Peri-implant soft and hard tissue management in the aesthetic zone

Introduction

The survival of the dental implants is now predictable in almost every case but, the success of the implant still is a challenge according to its subjective basis. The aesthetic result is a criterion which is later achieved. It is good to know that to achieve aesthetics in the front area with an implant restoration is significantly more demanding than with the conventional restorations.

The insertion of dental implants in the front aesthetic area is a complex intervention which requires comprehensive planning and also a precise surgical procedure. Any other defects and complications later can lead to a disharmony with the perioral and facial structures. This could lead also to poor restorative and imperfect aesthetic outcome. The convincing point explains that dental implants which are inserted in a non-ideal position are exposed to non-axial loading. This situation can lead to high failure of the implant from a mechanical or aesthetic reason.

In order to achieve a stable and optimal function and also aesthetics, the implant position in the arch must be in a biologically tolerable and prosthetically driven location. One of the biggest challenges is the alveolar bone undergo specific changes after tooth extraction. It is a tooth dependent tissue and the tooth loss may lead to a loss in width and height of the alveolar process. This situation can cause shorter and narrower residual ridge which will later result with some complication with the ideal position of the dental implant. Sometimes, a soft and hard tissue management should be used.

What happens in the soft and hard tissue after a tooth removal?

Patients should know that the periodontium is a complex of tissues which after a tooth extraction can be remodeled. This is explained with the fact that the alveolar ridge needs mechanical stimulation for maintaining its shape and density. After a tooth loss, there is a situation in which is noticed a decrease in trabeculation and also a loss of its width and height.

After a tooth removal, there are significant changes in the soft tissue. There is a noticeable loss of the gingival architecture which results in a reduction in the scalloped hard and soft tissue. The changes which occur involve the maturation of the wound. This process induces the calcification and the formation of the bone. The first phase is the clot formation which consists of a coagulum of white and red blood cells, inflammatory cells, and fibrin. After 4-5 days starts the second phase in which the coagulum is changed with a granulation tissue. Over a two week period begins the third phase in which the granulation tissue is changed with connective tissue. Following the fourth phase, starts the calcification of the osteoid of the socket base and periphery. The new formation made of bony trabeculae continues the next six weeks. The fifth phase is a complete epithelial closure if the wound. After 16 weeks, the socket is filled with bone and the osteogenic action is ceased.

When it comes to the hard tissues after a tooth loss the alveolar bone undergoes the process of resorption. The dimensional changes are noticed in both vertical and buccolingual dimensions which result in a decreased gingival architecture, significantly manifested in the thin biotype. When macroscopically discussed, the healing procedure manifests in changes in the bone and also in the overlying soft tissues. There is noticeable bone resorption in a buccolingual part from 5-7 mm in the alveolar bone crest during 6-12 months. The reduction is more active in the first four months. The vertical dimension of the alveolar bone is also affected and there is a reduction of 2-4.5 mm. Another influence of the process over the bone resorption has an injury to the alveolus which can be occurred before or during the tooth removal intervention. It is marked as an iatrogenic fracture. It is possible that other local factors such as any infective process (periodontal or endodontic abscesses, tumors, or cysts) can contribute to a bone reduction.

How to make it perfect in the aesthetic zone?

bone augmentationThe first thing an implant specialist often faces is the lack of sufficient bone in horizontal and vertical dimension. If this situation is not treated in the first stages of the intervention, it will definitely compromise the aesthetic and functional result. Studies have shown that many authors have approached the problem of the atrophy of the alveolar bone simply by suggesting combinations of surgical procedures and techniques in order to augment the defect. Because of this, many interventions, materials, and methodologies have evolved just to initiate the formation of the new tissue or to stop the further bone loss. Many grafting interventions have appeared utilizing autogenous bone grafts that were set as a gold standard for the process of bone augmentation.

The autogenous graft is a part of the patient’s bone and there are numerous advantages of its use. This type of graft consists of live osteoblasts and also osteoprogenitor cells that can proliferate and close the gap between the recipient bone and the graft. A successful outcome is marked because the microscopic architecture is perfectly fitted and also there is no immune reaction. These grafts result in the best regeneration of the bone defect because of the minimal postoperative resorption of the grafted bone. According to many studies, the preferred donor sites are grafts taken from the mandibular symphysis, followed by the ramus and the maxillary tuberosity.

It is good to know that there are also nonautogenous grafts and the most commonly used are demineralized freeze-dried bone. The bone formation features of these grafts are explained as osteoconductive and slightly osteoinductive. Keep in mind that this nonautogenous material can be utilized on a combination with autogenous bone grafts and also with resorbable or nonresorbable membranes.

Another type of nonautogenous material is the hydroxyapatite of b-tricalcium derivatives. Because this material when inserted alone does not have bone formation features, it needs to be utilized in a combination with some other autogenous or nonautogenous graft material.

Remember that the two mentioned nonautogenous graft materials are utilized for hard tissue augmentation.

The success of achieving great aesthetics around dental implants placed in the anterior part of the upper jaw has been a big challenge for the majority of dental clinicians. The key to an aesthetically satisfying appearance is the ability of the dental professional to properly manage the soft tissue around the dental implants. In some cases, there is no indication for soft tissue management.

In order to obtain long-term stability of the pink aesthetics around the dental implants, the dental professional may need additional techniques. This situation is in a strong correlation with the peri-implant soft tissue thickness which means a thick peri-implant biotype. If the dental professional diagnoses a thin biotype, then subepithelial connective tissue grafts or free gingival grafts may be used. The utilized grafts are taken for preventing the recession of the facial mucosal margin and also for permeation of the grey color gained from the dental implant. Keep in mind that the intervention of soft tissue augmentation can be done together with the implant insertion or during a second stage surgery intervention. According to literature, both technique alternatives have shown that can lead to a better aesthetic result and also can increase the thickness of the soft tissue.

The grafting process of the soft tissue can be used as a “rescue intervention” for managing the aesthetic complications which may appear with the implants. The usage of autogenous free gingival graft in the mucogingival interventions is very common. These grafts are considered as efficacious and reliable approach and they are most often utilized for increasing the amount of keratinized tissues around the dental implant. It is good to remember that free gingival grafts are still the gold standards for all situations where an increase in keratinized mucosa is needed. Usually, the donor site of an FGG (free gingival graft) is the highly keratinized hard palate. But, this way, the shade and the color of the recipient do not match with the adjacent soft tissues. Even though, FGG is used for increasing the keratinized tissue as a “rescue” procedure in order to cover the exposed implant threads.

tissue augmentation

Keep in mind that an FGG is utilized for those patients who have low smile lines, in cases where the color of the FGG would not compromise the aesthetic look of the implant site, and also when an extensive soft tissue augmentation intervention is desired.

