Dental Implants in Marylebone

Following tooth loss, different and alternative options and procedures are recommended by your dentist to replace your missing tooth and to restore appearance, speech and chewing comfort.

Although it may sound more time-consuming and more costly, dental implants, as discussed earlier, offer a few advantages of more long-term stability and less invasiveness to the adjacent tissues and teeth. Like a tooth root, a single titanium implant is firmly attached or integrated into the jaw bone.

An implant could be placed immediately or soon after a tooth is extracted to preserve the jaw bone. In cases of residual acute infection, a delayed surgical approach is preferred to minimise the infection risk. In some instances, as a result of bone loss, additional bone grafting is required before the dental implant placement. Following the treatment, you will have long term reviews with both your dentist and your hygienist.

The procedures and timescale for treatment are outlined below:

At the time of your consultation phase, diagnostic x-rays, e.g. CBCT Scan, is requested, and study models are taken to confirm that treatment possible.

Under strict sterile conditions and local anaesthetic, the bone topography will be assessed, following which your implant will be placed and covered again. You will be then reviewed within two weeks for the control of tissue healing and possible suture removal.

When the bone graft has healed and the placed implant has integrated, an appointment is made to commence the process of implant restoration. Under local anaesthetic, the implant may be exposed, and a healing collar called healing abutment is placed on the implant. The technique indicated abutments (posts), and a provisional crown could be inserted on the implant at this stage.

To modify the soft tissue healing, immediate provisional restoration may be placed to optimise the bite, colour, position, projection and shape of the definitive crown.

During the final treatment phase, the implant will be restored. An analogue or digital impression will be provided to design and fabricate the final crown.

During the maintenance phase of the implant treatment, regular hygiene visits and check-ups are planned on a quarterly or biannually basis to prevent and intervene with any possible inadvertent risk for biological or mechanical complication around your functional dental implants.

Upper and Lower Fixed prosthesis on 6 implants

1. A solution for everybody
2. Procedures from diagnosis to aftercare,
3. Main benefits
4. Other frequently asked questions

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The concept of ALL-ON 4 or 6 implants for the Straumann® Pro Arch is based on a fixed rehabilitation of removed/missing teeth utilizing immediate placement and loading of four or six dental implants with a provisional fixed bridge. This requires a careful and comprehensive treatment planning procedure encompassing CBCT radiography, sophisticated surgical procedures, and laboratory stages, converting the provisional bridge to the final full-arch prosthesis.

Based on the recent scientific literature reviews, it has been concluded that only two 2 appropriately placed posterior respective anterior implants are deemed to support a fixed prosthesis adequately and to avoid the need for undertaking any major bone graft­ing procedures (Mericske-Stern and Worni, 2014).

Straumann® offers a comprehensive portfolio for the treatment of edentulous patients – a task that often remains a challenge considering the expectations and clinical limitations involved. Here, we can help you evaluate and offer the right solution – be it removable or fixed restorations and straightforward or advanced indications.

• Patient-centric Freely chooses the treatment based on the specific indication and the patient’s needs, preferences and financial situation.
• Peace of mind Trust in outstanding materials that deliver high performance, strength, and longevity.
• Practice growth Combine broad treatment options with comprehensive patient communication and practice development tools to foster your practice growth. Please refer to the following link from the Straumann® official patient site for further insight into the restorative solutions for edentulous patients:

Please refer to the following links from the Straumann® official patient site to access dental implant patient brochures and videos about the following subjects:

1. A solution for everybody:
https://www.straumann.com/en/patients/patients-expectations.html

2. Procedures from diagnosis to aftercare:
https://www.straumann.com/en/patients/treatment-steps.html

3. Main benefits:

• Reduced treatment complexity
• Immediate function and aesthetics
• Clinical long-term success
• High patient comfort

https://www.straumann.com/en/patients/why-do-dentists-love-straumann.html

4. Other frequently asked questions:
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Image left: LOCATOR® on two dental implants.

Image Right: Bar with pre-fabricated individualized parts on four dental implants

Over-denture is a favourable and straightforward prosthetic treatment modality for elderly patients. There are fewer implants involving limited traumatic surgical invasion, and fewer clinical chairside and financial resources are required. There are instances where the provision of the conventional implant-supported fixed prosthesis (ISFP) is not clinically feasible due to the extensive atrophied residual alveolar bone where only a few implants could be placed in the front region of jaws rendering provision of implant retained overdentures (ISOD) a viable and predictable treatment modality. This alternative also facilitates the replacement of lost hard and soft tissue, especially in patients with congenital/acquired defects, to improve aesthetic, phonetics and avoid food entrapment.

