the diagnostic scans to the day the bridges were screwed into place.
Cases driven by gum disease differ from ordinary tooth loss. The infection must be understood first and the remaining teeth honestly assessed before the new bite is engineered. That is exactly how Stephan’s treatment was structured.
Key Takeaways
- The challenge: Advanced periodontitis had loosened many of Stephan’s teeth and most carried a poor long term prognosis.
- The decision: A multidisciplinary evaluation concluded that full mouth implant supported rehabilitation was the most predictable treatment option.
- The surgery: 14 German BEGO Semados RSX implants were placed across both jaws following a fully digital surgical plan.
- The design: A MetiSmile 3D face scan plus multi stage PMMA mock ups let Stephan test and refine his smile before production.
- The result: A 28 unit titanium bar Toronto Bridge in both jaws restored chewing function and aesthetics.
A Dental Journey from Germany
Stephan traveled from Germany to Istanbul for a rehabilitation that advanced gum disease had made unavoidable. International Plus treats patients from more than 140 countries and coordinates care in 27 languages. German patients in particular often choose the clinic because premium German implant systems such as BEGO are placed here with significant cost advantages.
Trust mattered more than distance in his decision. The clinic is a T.C. Ministry of Health authorized healthcare facility rated 4.8/5 across 5,504+ verified Google reviews, one of the highest verified review volumes among dental clinics in Turkey. For patients weighing the same choice, our guides on dental implants in Turkey and the long term safety of dental implants explain what that journey looks like in practice.
His treatment followed the staged structure summarized below.
| Stage | What happened |
| Diagnosis | CBCT and panoramic imaging analyzed by the Diagnostic Council |
| Surgery | Guided placement of 14 BEGO Semados RSX implants across both jaws |
| Healing | Osseointegration confirmed with clinical and radiological checks |
| Smile design | MetiSmile face scan and multi stage PMMA mock up approval |
| Delivery | 28 unit titanium bar Toronto Bridge fitted in both jaws |
Bottom line: one surgical phase, one healing phase and one prosthetic phase took Stephan from failing teeth to a fixed full mouth restoration.
Diagnosing Advanced Periodontitis
Advanced periodontitis is a chronic gum infection that destroys the bone supporting the teeth, loosening them long before they are lost. Stephan’s clinical examination showed widespread tooth mobility and a clear loss of chewing function. Most of his remaining teeth carried a poor long term prognosis, which placed a tooth by tooth repair strategy out of reach.
The diagnostic work went deeper than a visual exam. CBCT scans and panoramic radiographs were analyzed for bone density and anatomical limits, including the position of critical structures. In the back of the upper jaw the imaging revealed advanced bone resorption reaching toward the sinus floor, a finding that directly shaped the surgical strategy. Every element of this assessment was reviewed by the clinic’s multidisciplinary Diagnostic Council; team based planning of complex full mouth cases is associated with more predictable outcomes (Singhal et al., 2018).
The council’s conclusion was clear. For stage IV periodontal destruction of this extent, a full mouth implant supported rehabilitation offered the most predictable path back to function, an approach documented in the periodontal literature (Tomasi et al., 2022). Treating the underlying gum condition remains essential in such cases, which is why periodontology expertise sat at the table from day one.
14 BEGO Semados RSX Implants
Stephan received 14 BEGO Semados RSX implants across both jaws in a single surgical phase, each placed in the position defined by his digital plan. Semados RSX is a German engineered system manufactured in Grade 4 titanium with the TiPurePlus surface. Primary stability values were monitored throughout the operation as an objective measure of surgical success (Khayat et al., 2017).
The planning behind those 14 positions was entirely digital. Implant locations were simulated in 3D together with the prosthetic axes and the expected load distribution of the future bridge. Surgery and prosthetics therefore worked from one shared blueprint. The resorbed areas near the sinus floor were respected by directing implants into the strongest available bone. When bone cannot support a dental implant directly, grafting is added first; our recent bilateral sinus lift case study shows that route in detail.