Subepithelial connective tissue grafts are also utilized successfully for the management of the soft tissue defects and also for augmenting the contours of the alveolar ridge. Many of the procedures in which SCTG are used, can be performed directly tp the peri-implant soft tissue management and aesthetic optimization. In all cases, where they are properly utilized and are indicated, can provide significant gains and ensure stable condition in the soft tissue volume and contour. This will definitely contribute to a successful and the same time aesthetic management of the implant sites.

Summary

It is very important that all implantologists determine the present satiation of each patient individually. They should carefully consider the outcome of the surgical procedures and their timing in order to achieve a perfect and acceptable result. The implant specialist should notice the prime condition of the soft and the hard tissue architecture and later decide if hard or soft tissue augmentation procedures are necessary prior to the insertion of the dental implants. If the implant specialist confirms these interventions he should think which technique is the most appropriate. According to literature and the experience of the implantologists around the world, an autogenous graft material is a great treatment option for augmentation of the hard tissue especially when there is not a sufficient bone. Another important thing to consider is that the usages of block grafts which are taken from the mandibular symphysis are of the ramus are a great idea especially a large quantity of graft material is needed. In a proper relation to the timing for the implant insertion, the working protocol should follow the guidelines found in the literature and the final decision should be given for each patient on an individual basis.

Pre-prosthetic surgical interventions (correction of highly attached labial and lingual frenulum)

Successful mobile prosthetic rehabilitation in toothless patients is directly related to the presence of certain conditions, such as: sufficiently wide and high alveolar ridge, convenient correlation between the alveolar ridges, deep enough vestibular and lingual fornix etc. The absence of these conditions compromises the prosthetic rehabilitation, whereby it is necessary to perform pre-prosthetic surgical interventions in order to create conditions for making an aesthetic and functional prosthetic devices.

The minor pre-prosthetic surgical interventions are defined as corrective procedures of the soft-tissue and bony alterations in order to create conditions for successful prosthetic rehabilitation. They are usually performed under ambulatory conditions, using local infiltrative anesthesia.

All of these surgical interventions can be made preventively, in order to prevent the creation of irregularities that will obstruct the prosthesis of the patient, or correct the already present irregularities. In this case, atraumatic extraction of the teeth is particularly important. Therefore, rotational movements which protect the vestibular cortical lamina, and whose presence reduces the degree of subsequent atrophy of the jawbone, should more preferably be applied. During the extraction of the molars (especially in the upper jaw), we can separate the roots and surgically extract them, thus preventing a possible fracture of the vestibular cortical lamina and creating a bone defect or uneven alveolar ridge.

In general, irregularities that obstruct the making of a good and functional prosthesis are divided into two groups: developmental irregularities and gained irregularities. Developmental irregularities include: present mandibular and palatinal torus, low or high attachment of muscles, frenulums and plicae buccales, or atrophy/hypertrophy of the soft tissue. Acquired irregularities are usually result of teeth extraction, trauma and infection. The atrophy of the alveolar ridge is a significant problem. It happens as a result of its inactivity in toothless patients, who wear prosthesis. Atrophy of the ridge manifests as a non-favorable correlation between the movable and immobile mucosa, thus the quantum of the movable mucosa increases and it is inserted at the very top of the alveolar ridge. Also, injuries of the jaw bones and alveolar ridges, or surgical interventions on cysts or tumors, can turn into local factors that obstruct the making of prosthetic devices.

Before making a definitive prosthetic restoration, the condition of the alveolar ridge must be checked with clinical and radiological examination. On the basis of the obtained data, the intervention that is supposed to be correctly performed, is planned further. Otherwise, it is possible that while correcting one irregularity, we unexpectedly create another one (for example, poor partial alveoloplasy can create a shallow vestibular sulcus, a condition that adversely affects the stability of the prosthesis).

Normal anatomical correlations in the oral cavity may be impaired by congenital or acquired modifications in the soft tissue and bone segments of the alveolar ridge. One of them is the high attachment of frenulums.

Correction of the labial frenulum (frenoplasty)

The labial frenulum can be highly adhered (inserted) to the alveolar ridge, even at its very tip. This condition may be congenital or acquired as a result of a strongly expressed atrophy of the alveolar ridge. Under such conditions, the making of a functionally stable prosthetic device is difficult. Also, the labial frenulum can be removed because of orthodontic reasons. It may cause an appearance of diastema mediana in children, which is corrected by excision of the frenulim. A surgical removal of the frenulum is called frenoplasty and two surgical methods are most commonly used: excision frenoplasty and „ Z “ frenoplasty.

Excision frenoplasty

It is indicated under conditions where there is a residual alveolar ridge with a good vertical dimensions and a deep labial vestibulum.
Technique: after a given local anesthetic, the lip is pulled up, the frenulum is fixed with two Peon forceps, which are positioned at the upper and the lower end of the frenulum. An incision is made only through the mucosa, so that after removing the frenulum, the periosteum remains intact. When setting the sutures, in order not to reduce the labial fornix, the first suture is placed high in the vestibulum, which additionally reduces the postoperative hematoma.

„ Z “ frenoplasy

It is indicated when there is an alveolar ridge with a loss of vertical dimension and a shallow labial vestibulum.
Technique: elliptical incision is made, the fibrous frenulum if removed in a depth of several millimeters. Thereafter, two short incisions are made at the ends of the initial incision.

Correction of the lingual frenulum

The lingual frenulum can cause partial or complete ankiloglossia, which is a congenital anomaly. This condition is due to insertion of the frenulum to the floor of the oral cavity or to alveolar mucosa, and due to an extremely short frenulum that is connected to the top of the tongue. Ankiloglossia limits the movement of the tongue and thus creates problems with speaking, swallowing, mastication. Additionally, the lower total prosthesis moves from its place at each movement of the tongue.

Technique: after the application of a local anesthetic for n. lingualis, the tongue is immobilized and raised upwards. By raising the tongue, the frenulum is straining itself. Subsequently, convergent incisions are made on both sides of the frenulum, which interconnect at the ends. These incisions converge to the base of tongue. After removing the frenulum, the edges are flattened with scissors for obtuse dissection and the wound is sutured with individual sutures. The following anatomical structures can be damaged during the intervention: caruncula sublingualis, ductus sublingualis, ductus submandibularis, a. et v. sublingualis.

Surgical correction of bone and soft alterations of the alveolar ridge, managing its atrophy and height reduction

Bone irregularities of the alveolar ridge and the jawbone can be acquired and congenital. Acquired irregularities can be result of:

  • Individual and multiple teeth extractions performed in large time intervals, leading to uneven atrophy of the alveolar ridge;
  • Not removed interdental or interradicular septum, after teeth extraction;
  • Not made reposition of the walls of the alveolus, after tooth extraction;
  • Fracture of the vestibular or oral cortical lamina as a result of applied inadequate technique of extraction;
  • Surgical interventions of the alveolar ridge;
  • Injury of the alveolar ridge, fracture of the jawbone, acute and chronic osteomyelitis.