Most of the old patients often ask for better prosthesis stability, particularly in the lower jaw. In patients with compromised manual dexterity, overdentures would be less demanding for the practice of self-performed plaque control.

Soft tissue complication due to the adverse effect of mucosal coverage, initiating or accentuating severe gagging reflex, patient intolerance to dentures due to psychological/physiological reasons in some cases together with requirements for higher maintenance involved are some of the inherent back draws which may render the provision of IS & IR OD design less appropriate in some individuals. In some cases, inadequate restorative space over the abutments renders the OD bulky what is not acceptable for some patients. To avoid this problem, the technician may reduce the denture's acrylic body over the abutments, which render the construction less resistant to fatigue fracture. In the case of the very well preserved alveolar ridge, the patient may not benefit from specific advantages of overdentures, and an ISFP may be a more appropriate option.

The inherent problems such as divergent and buccally directed implant alignment, long teeth, open interdental spaces and incongruent implant distribution/ tooth position render the provision of maxillary ISFP rather challenging. To address the aesthetical requirement for such morphological discrepancies, gingival-mask (epithesis), as well as buccal flanges for ISFP (Mericske-Stern et al. 1998b), has been satisfactorily fabricated.

The optimum implant placement in overdenture cases is more consistent with the available bone quality and quantity. The denture base also facilitates phonation by restoring the phonetic zone. Some literature reports a higher survival rate (stability) for the OD than for the actual implants. They also reveal that the mandible survival rate is more favourable than the maxilla, where failures are mainly related to poor bone quality, short implants, and long lever arms. The different anchorage systems of overdentures (balls, bars, and magnets, single attachments) do not seem to influence the implant failure rates (Jemt et al. 1996).

Naert et al. (1997) reported a cumulative success rate of 97% in their 9-year longitudinal study for the IROD. There was no difference observed in SR for the mandibular IROD, whether the two implants were connected by a bar or left individually. It should be borne in mind that these data relate to the IROD, where OD is mucosally supported in the distal areas.

The increasing demand for the fabrication of maxillary IR/S OD suggests a strong need for this modality of therapy when treating specific selected cases of the edentulous maxilla. However, the provision of IR/S OD should not be considered a remedy to salvage the failing fixed prosthesis. To improve this modality's success rate, meticulous surgical protocol, well-designed rigid supra-structure supported by adequate number and size of the implants (minimum four well-distributed) is a crucial functional demand of OD in each case.

Biomechanical parameters of the implant-supported and implant-retained prostheses (IS & IR) are influenced by the design of the sub-structure, supra structure, and impression technique applied. It should be emphasized that biomechanical principles applied for IROD are very different from that of for ISOD, where four implants are connected with a rigid bar providing a semi cross-arch stabilization as it has been shown that a rigid bar (Dolder bar) on telescopic attachment provides support and stability comparable to the framework in fixed prostheses (Mericske-Stern et al. 1998b).

As there are more components (abutments, bars, clips, anchors, female retainers) involved in constructing the overdentures, more technical and clinical complications are reported requiring more service and maintenance (Taylor 1998). Denture base and underlying soft tissue deterioration are also more specific to the overdentures. Therefore, the clinician should explain the importance of the routine maintenance service and possible non-routine repairs required after the provision of overdentures in the context of the cost-benefit discussion.

Fractures and loosening of the abutments (mainly in maxilla due to non-parallel implants), retaining screws, bar clips (mainly in the mandible), female parts of ball anchors and fracture of the bar and its extension, acrylic tooth, resin, prosthesis, and framework are complications related to IR/S OD:s.

Soft tissue hyperplasia, stomatitis, soreness, and food impaction may require adjustments of the prostheses or reline of the overdenture, occlusal correction, tooth re-arrangement and redesigning of overdenture (Jemt et al. 1996). Hyperplasia has been mainly associated with the maxillary OD, while the marginal soft-tissue recession has been observed more around the mandibular OD.

