The German “Heil- und Kostenplan”, the written treatment and cost plan every dentist in Germany issues before implant work, does not tell you what you actually want to know: how long the operation takes, whether it hurts, when you can eat normally again and why there are often six months between the first appointment and the finished crown. This article explains the dental implant process in Germany step by step, with times, costs and sources.
A dental implant takes seven steps: consultation, CBCT scan, treatment plan, surgery, healing, impression and crown. Surgery for a single implant takes 30 to 60 minutes under local anaesthetic. Pain is manageable with ibuprofen and usually settles within a week. Healing in Germany typically takes 3 to 6 months. In Tbilisi the same process is planned so that diagnostics, surgery and restoration fit into a 2 to 3 week stay, with the final crown or bridge following after healing. Prices from 629 € (£540 / $730) for an implant plus crown, from 3,890 € (£3,340 / $4,500) for an All-on-4 arch, fixed price before you travel.
The seven steps at a glance
From the first conversation to the finished crown you pass through seven stages. The actual time in the dental chair is about three hours; the rest is waiting for appointments, approval from the German insurer and the healing itself.
| Step | What happens | Duration |
|---|---|---|
| 1. Consultation | Examination, photos, questions about medical history and medication | 30 to 45 minutes |
| 2. DVT (3D X-ray, CBCT) | Scan of bone height, nerves and sinus | 5 minutes, assessment 1 week |
| 3. Treatment plan | Implant position, surgical guide, written treatment and cost plan | 1 to 3 weeks |
| 4. Surgery | Placing the implant, bone graft if needed | 30 to 60 minutes per implant |
| 5. Healing | Bone fuses with the titanium (osseointegration) | 6 weeks to 6 months |
| 6. Impression | Uncovering, scan or impression for the lab | 2 appointments, 1 to 2 weeks |
| 7. Crown | Fitting and adjusting the bite | 30 to 45 minutes |
Steps 1 to 3: consultation, CBCT and treatment plan
The first three steps decide whether an implant makes sense and whether bone is missing. Nobody should schedule implant surgery without a DVT, the German term for a CBCT scan, because only the 3D image shows bone height and bone width. In the consultation the practice asks about diabetes, blood thinners, bisphosphonates for osteoporosis and smoking, because all four affect healing.
On the CBCT the surgeon measures the distance to the lower jaw nerve and to the sinus. From this comes the plan with implant type, length, diameter and often a surgical guide. For patients in the GKV, Germany’s statutory health insurance, the treatment and cost plan goes to the insurer before surgery. More on brands and types under Dental implants.
Step 4: the operation and how long it takes
A single implant is placed in 30 to 60 minutes, often faster with a surgical guide. Two to four implants take 1 to 2 hours, a full arch with four to six implants and an immediate temporary 2 to 3 hours, both arches with extractions 4 to 6 hours. A bone graft adds 30 to 60 minutes.
The sequence on the day of surgery is always the same. The anaesthetic takes effect after 5 to 10 minutes. The surgeon opens the gum, drills the implant site in several stages, screws in the implant and closes it with a cover screw under the gum or a visible healing cap. Then the site is stitched. You feel pressure and vibration, not pain. You should not drive yourself afterwards, even without sedation.
Pain after a dental implant: what is normal
Most patients describe the days after implant placement as uncomfortable rather than bad. Pain peaks on the second and third day and settles by the end of the first week, according to the patient guide from Dentaly. Swelling peaks after 48 to 72 hours and goes down over a week.
Ibuprofen 400 mg every six to eight hours is usually enough. In the first 24 hours apply cold packs in 10 minute intervals with breaks. No rinsing, no sucking through a straw, no smoking, no sport for three days. After a bone graft, 10 to 14 days of swelling is normal. Not normal is pain that increases after the third day, fever, pus or numbness of the lip or chin that persists after 24 hours. In that case call the practice the same day.
What you can eat after a dental implant
On the day of surgery only cold and soft food, then over two weeks move up from puréed to soft to normal. Nothing that has to be chewed on the implant side, nothing hot in the first 48 hours, no small seeds that can lodge in the wound. Pause coffee and alcohol for three days.
| Period | Suitable | Avoid |
|---|---|---|
| Day of surgery | Cold soup, yoghurt, pudding, smoothie without seeds | Hot food, straws, alcohol, coffee |
| Days 1 to 3 | Mashed potato, scrambled eggs, porridge, puréed soups | Bread crust, nuts, seeds, spicy food |
| Days 4 to 7 | Pasta, soft vegetables, minced meat, bananas, soft cheese | Raw vegetables, steak, crisps, sticky food |
| Week 2 | Almost normal, chew on the other side | Very hard food on the implant side |
| From week 3 | Normal diet | Do not load the healing cap |
After a temporary All-on-4 bridge the soft diet lasts not two weeks but until the final bridge, because the temporary must not be fully loaded during healing.