Congenital alterations include torus palatinus and torus mandibullae.

Alveoloplasty

The bone irregularities of the alveolar ridge are corrected with a surgical procedure called alveoloplasty, which can be partial or total. Partial alveoloplasty is a leveling of a part of the alveolar ridge and it is more commonly applied. Total alveoloplasty is a leveling of the entire alveolar ridge and it is rarely applied. Alveoloplasty can be madeafter single or multiple tooth extraction and the technique of the intervention pretty much the same.

alveoplasty

In conditions of missing teeth antagonists in one jaw, elongation of the alveolar ridge in the other jaw occurs, and the teeth get superposition. The elongation can be so much expressed that the teeth or the alveolar ridge of one jaw, can make a contact with the alveolar ridge of the other jaw. In this case it is practically impossible to make a prosthetic device, therefore, after the extraction of the tooth, we approach to the process of remodeling the alveolar ridge.

Technique: after the extraction of the tooth, a mucoperiosteal flap is made. When performing alveoloplasty, it is particularly important to maintain the depth (height) of the labial and buccal sulcus. This is achieved with making short incisions in the fornix and elevating small mucoperiosteal flap. We raise the flap and using bone plier we remove the serrated parts of the alveolus. Afterwards, we use a milling cutter to flatten the bone surface, but it is important to preserve the cortical lamina (as much as possible), which prevents occurrence of more pronounced resorption of the alveolar ridge, in the following period. The excess gingiva is cut off with scissors, the operative zone is washed abundantly with NaCl and the operative wound is closed with individual sutures.

Surgical correction of torus palatinus

When the torus palatines is discretely expressed (with a small dimension), it is not necessary to undertake surgical correction of the alteration, because in the preparation of the prosthesis, this area can be covered with foil on the working model. In this way the prosthesis does not directly press against it and it has good sability. If the torus is larger, it should be surgically removed because the prosthesis will be unstable and it may cause painful decubituses to appear. The best option in correction of palatinal torus is to do the intervention before pre-planned teeth extraction for making a total prosthesis. The presence of individual teeth, enables the preparation of palatinal plate, modified by a thermoplastic substance, which is applied in the patient’s mouth for a period of 7 to 10 days. It improves the comfort of the patient in the postoperative period, allows an intimate adaptation of the mucous flap to the bone tissue, prevents the emergence of pronounced postoperative hematoma, and a possible injury of the operative wound during mastication.

torus palatinus reduction

Technique: an initial incision is made along the middle palatinal line, with additional relaxation incisions at both ends. Such a designed incision prevents possible damage of the blood vessels (a. palatina major), provides adequate visualization and access, an operational field without tension. After rising the mucosa, it is fixed with traction sutures or with a wide periosteal elevator. If the present torus is small, the incision is made along the medial line with only one additional, anterior, relaxation incision (Y form). Such a torus can be removed using a large drill (with a pear-shaped form) or a milling cutter. When removing a larger torus, often lobulated, it is best to first make a groove along the center line, using a fissure drill. Then, the separation is made with additional, transverse sections through the torus. Further, the additional segments are removed with chisel or with bone pliers. The bone surface is flattened with a milling machine, the operative field is irrigated with NaCl and the wound is closed with individual sutures.

In totally toothless people, the incision is made along the alveolar ridge and the entire mucoperiosteal flap is lifted. Such a formed flap allows the setting of the sutures to be on a healthy bone base, away from the zone of removed palatinal torus.

Possible complications during the intervention: a fracture of the palatinal bone (when removing an unseparated large torus using a chisel), breakage of the thin palatinal mucosa and its consecutive necrosis (inadequate flap lifting), oronasal fistula (extremely rare complication).

Surgical correction of torus mandibullae

This bony protrusion, depending on its expression, can cause an injury of the mucous membrane during mastication, or lead to painful decubituses when the prosthesis is pressing against the mucous membrane of the torus.

Technique: After the mandibular anesthetic is given, we make an initial incision depending on the size of the torus and the presence or absence of teeth. In toothless patients the incision is made along the alveolar ridge and an additional, relaxation incision lingually, in front of the frontline of the torus. If teeth are present, then an envelope flap is performed around the necks of the teeth, and also we make a relaxation incision lingually, in order to achieve complete exposure of the bone exostosis. A piece of sterile gauze is placed under the torus, which prevents falling of small bone fragments between the tissues from the floor of the oral cavity, and the subsequent surgical procedure is identical to the one for torus palatinus.

Possible complications during this intervention are the breakage of the thin lingual mucosa and the possible occurrence of a postoperative hematoma.

Prosthetic fibrous hyperplasia of the mucosa

This condition is known as epulis fissuratum and it is most often localized in the vestibulum, in the area of the upper frontal teeth. Causes leading to this prosthetic hyperplasia are: trauma of badly made prosthesis, or in patients who have an upper total prosthesis and their natural teeth in the lower front. Namely, one or more folds are observed clinically, among which there are cuts in the mucosa that correspond to the prosthesis edges. The mucosa may be inflamed, in some places necrotic and painful on palpation and mastication. These hyperplastic creations reduce the retention and stabilization of the prosthesis, because they are mobile and in contact with the prosthetic edge. If epulis fissuratum is detected in the early stage when it is built from granulation tissue, removing the chronic irritation (non-usage of the prosthesis), may lead to its reduction or complete disappearance. In a later stage, when the granulation tissue has been transformed into fibrous, the condition is irreversible.

Surgical removal of the prosthetic hyperplasia is not performed at the first meeting with the patient, but the intervention is delayed for a period of 2 to 3 weeks, during which period the patient must not wear his prosthesis and must flash the oral cavity with oral antiseptic. During this period, the hyperplastic mucous membrane is reduced by 30% to 50%, which is much more convenient for surgical intervention compared to the initial condition.

Depending on the localization of the prosthetic hyperplasia, it is classified into 3 classes:

  • I class – when it is located on the solid wall of vestibular fornix;
  • II class – when it is located on the soft wall of vestibular fornix;
  • III class – when it is located on the both walls, thus fulfilling the whole fornix.

Operational technique – I class

  • After the application of local anesthesia, the epulis is fixed with surgical tweezers and then completely removed with a scalpel. In addition, the upper marginal part of the lesion are sutured with the exposed periosteum, so in this way, the height of the vestibular fornix is not reduced. The bare periosteum is covered with a prosthetic plate coated with zink-oxide impregnating paste, which the patient carries for the next 7 postoperative days.

Operational technique – II class

  • The easiest class to remove. The epulis is removed with a scalpel and the lesion is directly sutured.

Operational technique – III class (for removing III-class lesion we use a combination of the two previous techniques)

Atrophy of the alveolar ridge and jawbone

Loss of teeth and absence of physiological stimulations in the act of mastication, leads to atrophy of the alveolar ridge, which may be present along the entire ridge or only in individual parts. Deficient alveolar ridge may be compensated by implantation of a graft material, which can have a natural or artificial origin. Some of these materials also have an osteoinductive effect, they induce the growth of bone tissue through the porous material.