Fatigue fractures, impaired phonation, and aesthetic problems are the observed complications in maxillary ISFP, requiring redesigning prostheses. At the same time, lip biting is more prevalent in conjunction with the lower ISFP. In contrast to overdentures, the need for all kind of services may decrease over time for ISFP (Jemt 1991).

The provision of IR/S-OD favours the masticatory comfort and efficiency, phonetics and aesthetics of the patient. Subjective criteria such as hygiene procedures, oral comfort, and ease of handling the prosthesis are determinant factors for patient preferences.

Comparing the patients' experience before and after oral rehabilitation with IR/S OD reveals a higher overall satisfaction, decreasing slightly over time. This so-called "combination syndrome" due to loose maxillary conventional complete denture with anterior resorption and unstable posterior contacts is described following the provision of inter-foraminal IROD (Lechner & Mammen 1996).

The literature suggests that mandibular IROD is a predictable and successful treatment modality that improves life quality, especially in patients who have already experienced wearing their conventional dentures satisfactory and successful. Where short implants are placed due to the severely atrophied jaw, it is recommended to insert more than two implants and connect them by a rigid bar to retain and support the prosthesis with a complete denture design.

The success rate of dental implants retaining and supporting overdentures may vary but be similar to a fixed prosthesis. However, only after assessing cost/benefits, risk benefits, patients' preferences, advantages and disadvantages of fixed contra removable option for each specific case, the application of each modality may be indicated and justified to achieve an optimal clinical outcome in the best of patients' interests.

Maxillary alveolar/cross-arch CAD/CAM bar & mandibular cast gold bar supra-structures support upper alt. lower full-arch removable prostheses/over-dentures.

The patient's clinical appearance wearing upper and lower full arch removable prosthesis/over-denture using alveolar/cross-arch implant-supported bar supra-structure.

Maxillary mucosa-supported/retained acrylic prosthesis; mandibular partial removable acrylic prosthesisCourtesy(Dr Nico Kamosi).

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As a result of tooth extraction, dental infection, trauma and postoperative bone resorption, it would be necessary to reconstruct or augment the bony ridge defect before or simultaneous to implant placement to ensure sufficient bone around the implant. The alveolar ridge may need to be restored to assure a long-lasting and stable tooth replacement utilizing dental implants.

Both the function and the aesthetics of the implant-supported teeth can be severely compromised when the supporting bone and gum is deficient. In the absence of intact bone, it is impossible to replace a lost tooth using an implant-supported crown option.

These materials are sometimes covered with a protective collagen membrane derived from porcine (pig) or bovine (cow) collagen. The membrane protects the bone graft particulates while preventing displacement and early resorption of the graft material.

Most of the collagen membranes resorb entirely by the body following the bone regeneration If you do not wish consent to having any animal-derived graft or membrane products, please inform your doctor before signing the consent forms.

Bio-Oss® is a natural bone mineral derived from bovine (cow) bone with similar micro-architecture as human bone with bone scaffolding or osseo-conductive properties promoting the blood vessels' ingrowth and bone cells which gradually integrate into the native bone completely.

Bone ceramic particulates, e.g. Vitabone or Regen®, are synthetic bone graft materials made from tri-calcium phosphate naturally present in your own bone, while it has a faster resorption profile of three to six months.

• Morphology determines: vascularisation & osteo-conduction
• Composition determines: degradation & biocompatibility
• Degradation determines: replacement (substitution) of bone filler material by bone
• Similarity to the optimal characteristics of a bone substitute:
  Optimized 3D structure morphology; Osteoblast-friendly topography (osteo-conductive)
• Fully synthetic composition: no risk of transfection, reproducibility; Controlled" degradability e.g. while initiating mineralization, protects against excessive resorption".

For minor bone deficiencies, guided bone regeneration may be implemented. This may involve using a membrane that acts as a biological barrier to promote bone regeneration and mineralization around the defective alveolar ridge. The barrier prevents other cells from growing into the defect whereby enables merely the bone cells ingrowth.

Guided bone regeneration or 'augmentation' procedure is performed using various techniques and materials, including human/animal-derived and synthetic products. Based on the amount of bone required, the patient's bone or a mixture of all these may be used.