Healing time and immediate loading
The classic rule is three months in the lower jaw, up to six months in the upper jaw. It dates from the early years of implantology, as an article in the Implantologie Journal (ZWP online), a German dental trade journal, traces. According to the same article, modern surfaces shorten healing to six to eight weeks.
Whether earlier loading is allowed has been examined by the Cochrane Collaboration. The review by Esposito and colleagues (Cochrane Review CD003878, 2013) found in 15 randomised trials no difference in implant or prosthesis failures in the first year between immediate loading (within one week) and conventional loading (after two months). The precondition is good primary stability, which the surgeon measures by insertion torque. Later meta-analyses see a slightly higher failure risk with immediate loading, roughly 96.8 versus 98.6 percent survival.
With firm bone a temporary can therefore come early; with soft bone, after a bone graft or in smokers it stays at three to six months. With All-on-4 the temporary bridge is usually fitted within 72 hours. The final bridge is placed once the implants have healed. With us the written plan states whether that happens within the stay or at a second short visit, and what is included. Details under All-on-4 dental implants.
Bone graft and sinus lift: when needed, what it costs
A bone graft is needed when the jaw offers less than about 6 millimetres of height or 5 millimetres of width, which is common after long-standing tooth loss. In the back of the upper jaw the sinus lift raises the sinus membrane and fills the space with bone substitute. The German statutory insurer pays nothing towards it.
According to Allianz, a German insurer, an internal sinus lift costs 300 to 500 €, an external one 600 to 1,150 €. Dentaly quotes 700 to 1,400 € for the external sinus lift and 300 to 1,500 € for a bone graft depending on extent. ERGO, another German insurer, is in the same range at 300 to 500 € per half of the jaw. A block graft from the patient’s own bone can exceed 2,000 €.
The second price is time. After an external sinus lift the bone heals for 4 to 6 months before the implant can be placed, and the whole process stretches to 9 to 12 months. That is why surgeons plan around the graft where possible, with shorter or angled implants as in All-on-4. In Tbilisi the CBCT decides before you travel. If a graft is needed, it is listed with its price in the offer before you book.
General anaesthetic or sedation
For one or two implants local anaesthetic is enough, sedation is a comfort option and general anaesthetic is rarely needed in healthy adults. According to Techniker Krankenkasse, one of Germany’s large statutory insurers, the insurer pays for general anaesthetic only when no other form of pain control is possible, for example in certain oral surgery procedures, disabilities or documented dental phobia.
ARAG, a German insurer, quotes around 100 € per hour of general anaesthetic plus 50 to 120 € in material costs for ventilation; CosmosDirekt, another insurer, reckons with 200 to 300 € for the first hour and 100 to 150 € for each further hour. Twilight sedation costs 90 to 160 € according to the same sources, because no anaesthetist is required. A complete dental restoration under general anaesthetic over four to six hours therefore comes to 600 to 1,000 € for the anaesthetic alone. Our packages include local anaesthetic; sedation is offered as an extra with its price before you travel.
Implant or bridge
If the neighbouring teeth already carry crowns or large fillings, a bridge is often the better and cheaper solution. If they are healthy, the bridge costs two healthy teeth that have to be ground down, and over 15 to 20 years the implant is usually the more economical choice.
The bridge is finished in two to three weeks, without surgery, with the German insurer’s fixed subsidy (Festzuschuss). But the bone in the gap keeps shrinking underneath it, and after 10 to 15 years the bridge often has to be replaced. The implant preserves the bone and needs no neighbouring teeth, but at the start there is surgery, healing time and, where bone is missing, a graft. With poorly controlled diabetes, heavy smoking and bisphosphonate therapy there is much to be said for the bridge.
Recognising an infection around a dental implant
The most common late complication is peri-implantitis, an inflammation of the bone around the implant. The meta-analysis by Diaz and colleagues in BMC Oral Health 2022, discussed in the Zahnärztliche Mitteilungen, the journal of the German dental association, found signs of peri-implantitis in on average 19.5 percent of patients and 12.5 percent of implants. The precursor, mucositis without bone loss, is even more common at around 43 percent according to Derks and Tomasi 2015.
The warning signs are the same as for periodontitis: bleeding gums when brushing around the implant, redness, swelling, pus, a foul smell, a receding gum line with exposed metal and, very late, a loose implant. Pain is often absent until the late stage. That is why six-monthly check-ups and professional cleaning are mandatory. The biggest risk factors are smoking and untreated periodontitis on the remaining teeth. After treatment in Tbilisi your dentist at home takes over aftercare; the implant passport tells them the brand and size.