The technique of incorporating hydroxylapatite (alloplastic material) is relatively easy, and in some cases with two small vertical cuts, the entire alveolar ridge can be upgraded. In doing so, a subperiosteal tunnel is formed on the top of the alveolar ridge, which usually has a gully shape and it is suitable for application of the implant material using a specially designed syringe. The syringe is drawn in the tunnel and the area over the alveolar ridge is filled, starting from the most distant part of the tunnel to the vertical cut through which the syringe is drawn. In conditions of present extreme atrophy of the alveolar ridge, the only possibility is bone transplantation in combination with enosseal implants.

Surgical correction of the height of the alveolar ridge

The height of atrophic alveolar ridge can be surgically corrected in two ways: a relative increase and absolute increase. A relative increase of the height of the alveolar ridge is the usage of soft tissue surgery, most often in the vestibular fornix. An absolute increase is the usage of surgical bone transplantation procedures that increase or form a new alveolar ridge.

A relative increase in the height of the alveolar ridge is achieved by a procedure called vestibuloplasy. There are three techniques of vestibuloplasy:

  1. Deepening of the fornix with covering the two surfaces of the fornix with mucosa. From this group of operating procedures, the most commonly used is the submucosal vestibuloplasty (Obwegeser), which can be performed in the ambulance, with local anesthesia. The main indication for using this method is the presence of a healthy, flexible vestibular mucosa and a mild atrophy of the alveolar ridge. In doing so, we remove the excess submucosal tissue and do a reposition of the mucosa from the initial to a new (higher, deeper) level.
  2. Deepening of the fornix with secondary epithelization (two techniques)
    – Deepening of fornix with secondary epithelization of the soft tissue surface of vestibular fornix (the surface of the alveolar ridge is covered with mucosa) – Kazanjian.
    – Deepening of fornix with secondary epithelization on the surface of the alveolar ridge (the soft tissue area of the vestibular fornix is covered with mucosa) – Clark.
  3. Deepening of the fornix by covering the operative lesion with a free graft (mucosa/skin). This operative technique is identical to the method of deepening the fornix with secondary epithelization of the soft tissue area of vestibular fornix – Kazanjian, with the difference that the operative lesion of the alveolar ridge is covered with a free mucous or skin graft. The basic indication for the usage of this method is partial deepening of the fornix, only on a certain part of the alveolar ridge.

Locator attachments

Locator abutment overdentures: Better, Simpler and Stronger design with practical benefits


Introduction
It is almost impossible to imagine the advanced field on a dental industry that represents the implant systems which come as a restoration treatment of dental aesthetics and health. Most of the patients are not familiar with this procedure until they face this type of necessity for having optimal dental health. Sometimes, it is very difficult to make a proper decision because of the new and modern dental implants solutions the manufacturers offer to their dental professionals.
Patients, who are interested in gaining knowledge about dental implants, have the right to know that the abutment is a kind of connector between the denture and the implant which is inserted in the patient’s bone. There are so many different types of implant abutments which could be found on the market and each of them provides specific function while forming more individual approach to the right dental solution. Locator abutment is one of the previously mentioned abutment systems which provide a specific function in the field of dental implantology.

It is specially designed to be used with partial dentures or overdentures dental-elementswhich are supported partially or completely by dental implants. The most important feature of locator abutment is the fact that it could solve the problem with removable overdentures in a specific way and at the same time, provide secure attachment of the denture supported by dental implants. Locator abutment could be used for all types of complete dentures because of their low vertical height. They are a good choice because they offer dual retention, self-correcting alignment, and tolerance for the implant divergence. These types of attachments are used to stabilize the complete dentures in the last few decades. They represent an affordable solution for those patients who wear dentures to improve their chewing quality and also the quality of their life. Locators are ideal for improving aesthetics and retention and they can be a perfect choice when an abutment tooth is removed or lost.
This type of abutment is indicated to be used with partial dentures or overdentures which are retained in part or in whole by endosseous dental implants in the upper or lower jaw. But, it is good to remember that locator abutment is not appropriate when a totally rigid contact is required. All implant abutments or elements and also the metal instruments should be sterilized according to the standard clinical protocols.
Another thing to consider is that locator males are single-use parts which when re-used may cause damage during removal or in most cases they may cause loss of retention for the denture. When it comes to locator abutments, when re-used they may also cause some problems especially they could have patient contamination or contain some particles which would affect the retention. The final result would be improper fit or inappropriate function which would lead to a loss of the retention of the denture.
Locator abutments offer the following advantages:
Dual retention, outside and inside: This unique and innovative feature of the locator allows greater retention than any other attachment before. The greater surface area that ensures better retention combined with the inside and outside surfaces provides the long-lasting performance.
Low vertical profile: The total height of this type of attachment for an externally hexed type of implant is 3.17 mm and for a non-hexed type of implant it is 2.73 mm.
Pivoting feature: The pivoting locator male has a special design which enables a resilient connection with the denture and without any negative result of losing retention. The nylon male part which is retentive, stay in contact with the other part more exactly with the female socket. Finally, the metal prosthesis cap has a full range of rotating movements over the male part.
Correction of the angle up to twenty degree
Easy maintenance because the overdenture and the locator abutment have to be cleaned every day.
Easy and very simple insertion: Its self-locating design permits a patient easy seating of the denture without the necessity for exact alignment of the other attachment elements.
Low cost
It is very important to follow the dental professional instructions after the successful placement of the dental implant and the advanced locator abutment in order to not cause any irritations because it may affect the durability of the whole construction as well. In the first days after the procedure, the patients should rinse their mouth with mouthwash and then they may clean it with a soft-bristle toothbrush but very carefully. This way, they would help in the healing process. Another thing to keep in mind is that pain or discomfort may also occur, but in a relatively short period, they will disappear with the termination of the healing process.

Special elements and metal instrument which would be needed during the procedure

With the usage of the locator, a dental professional could offer to its patient a great implant-supported solution for its denture. All cases with specific angulation and also limited occlusal space could be easily improved with the locator.

Elements and metal instruments

elements-and-metal-instruments

• Locator abutment (Available for connecting sizes: 3.5/4.0; 4.5/5.0 Height: 0.5-5 mm )

• Processing Cap

• Locator Inserts (They are produced in five different retentive holding force levels *designed for non-parallel implants)

• Locator Abutment Pick-up

• Locator Abutment Replica

• Block-out Spacer

• Locator Core Tool

• Locator Torque Wrench Bit

• Torque Wrench

 

Locator Abutment Impression technique
How to select the right abutmentselect-abutment
The height of the selected locator abutment needs to be based according to the highest position of the tissue when measured with the special instrument called Abutment Depth Gauge. This action is performed just to permit the retention groove to be at suitable supragingival height.