In the absence of bone augmentation, the bone defects resulting from trauma or extracted tooth, gum recession may be developed around the neck of the implant, which would result in the aesthetic and biological complication,especially in the aesthetic zone. Although bone grafting procedure is often very successful, some biological complications such as infection or resorption may interfere with successful graft integration and consolidation.Autogenous bone grafts can be harvested from the upper or lower arches, such as the wisdom tooth area, the chin

Straumann®Emdogain consists of amelogenin for periodontal regeneration

Straumann®BoneCeramic is used for filling and/or augmenting intraoral/maxillofacial osseous defects

Straumann®Emdogain+Straumann®BoneCeramic is indicated for:

• Augmenting intraoral/maxillofacial osseous defects
• Bony defects of the alveolar ridge
• Tooth extraction sites
• Pneumatized sinus
• Intrabony periodontal osseous defects and furcation defects

Bone and gum augmentation can reconstruct much of the loss that follows tooth removal.

This can be carried out either before or at the time of implant placement.

Bone loss at the back of the upper jaw can make it more difficult to place implants because of the presence of the Sinus. Have a look at the Sinus Augmentation section to see how we resolve this problem.

A bone graft material is placed below the tissues with a collagen membrane to contain it.

Additional gum tissue can be harvested from the palate, where it is very thick.

The bone graft material is usually a Bovine Extract (Bio-Oss), although non-animal products are also available.

• Bone replacement materials together with resorbable collagen membrane used
• Enhancement with connective tissue grafting
• Grafting with implant placement
• Grafting as a separate procedure.
• Healing of ridge takes between 6-9 months.

If you have too little bone at the back of the upper jaw,a sinus augmentation can solve the problem. Sinus Augmentation makes it possible to increase the amount of bone and place implants.

We have carried thousands of bone augmentation procedures over the past 25 years resulting in many happy patients having their implants.

This procedure aims to increase the amount of bone available at the back of the upper jaw. The sinuses occupy much of the space in this region, and the aim of this surgery is to place a graft below the sinus lining to create a greater quantity of bone at the sinus floor.

This procedure is carried out in the dental chair with a local anaesthetic. The bone-replacement graft material is allowed to heal for a period of nine to twelve months. During this period,the graft is replaced by new bone, and once it has healed, dental implants can then be placed.

Some surgeons use bone harvested from the patients' hip or jaw for this procedure. However, we have found that dental implants placed in the bone-replacement graft materialfollowing healing have the same success rates as dental implants placed in the nongrafted bone.

The use of the bone-replacement graft means that there is no need for a general anaesthetic or a hospital stay or a second surgical site and allows for a quicker recovery after surgery.

Sinus graft is a technique-sensitive procedure. The success of the procedure requires surgical and prosthodontic skills.

Despite complications such as tearing of the sinus membrane, infection of the graft, or loss of the implants, any long-term sinus complication rarely occurs.

Tolman, D., 1995. Reconstructive procedures with endosseous implants in grafted bone. JOMI 1995)

The lining of the healthy sinus is a structure with immunologic homeostasis. Bathed with mucin, lactoferrin, sIgA, which inhibits epithelial colonization of microorganisms and, in conjunction with ciliary action, maintain a sterile sinus environment. The sinus lining's reparative capacity is rapid, and it returns to a sterile state soon after sinus graft wound healing.

Misch CM. 1992. The pharmacologic management of maxillary sinus elevation surgery. J Oral Implantology. 1992

Endoscopy prior and posterior to the sinus grafting has demonstrated normal sinus function, including ciliary action. It appears that as long as the sinus graft does not extend high enough to interfere with ostium function, grafting in this area of the maxilla is not contraindicated physiologically and is generally a benign procedure.

Watzek G. et al., 1998. Anatomic and physiologic fundamentals of sinus floor augmentation. Quintessence 1998.

A review of biopsy from the sinus grafts been reported separately demonstrates that bone forms endosteally from the sinus floor with every material reported as long as a pace is maintained beneath and an intact sinus lining to form a closed wound environment.

Lazzara RJ. 1996. The sinus elevation procedure in endosseous implant therapy. Current opinion in Periodontology 1996,

Summers RB. 1994. A new concept in maxillary implant surgery. Comp ContinEduc Dent 1994

Jensen OT, Sennerby L. 1998. Titanium micro-implants retrieved from human sinus cavity bone grafts. JOMI. 1998.

The addition of osteoconductive alloplastic materials that maintain an apace above the sinus floor within a blood clot has been associated with the bone formation that ascends from the floor of the sinus several millimetres up into the graft.