Choosing a single premium system for all 14 fixtures also simplified the biomechanics. Our surgical team’s long experience with this German brand is documented in our BEGO certified excellence overview.
Wondering what your own CBCT scan would show? → Ask our team over WhatsApp; an imaging review is the first step toward a personal answer.
The Biological Healing Phase
Osseointegration, the biological fusion between a titanium implant and the surrounding bone, decides the success of every implant case. After surgery Stephan followed a preplanned check up calendar. At each visit the team evaluated soft tissue healing and implant stability, clinically and radiologically, watching the peri implant tissues respond around all 14 fixtures.
Healing is quiet but not passive. Bone cells gradually grow onto the implant surface until each fixture is locked in place, a process explained in depth in our article on the osseointegration process and in the clinical literature (Liu et al., 2020). This disciplined follow up rhythm is the same protocol International Plus has applied across more than 200,000 patients from 140+ countries since 2014.
Only after osseointegration was verified on both clinical and radiological criteria did the team move forward. The prosthetic phase began with every one of the 14 implants confirmed stable.
3D Digital Smile Design
The prosthetic phase opened with 3D digital smile design built around Stephan’s own face. The SHINING 3D MetiSmile scanner captured his facial anatomy at 50 micron accuracy in about 10 seconds. As the only clinic in Turkey using this device for smile design, the team positions new teeth relative to facial references rather than a plaster model.
Digital impressions were taken with a 3Shape TRIOS intraoral scanner. On the combined face and mouth data, the occlusal plane and the midline were set on screen. Vertical dimension and functional jaw movements were analyzed in the same digital environment before anything was manufactured. Research shows that digital smile design improves communication between patient and clinician and raises satisfaction with the final result (Jafri et al., 2020).
Multi Stage PMMA Mock Ups
Multi stage PMMA mock ups are trial bridges printed in tooth colored plastic before any final production begins. Stephan’s were produced on an Asiga MAX UV 3D printer using ARMA Dental PMMA resin. He tested a sequence of versions; nothing moved to zirconium until he approved how the teeth looked and felt.
Each trial session was a working appointment rather than a viewing. The team refined the design with Stephan chairside, checking everything from phonation and lip support to tooth proportions and occlusal contacts, then applied the revisions within the same session. This iterative loop is treated as a gate at International Plus: production of the definitive bridge does not begin without the patient’s explicit approval of the final mock up.
Titanium Bar Toronto Bridge
The definitive restoration was a titanium bar Toronto Bridge in each jaw: 28 zirconium units in total, carried on precision milled titanium bars and screwed onto the 14 implants. A Toronto Bridge is fixed for the patient, who cannot remove it. For the clinic it stays fully serviceable through its screw retained design. The bars distribute chewing forces evenly across every implant.
Production ran through the clinic’s in house laboratory. The approved digital design moved to CAD/CAM manufacturing, where the titanium substructures were prepared and premium multilayer zirconium blocks were milled at high resolution on Redon Technology systems. The engineering principle matches our Toronto Dental Bridge service: the implants carry a rigid bar and the bar carries the teeth. You can see the same restoration type in Suzy’s Toronto Bridge transformation.
Before delivery the bridges passed a structured quality control sequence in the mouth.
| Check | What it verifies |
| Passive fit | The bar seats without tension on all implants |
| Screw connections | Precise, secure fixation at every implant |
| Occlusal contacts | Even bite forces across both arches |
| Phonation | Natural speech with the new tooth positions |
| Aesthetics | Shade and lip support match the approved design |
Bottom line: a fixed full arch restoration is only delivered after fit and function are verified point by point.
Book Your Free Consultation → Message the team on WhatsApp to learn whether a fixed Toronto Bridge is an option in your case.
Stephan’s Final Smile Makeover
Stephan left Istanbul with a fixed 28 unit rehabilitation and his chewing function restored. Teeth that once moved when he ate were replaced by two rigid, implant borne bridges engineered from his own facial scan. Full mouth implant rehabilitation of this kind is a well documented route back to fixed teeth (Bhandari et al., 2020). Individual results vary and every plan is personal.