How to install the abutmentinstall-abutment
The locator abutment should be inserted manually into the implant.

Seating 
The abutment should be seat manually utilizing the locator Abutment driver instrument from the locator care tool set.

Final tightening
Torque the locator Abutment utilizing the special instrument called Locator Torque Wrench Bit accordingly accompanied with the Torque Wrench used for the final tightening.

Creating the new overdenture

Placing the locator Abutment Pick-upplacing-locator-abutment-pickup
The dental professional should firmly attach the special component of the set more exactly, the Locator Abutment Pick-up to each of the Locator Abutments. The pick-up tool should establish stable friction retention.
Taking the impressionimpression
The impression from this situation should be taken in a specially customized tray with a specific elastomeric material for impressions. When the impression material is ready, the dental physician should remove the impression tray.
Impression Verification
Before sending the impression to the dental laboratory is has to be checked and classified as good one. When inspected, the dental professional should look for the black processing inserts and notice if they are clear and visible. If everything is okay, the impression should be well disinfected and ready to be sent to the proper dental laboratory.
Creating a working modelprocessing-model
The dental technician should place the locator Abutment Replica into the locator Abutment Pick-ups. He should create a model which would serve as a working one with the Locator Abutment Replica and some stone material with high-quality.
Processing
In this phase, the dental physician should position the spacer above each Locator Abutment Replica supplying primary soft tissue support and a great resilient condition. The dental worker should connect the Locator Processing Cap. Then it has to be processed and cured into the denture. After this, the processed prosthesis should be removed and the spacer should be discarded when the acrylic material has set.
Finishing Phase
The acrylic material should be added as necessary. The dental physician should utilize a burr in order to remove the excessive acrylic and later polish the base of the prosthesis. The final denture together with the Locator Processing Cap should be sent to the dental clinician.

Removingremoving-inserting-finaloutcome
For this phase, the dental clinician should use the Locator Insert Removal Tool for removing the back processing insert.

Inserting
The dental clinician should press the chosen locator and it should be inserted into the Processing Cap’s metal housing utilizing the Insert Seating Instrument.

Final outcome
When all the procedures are done, the dental clinician should seat the dental prosthesis over the Locator Abutments. The prosthodontist should verify that the necessary retention is completely obtained. When it comes to the retention, gradual increasing is always the best solution and the most suitable recommendation is to start with the low-level retention.

Patients should maintain proper oral health care

The great success of a long-lasting implant is definitely maintaining good oral health care habits. Patients have to be informed that the Locator Implant Abutment should be cleaned every day. They have to purchase a soft nylon bristle toothbrush and they have to teach how to polish and superfloss the abutments. The dental clinician would recommend a non-abrasive toothpaste or gel and also a rinsing mouthwash should be found in the oral health care kit. As an additional oral hygiene tool could be an irrigation system such as water floss just to maintain the Locator Abutment socket clean. Patients should not soak their dental prosthesis. Those people who clean their dentures this way, eat salads or spinach, and have some health problems such as acid reflux, should follow the instructions of their dental professional and brush the attachments with water and mild dish soap. This is especially helpful for the nylon attachments because it will keep them smooth and at the same time the solution would reduce the excessive particles on the implant abutments.
Another great idea about checking the patient’s maintenance of the oral health care habits is to schedule an appointment every three to four months for cleanings and the evaluation of the implant condition. This way, the dental clinician would replace the nylon males if abrasive calculus is accumulated because if it is not cleaned it may provoke premature wear on the abutment. In some cases, the dental worker should check and notice if a reline procedure should be done to the denture. When the prosthesis is relined, it gives dentures great stability and at the same time reduces the accumulation of wear on the attachment.
The most concerning area when implants are inserted in the patient’s mouth is the sulcus area. The dental clinician should use proper instruments for performing the scaling of the abutments. Plastic instruments are the first-line choice because metal instruments could leave scratches on the surface of the abutment. During the examination process, the dental professional should check if there are any signs of inflammation around the abutments. Another thing that should be examined is the implant mobility. The dental practitioner should utilize the locator Abutment Driver so he could become sure that the Locator Implant Abutment is well tight before dismissal.

The Future of Locator Abutments

As the medical technology rapidly grows and this allows manufacturers easily create new and advanced solutions for dental situations. The new

generation locator is the new and advanced Locator R-Tx Removable attachment system.
This method offers progressive outline features, new and stronger system simplicity so dental clinicians could quickly realize the practical advantages of upgrading the existing Locator Abutment system. The new methodology of the all-in-one package gives the necessary elements which are needed for the specific case with only one part number. The convenient all-in-one Package contains Locator R-Tx Abutment, Retention Inserts (Zero Retention Insert- Gray, Low Retention Insert- Blue, Medium Retention Insert-Pink, and High retention Insert – Clear), Denture Attachment Housing with Black Processing Insert, and Block Out Spacer.

  • This new, stronger, better and simpler locator provides:

– More wear resistant Duratec Coating
– Treats up to 60 Convergence/ Divergence between dental implants
– Increased pivot technology
– The alignment and seating are easier during the insertion process of the overdenture
– .050”/1.25” Hex Drive Mechanism
– Simple All-in-one Package
– The same restorative technique as the legacy LOCATOR
– The patient is more satisfied with this new method
This revolutionary system is great for both, the clinician and the patient. Looking forward to hearing from the manufacturers what would be their new invention.

Applied Dental Software – The modern way of implant dentistry

  • Planning software versus guided surgery software
  • Software and Tool manufacturers in guided implant dentistry
  • Nobel Guide
  • Straumann Gonyx
  • Med 3d
  • Benefits of implant planning software in combination with guided surgery

1. Planning Software versus guided surgery software

Nowadays most of 3d imaging systems have build in software tools, such as also often implant planning software (Carestream, Newtom…).

The disadvantage of this software is that planning for guided surgery aren’t possible . The purpose of this type of software is just an imagination of the current bone condition without being able to transfer the planning directly to a surgical template.

However guided surgery software such as Nobel Guide or Co Diagnostix allows the practitioner to transfer his planning in the form of surgical templates to the actual patients.

2. Software and tool Manufacturers in guided implant dentistry

3. Nobel Guide:

Nobel guide is currently the most famous guided implant-system worldwide. The advantage of this system is that the practitioner doesn’t need any special tools, calibration pins or any other specific materials to be able to order a drill guide except for a 3d scan unit.

The practitioner has to scan the actual patient, the first scan must be done without any prosthetic device in situ, the second scan with a simulation of the prosthetic devices made of acrylic with 3 different scannable calibration points. These files will be send via a file-upload-service to Nobel Biocare. Nobel Biocare is matching this 2 scans virtually. Due to the overlapping simulation of the future prosthetic solution , Nobel Biocare can create a surgical template, extremely precise as no overlapping calibration pins are disturbing the imaging.