Jensen OT. 1998. Treatment planning for sinus graft. The sinus bone graft, Quintessence 1998

Osteoinductive materials form new bone endosteally from the sinus floor as expected and form bone de novo within the graft depending on its osteoinductive (and osteoconductive) capacity.

Kirsch et al., 1998. Sinus graft using porous hydroxyapatite, in the sinus bone graft by Jensen., Quintessence 1998.

In general, autografts are highly osteoinductive and may be less dependent on sinus floor endosteal bone migration.

Marx RE. 1995. Osseointegration in natural bone, radiated bone, grafted bone—University of Miami Symposium Syllabus.

Materials containing BMP used in the sinus include allograft, autograft, BMP-2,7, which by themselves form the complete consequence of bone formation.

Nevins et al., 1996. Bone formation in the goat maxillary sinus induced by absorbable collagen sponge implants impregnated with recombinant human bone BMP2. Int J Perio Rest Dent 1996.

Animal studies using block autografts showed a high level of osseointegration compared to particulate autografts. Human studies?

Lew et al., 1994. A comparative study of osseointegration of titanium implants in the cortico-cancellous block and cortico-cancellous chip grafts in the canine ileum. J Oral Maxillofac Surg.1994. Intimacy of graft-vitality/fixation,consolidation/scar tissue vitality

Sinus allografts may have more late loading failure, more infections, and more stage 2 uncovering failures than other materials.

Jensen OT. Greer, R., 1992. Immediate placement of osseointegrating implants into the maxillary sinus augmented with mineralized cancellous allograft and Gore-Tex. Quintessence 1992.

Do they interfere with bone formation and osseointegration, implant fixation in the remodelling phase? vital/nonvital bone due to incomplete replacement by creeping substitution

Aspenberg et al., 1988. Rapid bone healing delay by bone matrix implantation, JOMI. 1988

The mechanical significance of this is unknown, but it probably makes fatigue failure more likely!

Frost, H., 1998. Vital biomechanics of bone-grafted dental implants. In the Sinus Bone Graft by Jensen, Quintessence 1998.

The way the various sinus grafting materials undergo angiogenesis, osteogenesis, consolidation, osseointegration, and remodelling requires more study to determine the exact mechanism of healing, establish the optimal grafting material, and further define the critical stages of healing.

Sinus lining/ endo-periosteum as the source of angioblast-osteoblast and /or Pluripotent cells and vascular capacity Summers RB. 1995. The osteotome technique: part 4- future site development. Compendium 1995.

No significant morphogenic protein or Osseo-proliferative contribution is found from the infractured sinus wall, demonstrating a more passive or osteoconductive effect.

The type of implant surface texture (rough-surface including HA-coated & TPS implants) and the material appears to be an essential variable in the bone graft setting. This indicates that in grafted bone, these surfaces may have a greater capacity to osseointegrate.

Jensen et al., 1996. Report of the sinus consensus conference of 1996. JOMI.vol. 13. 1998.

In the nongrafted setting, rough surfaces have resulted in more significant bone contact and greater torque removal capacity in the human tibia.

Carlsson L. et al. 1994. Bone response to HA-coated and commercially pure titanium implants in the human arthritic knee J Orthop Res 1994.

The biomaterial surface's chemical nature may also result from its increased capacity to bridge small gaps between the implant surface and the bone graft (up to 1mm). In contrast, machined titanium bridges osseous gaps of only 0.25 mm consistently to form intimate, early contact and then osseointegration.

Jensen JA. et al., 1993. A histological evaluation of the effect of HA-coating on interfacial Response. J Mater Sci Mater Med 1993.

However, there is no evidence to determine if rough surfaces are > favoured in the bone-graft setting and data regarding comparative success rates of the different implant surface is required.

Carlsson L. et al. 1988. Implant fixation improved by close fit :

Cylindrical implant-bone interface studied in rabbits. ActaOrthopScand 1988.

(O T. Jensen et al.1996.JOMI.vol. 13. 1998)

• Retrospective data from sinus floor augmentation bone grafts were collected from 38 surgeons for 1007 sinus grafts that involved the placement of 2997 implants over a 10-year period. The majority of implants followed for 3 years or more post-restoration.
• 229 implant failures reported with a 90% success rate of implants placed in sinus grafts with at least 3 years of function.
• Controlled perspective?)
• Multivariate/multifactorial database!