The process in Tbilisi: 2 to 3 weeks instead of 3 to 6 months
In Germany the process is spread over six to eight appointments across three to six months; in Tbilisi it is condensed into 10 days to 3 weeks. This is possible because planning is done before you travel with your CBCT via WhatsApp, and the lab and the surgery are in the same place. Healing takes just as long, only the waiting times disappear.
| Germany | Tbilisi (Dental Tourism Georgia) | |
|---|---|---|
| Consultation and CBCT | 2 appointments, 1 to 3 weeks | Before you travel via WhatsApp, CBCT from home or on day 1 |
| Treatment plan | Written cost plan, insurer approval 2 to 4 weeks | Written fixed price before booking |
| Surgery | Appointment after approval | Day 2 to 3 of the stay |
| Healing | 3 to 6 months at home | Same length, at home |
| Final crown or bridge | 2 further appointments | Per plan, during the stay or at a second short visit |
| Total duration | 3 to 6 months, 6 to 8 appointments | 2 to 3 weeks on site, aftercare at home |
| One implant with crown | 2,100 to 4,500 € | from 629 € (£540 / $730, NTA®) or 1,258 € (£1,080 / $1,450, Straumann®), plus about 1,500 € travel |
| All-on-4, one arch | 8,000 to 20,000 €, typically 15,000 € | from 3,890 € (£3,340 / $4,500), plus about 1,500 € travel |
| Bone graft, sinus lift, sedation | 300 to 1,500 € extra, anaesthetic 200 to 300 € per hour | Extras, priced in the offer before you travel |
The sums only clearly favour travel with several implants. A Straumann® implant with crown costs 1,258 € in Tbilisi, about 2,758 € with flights and hotel. That is at the lower end of the German range, and the time involved argues for the practice at home. For an All-on-4 arch, 3,890 € plus 1,500 € travel stands against a typical 15,000 € in Germany. Included are CBCT, surgical guide, implants, surgery under local anaesthetic, bridge, airport transfer, coordinator, implant passport and aftercare plan. All prices under Prices, the trip itself under Your trip. Every plan is checked by Dr Ketevan Mamulashvili, prosthodontist, before it is sent to you.
Frequently asked questions
How long does a dental implant take in total?
In Germany, from the consultation to the crown, usually 3 to 6 months, with a bone graft 9 to 12 months. The operation itself takes 30 to 60 minutes per implant. In Tbilisi planning and surgery are combined into 10 days to 3 weeks, healing takes just as long, and the final restoration follows according to your written plan.
How bad is the pain after implant placement?
Comparable to a tooth extraction, usually less. The peak is on the second and third day, and by the end of the first week the discomfort subsides. Ibuprofen 400 mg on a fixed schedule is usually enough. Pain that increases after the third day, fever or pus are not normal; in that case call the practice the same day.
When can I eat normally again after a dental implant?
After about two weeks, on the implant side preferably only after three. On the day of surgery only cold and soft food, days 1 to 3 puréed, days 4 to 7 soft cooked, week 2 almost normal while chewing on the other side. After a temporary All-on-4 bridge the soft diet lasts until the final bridge.
What does a bone graft cost in Germany?
An internal sinus lift 300 to 600 €, an external sinus lift 600 to 1,400 €, a bone graft 300 to 1,500 € depending on extent, large block grafts more. The statutory insurer pays nothing towards it; supplementary dental insurance reimburses depending on the policy. It extends the process by 4 to 6 months. In Tbilisi it is priced in the offer before you book.
Is a general anaesthetic sensible for a dental implant?
For one to four implants, rarely. Local anaesthetic is enough; sedation takes away the anxiety and costs 90 to 160 €. General anaesthetic at 200 to 300 € per hour makes sense for large restorations with many extractions, disabilities or documented dental phobia, and in those cases the German insurer sometimes covers it. Ask about this in writing beforehand.
How do I recognise an infection around the implant?
By bleeding gums when brushing, redness, swelling, pus or smell around the implant, later by exposed metal and loosening. Pain is often absent for a long time. Around one in five implant patients shows signs of peri-implantitis over the years; detected early, it is treatable. Six-monthly check-ups and cleaning are mandatory.
The short version
- Seven steps, about three hours in the chair, 3 to 6 months of healing. Surgery for one implant takes 30 to 60 minutes, pain subsides after a week, normal eating after two weeks.
- In Germany a bone graft costs 300 to 1,500 € extra and 4 to 6 months more time, general anaesthetic 200 to 300 € per hour. Around one in five implant patients develops peri-implantitis; aftercare prevents most of it.
- For a single implant the practice at home is usually the right choice. For one or two All-on-4 arches Tbilisi saves several thousand euros with the same brands, with a fixed price before you travel and 2 to 3 weeks on site.
Send us your CBCT or an X-ray via WhatsApp. You will receive a written treatment plan with a fixed price, checked by a prosthodontist, free of charge and with no deposit. A coordinator replies on WhatsApp in English.