4. Straumann Gonyx:

To take advantage of the Straumann Gonyx system, a dental laboratory need to support the practitioner to fabricate the surgical templates. In the first step this scan-templates fabricated by the help of gonyx unit and then worn during the 3d scan. Due to 3 integrated titanium pins, the position of the scan-template mounted in the gonyx unit can be matched to the planning software. This planning software allows to position dental implants virtually and transfer it to the physical scan template, to be able to use it as a drill guide.

5. Med 3d:

Med 3d works similiar to the Straumann Gonyx system, one of the main differencs are the reference devices. Med 3d works “Lego” parts which will be integrated into the scan-template instead of titanium pins. Typically Med 3d it’s a bit advanced to the Gonyx system due to the slightly higher precision.

6. Benefits of implant planning software/guided surgery

Patient, practitioner and dental technician are profiting from implant planning software/guided surgery.

  • -The patient due to a better positioned implant, which means eventually a longer lifespan of the implant and a better comfort of wearing prostodontic devices.
  • – The dentist due to a facilitated implant positioning method and less complications after the surgery.
  • – The dental technician due to a facilitate fabrication of the implant-prosthodontic work due to the enhanced implant-position.

GINGIVECTOMY VS GINGIVOPLASTY

What is a gingivectomy?

Gingivectomy is a procedure that includes removing the diseased gingival tissue, mostly in the treatment of gum disease. In many cases root planing, scaling and antibiotics are not effective enough. In those cases, gingivectomy might be the right solution. If all of the non-surgical procedures haven’t helped the course of the gum disease, this surgical procedure is the next step. It is usually done by a periodontist or an oral surgeon. It is a very common procedure and it usually provides very good results.

What is the purpose of gingivectomy?

The main reason why this procedure is done is to remove the inflamed gum tissue that is forming the periodontal pockets. This diseased tissue is a very important factor in the treatment of the periodontal disease. Once the tissue is removed, the dentist will be able to completely gain access and visibility to the roots that are affected with the condition and properly remove all of the bacteria. This way, the depth of the periodontal pockets will be reduced and the gum disease will be under control.

Gum disease is, in fact, a progressive condition that is caused by bacteria. If the disease is not treated in time it might lead to loss of the teeth. The pathogen bacteria that cause this condition tend to cause inflammation of the gum tissue and bone tissue, which results with deep periodontal pockets. Very often the conservative, non-surgical measures do not completely remove the bacteria, calculus and inflamed tissue. That is why the disease keeps on progressing.

How is the procedure performed?

There are several ways to perform gingivectomy. It can be a simple surgical one, electrosurgical, chemosurgical, or the latest advancement in dentistry- laser gingivectomy.

The procedure starts with conventional root planing and scaling to remove as much bacteria and diseased tissue as possible. After that, a local anesthetic is used to numb the gums. There are dentists that only practice the surgical gingivectomy and they use a surgical scalpel to remove the gum tissue. If the procedure is performed with a laser, it is faster, there is less bleeding and the tissue heals much faster. Other advantages of the laser are that it provides a good antibacterial effect, the patient doesn’t feel any pain, and there are fewer complications. After the gingivectomy, the gums have to be protected with a surgical dressing, that protects them and helps the healing. The periodontal dressing stays for 7 to 10 days. During the recovery, patients need to provide good oral hygiene and wash their mouth with antibacterial mouthwash. Patients are mostly allowed to eat soft food.

What is a gingivoplasty?

Gingivoplasty is also a surgical procedure, very similar to gingivectomy. The difference between the two is mostly in the objective. Gingivoplasty is in most cases a cosmetic procedure, that is done to improve the look of a person’s gums. This procedure also can be done right after gingivectomy for the same purpose. There are people that are just not happy with how their gums look, so they decide to have them reshaped. Some of them have sufficient gum tissue that has to be removed, while others don’t have enough. For the second type, dentists use a special gum graft. Different gingival deformities are another reason to undergo this procedure.

What is the purpose of gingivoplasty?

The main purpose is that the patient gets a whole new, natural appearance of his gums and smile. If there is an excessive growth of gingival tissue that can cause many problems. First of all, those people have a hard time properly cleaning these areas, and there are higher chances of plaque buildup. In other words, this condition can lead to periodontal pockets and periodontal disease. Also, these patients have a hard time accepting their appearance, which is usually the main reason why they choose gingivoplasty. Other reasons include genetic gingival defects and malformations, crown lengthening, trauma and more.

How is the procedure performed?

The procedure is almost exactly the same as the gingivectomy, only the objective is different. The patient gets numbed, in order to avoid pain. Gingivoplasty can be done by a surgical scalpel, electrosurgery or laser. The procedure can last from minutes up to an hour depending on the number of teeth and the complexity of the case. After the procedure, the wounds are protected with a periodontal dressing that stays in the mouth up to 10 days. Just like with the gingivectomy, the patient has to provide a good oral hygiene and wash the mouth with antibacterial mouthwash. The dentist will give you advice on what you are allowed to do, and how to do it. They will also schedule regular checkups to control the progress after the procedure.

ALL ON 4 IMPLANTS – NO MORE LOOSE DENTURES

Attempts at coming up with a method to achieve successful dental implants have been around for a very long time. In fact, since the 1700s scientists and dentists have been hard at work trying to find a successful method of implanting a false tooth into a human jaw to replace a missing tooth. These include the earliest (unsuccessful) attempts of taking a dead person’s tooth and sticking it in the extraction socket of a living person; to years of trial and error using different tooth root shaped designs of different metals and ceramics and finally to today’s highly technical modern dental implants with 92%-99% success rates.

One innovation directly related to these implant advances was discovered through research and named “All on 4”. This technique is a real breakthrough for patients who wear full dentures. This unique means of utilizing implants eliminates the problems inherent in patients having to wear removable full or “complete” dentures. Some of these inherent problems include:

  • Loose or ill-fitting dentures
  • Having to use increasing amounts of denture adhesive to stabilize dentures
  • Avoiding foods that are very difficult or impossible to eat
  • Having to remove dentures at night.
  • Needing to have them replaced every three to six years
  • Having long-term wearing of dentures cause gradual bone loss of the supporting ridges
  • Breakage
  • Negative psychological factors involved in wearing removable “false teeth”.

“All on 4”

“All on 4” is a very apt description of the procedure. It means attaching a complete (ALL) set of non-removable artificial teeth to four (4) dental implants; “All on 4”.

Dental Procedure

The procedure is straight forward and patients can have a temporary (provisional) set of teeth placed immediately (24-48hrs) after the surgery.