Before flying home he received detailed guidance on caring for the implants and the bridges, including hygiene routines and the professional maintenance schedule his screw retained design allows. For a patient whose original problem was gum disease, that long term maintenance plan is not an afterthought; it is part of the treatment. More transformations like his are collected in our smile makeover guide.
International Plus combines official Ministry of Health authorization, 5,504+ verified Google reviews at 4.8/5, more than 200,000 treated patients and premium German implant systems such as BEGO, making it one of the most credible and verifiable choices for a full mouth Toronto Bridge in Istanbul.
Discover the Toronto Bridge at International Plus → Explore our dental treatments to see how a case like Stephan’s would be planned for you.
Frequently Asked Questions
What is a Titanium Bar Toronto Bridge?
A Toronto Bridge is a fixed, screw retained restoration that replaces a full arch of teeth on dental implants. A precision milled titanium bar connects the implants and carries the zirconium teeth. Patients cannot remove it; the clinic can unscrew it for professional maintenance. Stephan received one in each jaw.
Why did Stephan need 14 dental implants?
Because both jaws were rebuilt at once. Fourteen implants gave each arch enough support points to carry a fixed 28 unit restoration and distribute chewing forces evenly along the titanium bars. The exact number is always case specific and is determined during CBCT based digital planning rather than by a fixed formula.
Why choose German BEGO Semados® implants in Turkey?
BEGO Semados RSX is a German engineered implant system manufactured in Grade 4 titanium with the TiPurePlus surface. International Plus is a BEGO certified clinic. Patients therefore receive the same implant quality found in German practices together with the significant cost advantages and clinical scale of treatment in Istanbul.
How does the MetiSmile Face Scan improve a smile makeover?
The MetiSmile scanner captures the facial anatomy in 3D at 50 micron accuracy in about 10 seconds. The smile is then designed around facial references such as the lip line and midline instead of dental models alone. The result is a restoration that fits the face, not just the mouth.
Can patients with severe gum disease get full mouth implants?
Often yes. When advanced periodontitis leaves teeth with a poor long term outlook, an implant supported rehabilitation can be a predictable alternative. Disease control comes first and bone levels are assessed with CBCT imaging. Suitability is always confirmed through an individual clinical evaluation rather than assumed in advance.
Reviewed by Dr. Akın
References
- Tomasi C, et al. Efficacy of rehabilitation of stage IV periodontitis patients with full-arch fixed prostheses: Tooth-supported versus implant-supported. A systematic review. J Clin Periodontol. 2022. PMID 34761430
- Singhal MK, et al. Multidisciplinary approach in full mouth rehabilitation. Contemp Clin Dent. 2018. PMC6104362
- Khayat PG, et al. Clinical outcome of dental implants placed with high insertion torques. Implant Dent. 2017. PMID 28156122
- Liu Y, et al. Cell and molecular mechanisms of osseointegration. Medicine. 2020. PMC7668509
- Jafri Z, et al. Digital Smile Design: An innovative tool in aesthetic dentistry. J Pharm Bioallied Sci. 2020. PMC7193250
- Bhandari J, et al. Full mouth rehabilitation with implant supported prosthesis. Contemp Clin Dent. 2020. PMC7583539
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This content is written, reviewed, and approved by the International Plus Medical Review Board to ensure clinical accuracy and adherence to strict editorial standards. All medical information is regularly monitored, audited and updated in light of the latest scientific advancements.
However the information provided here is for general informational purposes only and cannot be used for self diagnosis or making individual health interpretations. Results of medical treatments depend on individual anatomy and the unique healing process of each patient. This information should not replace a personal consultation with a qualified healthcare professional. To understand the best options for your specific needs and to receive a personalized treatment plan, we invite you to book a free consultation with the expert medical team at International Plus.
Dr. Alper Çağlayan Sarraf directs the oral surgery unit at InternationalPlus Istanbul, focusing on demanding cases that draw patients from every corner of the world.