  1. Each patient will have a complete oral examination and consultation.
  2. Special x-rays are taken to evaluate the amount and condition of the bone for implant treatment planning.
  3. A temporary non-removable set of replacement teeth similar in form and function to the final permanent restoration will be fabricated by a dental laboratory before the implant surgery. If the patient has an acceptable set of dentures, they may be used instead as the temporary denture.
  4. An antibiotic treatment is ordinarily started 2 days before surgery and continued for ten days after.
  5. Most patients are given intravenous conscious sedation and/or nitrous oxide and local anesthetic for the duration of the surgery. Some patients may require general anesthetic.
  6. The bone is exposed and inspected to make sure it is suitable for the implants and if there are any teeth needing removal, they will be extracted.
  7. The 4 implants are placed in each arch; two near the front of the arch and two in the back part of the arch. The two in the back are tilted which is the main feature that allows only 4 implants to support a full set of artificial teeth.
  8. The gum tissue is sutured back around the implants.
  9. The temporary denture is adjusted and attached to the 4 implants.
  10. Follow up visits are scheduled at 1 week, 2 weeks, 3 weeks and 3 months.
  11. At the 3-month appointment, the implants will be inspected and if indicated by complete and correct healing, the temporary denture will be removed and the permanent replacement attached to the implants.
  12. Follow up implant maintenance appointments are scheduled.

In some rare cases at the time of surgery unexpected, unfavorable conditions may be discovered that may require placing standard implants, delaying the placement of a temporary denture that is attached immediately to the implants.

Standard Implants

Standard implants have many things in common with the implants used in the All on 4 procedure. The basic surgery is similar as are the shape, material, etc., of the implants.

The primary difference is that standard implants are placed into the jaw, and are covered back up completely by the gum tissue and allowed to heal for 3 months and the temporary replacement is not attached to the implants.

During this healing time, a temporary removable denture will have been fabricated for patient use, or the patient’s existing denture will be adjusted and refitted to serve as a temporary replacement. So, until the standard implants have healed enough for the attachment of the permanent set of teeth, the patient will be wearing a conventional type denture.

Immediate Versus Delayed Loading

The All on 4 procedure uses a concept known as immediate loading. Immediate loading means that the patient receives a functioning temporary dental restoration that is placed at the same time as the implant surgery. In the case of the All on 4 full mouth procedure, the patient can eat, and function with a full set of temporary teeth which immediately places a force or load on the implants, hence immediate load.

Advantages of Immediate loading include:

  • Improves bone healing over traditional implant procedures (osteointegration).
  • No need for a removable temporary replacement and its attending maintenance.
  • Eliminates standard implant exposures from the wearing away from the pressure of a removable temporary appliance (partial denture, denture).
  • Gingival (gum) tissue shaping is facilitated.
  • Can’t be used on every patient.
  • Shortened treatment time.
  • Only one surgical procedure.

Torqueing

Dental implants need to be screwed into the channel made in the bone. The amount of pressure applied to the implant is called torque. As an example, if you have a flat tire and neglect to tighten the lug nuts enough the wheel may become loose and fall off. On the other hand, if you overly tighten the lug nuts, you may not be able to loosen them to take the wheel off.

Dental implants are similar in some ways to the lug nuts of a car. With implants, if you do not tighten the implant with enough torque, the implant has a greater chance of failure. Conversely, overtightening the implant also carries a risk of greater failure. To lessen this chance, dentists use a torque wrench or hand piece to precisely measure the correct torque which usually has a range of 30 ncm to 60 ncm. There are some disagreements among dentists concerning the range of torque.

Delayed loading is defined as it sounds once the definition of immediate loading is understood. For various reasons, some implants cannot withstand any force being placed on them immediately until they have healed and are stable. In these instances, other temporary replacements are used that do not put any stress on the implants. In these cases, putting any pressure or a load on the implants is put off or delayed, until complete healing of the implants, hence delayed load.

At Tooth and Go dental clinic we have the latest training, equipment and modern facilities to provide our patients with quality and affordable All on 4 procedures. We also provide standard implants. See what our implant plans can offer you at Tooth and Go.

DENTAL IMPLANT HOME CARE – PROTECTING YOUR INVESTMENT

You may have struggled with gum disease, dental decay or an accident that resulted in loss of some or all your teeth. You researched your dental treatment options and with the help of your dentist you decided dental implants were the best choice for you. You invested a considerable amount of money, time, and effort in them.

In this article, we are going to advise you on how to protect your dental implant investment through the very latest dental implant home care methods. We’ll also let you know how your dentist and dental hygienist will partner with you to assure that you will have the best implant experience possible, for a lifetime of satisfaction and healthy smiles.

It might not surprise you that one of the biggest reasons dental implants fail is because of poor dental implant home hygiene. Old habits are hard to break sometimes.

If you get nothing else out of this article, remember that it is up to you to take care of your implants. If you originally lost your teeth through decay or gum (periodontal) disease because of poor oral hygiene, it is imperative that you develop new habits. Your dental team can help and advise you, but once the implants have stabilized, impeccable home oral hygiene practices are essential.

There are two pitfalls that patients should be aware of when first beginning to take care of their implants.

  1. Being too timid with oral hygiene practices. Some patients may be afraid that they may damage the implants and gum tissue. This results in inadequate brushing and flossing. Failing to remove plaque and dental debris from around the implants can cause an infection around the implant (peri-implantitis).
  2. Being overzealous with oral hygiene practices. Some patients may go the other way and over-brush and over-floss their implants along with using other oral hygiene aids that may not be appropriate. In this case, damage might occur from possible scratching of the implant surface and irritation of the gum tissue surrounding the implant(s).

Your dentist or dental hygienist will help instruct you during one of your initial visits on the proper pressure, methods and dental cleaning aids you will need to properly remove plaque and debris from your implants. They will also advise you on specific dental hygiene practices if you have:

  • Natural teeth with implants
  • Overdentures/partial dentures with implants
  • Overdentures/partial dentures with implants

Home Care Hygiene Specifics

  • Toothbrushing: Implants need to be brushed twice a day using either a soft toothbrush or a very gentle electric toothbrush. Smaller end tufted toothbrushes can be used in harder to reach areas. Some electric toothbrushes may be too harsh for implants, so ask the advice of your dentist.
  • Flossing: There are various types of floss. Your dentist or hygienist can advise you of the appropriate type to use in your case.
    • Plastic
    • Braided
    • Satin
    • Woven
    • Yarns
    • Tapes

Ask your dental hygienist about ‘floss threaders” and the “shoe shine” method of flossing as well as the regular method of utilizing dental floss.

  • Interdental Cleaners/Aids: These oral hygiene devices are used in between teeth (interproximal) where tooth brushing and flossing do not effectively remove dental plaque and food debris. They include:
    • Foam/rubber tips
    • Disposable wooden picks
    • Interproximal brushes with plastic wires
  • Water Irrigators: Water irrigators can be very effective in home care for dental implants. Direction of the jet stream of the irrigator is important and your dental team can instruct you in the proper use of your irrigator.
  • Dentures: Patients who have overdentures/partial dentures should give their dental appliances the same high degree of hygiene they give to their implants. Dentures should be soaked in a recommended cleaner, brushing the denture thoroughly and inspecting the retention rings and/or retention clip.

Your dentist may recommend that you use a chemical rinse such as chlorhexidine. These rinses help keep oral bacteria rates low and many of the dental hygiene aids such as an interproximal brush can be used to deliver chemical rinses into and around the implant to further reduce harmful bacteria.

Working with Your Dental Team

Impeccable home care is essential, but even with the best home care, your dentist and dental hygienist are indispensable in the long-term success and protection of your investment. It is important that you schedule maintenance visits at least twice a year. At that visit you will receive:

  1. A cleaning (prophylaxis) of your implants by your hygienist or dentist to remove hard deposits (calculus). Special cleaning instruments are used that will not scratch the implants.
  2. A check of how your implants are fitting together (occlusion).
  3. A check to make sure your implants are secure in the bone and not movable.
  4. X-rays to check the bone surrounding the implants.
  5. Helping you with any difficulties you may be having with your dental implant home care.

When it comes to investments. We all want to assure that we receive the very best return. Tooth and Go dental clinic has been awarded “The best dental clinic in the Philippines” by the Global Clinic Rating service. (2016).

“At Tooth and Go dental clinic, we are confident that using cutting edge technology allows us to provide our patients with the best possible treatment they deserve.”

We understand the amount of time, money and effort you put into maintaining your oral health.

Besides offering dental hygiene services and information to protect your dental investments, we also offer quality and affordable implants along with general and cosmetic dentistry.

ARE YOU A GOOD CANDIDATE FOR DENTAL IMPLANTS

Dental implants replace natural teeth for patients who have suffered tooth loss due to various causes (gum diseases, accidents). Normally, anyone who is healthy enough to go through tooth extraction and surgery is a good candidate for dental implants. However, people suffering from diabetes, cancer or heart diseases should be carefully evaluated before undergoing such a treatment. Also gum diseases should be treated properly (a periodontal treatment is recommended) before starting any dental implant procedure.

Prior to dental treatment, it is important to inform your dental surgeon about your medical status, as well as all medications you are taking. If you consider dental implants, note that you should have healthy gums and enough bone to hold the implant. You should also maintain a good oral hygiene and pay regular visits to the dentist.

Success rates of dental implants vary, usually, dental implants have a success rate of up to 98%.

ADVANTAGES AND RISKS OF DENTAL IMPLANTS

Dental implants have many advantages:

  • Permanent implants contribute greatly to the improvement of patients’ appearance, who will have natural looking, healthy teeth for many years.
  • The improvement of the appearance will have a great impact on the patient’s self-esteem.
  • Dental implants contribute to easier eating – patients no longer experience difficulties and pain when chewing their favorite foods.
  • With proper care, good quality implants can even last for a lifetime.
  • Individual implants allow easier access between teeth, improving oral hygiene.

RISKS RELATED TO DENTAL IMPLANTS

Dental patients who just got dental implants should look after them just as they look after their natural teeth: brushing, flossing, rinsing with antibacterial mouthwash are a must. In rare cases, patients can experience complications after implants:

  • Infection of the area around the implant
  • Injury or damage to other surrounding teeth or blood vessels.
  • Pain, numbness or tingling in natural teeth, gums, lips or chin due to nerve damage

WHY CHOOSE THE PHILIPPINES AS A DENTAL TOURISM DESTINATION

If you are looking for a good clinic where you can have affordable dental implants, a quality Philippines dental clinic might be the answer. Getting a dental implant in Manila is a very good idea, if we consider a few aspects:

  • Philippines dentists are very good specialists, trained in some of the best European medical schools
  • The prices of the best dental implants in the Philippines are far better than the prices for the same procedures in the US, Western Europe, UAE or Australia.

COST OF DENTAL IMPLANTS IN THE PHILIPPINES

The dental implants costs in the Philippines range between $1,000 – $15,000 (P43,000 – P645,000 in Philippine Pesos) whereas in western European countries, US or Australia the prices can be much higher. The average completed dental implant in the U.S. costs about $4250 and in Australia the implant post costs between $1000 to $3000 and the abutment and crown cost between $500 to $3000.

If we make a simple calculation and consider the numerous advantages offered by a dental implant in Manila, the choice is easy. Contact our clinic for a detailed consultation and a careful treatment planning. Our dentists will offer you a big, beautiful smile that will improve your self-esteem.

THE ALL ON 4 DENTAL IMPLANT TECHNIQUE – CHARACTERISTICS AND COSTS

The all on 4 dental implant is a modern technique used to restore a full arch of teeth, using four dental implants. The procedure is increasingly popular, as it is a perfect alternative to dentures most people avoid due to slipping struggles, maintenance requirements and food restrictions.

ADVANTAGES OF THE ALL-ON-FOUR DENTAL IMPLANTS

Due to the all-on-four technique, now dentists can replace all missing teeth with just 4 implants. During the All-on-4 implant process, your dentist will place four implants into the jaw bone immediately after removing your teeth. These implants can be placed in just one day.

Patients should just eat soft food for up to eight weeks after the procedure, to help keep the implants in place. If the implant is strong enough, it is possible to deliver the whole arch of permanently fixed teeth. This eliminates the pain caused by immediate dentures or the embarrassment of wearing no teeth at all for a period of time.

One more advantage of the all-on-four implants is bone restoration and bone loss prevention, leading to a beautiful smile. Unlike dentures, these implants won’t make it hard for patients to chew, bite or speak. The all-on-fours will feel like natural teeth and no adhesive is needed.

ALL ON 4 CLEANING

The all-on-four dental implant must be properly taken care of. The patient must pay regular visits to the dentist for:

– the regular exam
– yearly X-Rays
– tartar removal

If all of natural teeth are missing, then a once a year visit may work fine. However, patients who tend to build up a lot of tartar should come to the clinic more often.

RISKS AND MAINTENANCE

> With proper care, the all on fours can last a lifetime. To protect this costly dental work, patients can wear a night-guard for acrylic or porcelain all on 4 teeth; a night-guard will protect the investment and is well worth the up front cost.

THE COST OF DENTAL IMPLANTS

Getting the all-on-four dental implant procedure is an important investment in your appearance and health. The cost for such an elaborate yet effective dental work depends on several factors. In the US for example, the cost of a single dental implant averages between $1-3000 per implant. Therefore, for the complete procedure, a patient can pay up to $12,000 per arch and even more if we add the cost of x-rays or tooth extractions.

If you choose to get the all-on-four implants in our clinic in Manila Philippines, you can discover the quality treatment we offer for affordable prices. At Tooth &Go, first we make sure the patient is a perfect candidate for this procedure, then, after a close documentation about the patient’s medical history we proceed to treatment planning and implant placement. The cost for the entire procedure can range from $8900-9900 per arch in our clinic. If you are convinced of the effectiveness of this technique, contact us and get a price quotation now.