Consensus: Sinus graft should now be considered a highly predictable and effective therapeutic modality. Sinus graft (sinus lift), introduced by Tatum (1986) and Boyne & James (1980)

• 61% implant failure when there was a 5mm or less of the presurgical bone present.
• 61% implant failure when implants were placed simultaneously with sinus bone grafting.
• Smoking was reported as a factor In 50 (31%) of the 164 implant failures.
• Ethanol abuse was considered a factor in 4 (3%) implant losses.
• End-stage peri-implantitis occurred in 49 implants (18 machined titanium, 36 HA-coated, 5 TPS).
• The overall success rate for delayed placed implants was 83.9% and 85.5& in the simultaneous group, statistically no differences.
• Regardless of harvest site, grafts did somewhat better with the delayed approach (87.4%) than with the simultaneous approach (79.1%)

Sinus spaces are cavities in the upper jaw (Maxilla) on each side of the nose and above your upper back teeth. Specially treated donor bone is placed into these empty areas. Over a period of time, this is replaced by new bone, thus providing a bed into which implants can be fixed.

Whatever type of bone is added o the sinus, it must be left to mature before implants are placed or brought into function. Implants can be inserted after four to nine months, although occasionally, it may be necessary to wait longer.

As with other one grafting procedures, the implants are left to become firmly attached to the bone. A slightly extended healing period is commonly chosen with an average of six to nine months before a denture or crown and bridgework are fitted. However, all bone grafting is unique to each individual, and this information is for guidance only.

At the time of the procedure: If any infection is found or a tear in the sinus lining occurs, it may be necessary to discontinue the procedure.

• The postoperative symptoms are unpredictable and vary in different patients.
• Severe complications are infrequent, but most patients will have some swelling and a minority bruising, and some may have temporary closure of the eyes.
• Occasionally mild nose bleedings may occur.
• You may not work for a few days.
• Later complications:
• The possibility of infections of the sinus post-operatively is very low.
• If this does occur and the infection continues after antibiotic treatment, it may be necessary to clean the sinus graft out. A rare complication is the development of a small hole from the sinus into the mouth. This can be treated.

• Avoid blowing your nose for 2 weeks.
• Sneeze through your mouth
• Avoid swimming or flying.
• Report nose bleeds or sinus pain or swelling immediately.
• Swelling is often worse by the 2ndor 3rdday and may persist for a few days. If it persists for more than a week, then contact the surgery immediately.
• Soft diet during the first days
• Rinse X3/Day with Corsodyl (0.2%) and GENGIGEL mouth wash
• Consume your antibiotic if/as recommended (please read the instruction inside the package)

One of the key factors in the long-term success of dental implants is the maintenance of healthy tissues around them. A cause-effect relationship between bacterial plaque accumulation and the development of inflammatory changes in the soft tissues surrounding dental implants has been shown.

The existing scientific evidence demonstrates a direct association between oral microbiota and bacterial peri-implant inflammatory lesions in the form of Peri-implant mucositis or peri-implantitis. Peri-implant disease is a collective term for inflammatory reactions in the surrounding tissue of functioning implant.

Peri-implant mucositis is a term describing reversible inflammatory reactions in the surrounding soft tissue of functioning implant, while peri-implantitis refers to inflammatory reactions with loss of bone supporting functioning implant.

Peri-implantitis" have been defined as a progressive inflammatory bacterial- infectious process deteriorating and destructing the supporting soft and hard tissues around functional osseointegrated implant eliciting bacterial, clinical and radiographic signs and symptoms e.g. bleeding and suppuration.

In both experimental research and human trials, it has been demonstrated that prolonged accumulation of bacterial plaque over a long period of time, may develop the reversible nature of "peri-implant mucositis" into the irreversible "peri-implantitis" rendering such complications either untreatable (failing) or amenable to treatment (ailing).

The disease of peri-implant mucositis has been shown to occur in about 80% of subjects with endosseous dental implant (50% of sites). The implementation of non-surgical mechanical and adjunctive use of local/systemic antimicrobials therapy to reduce the inflammation has been proved to be effective in the resolution of peri-implant mucositis lesions, but unpredictable in the effective treatment of advanced peri-implantitis lesions with a prevalence of 12-40% of sites, in 28%-56% of individuals.

Identified associated risk indicators may include: poor oral hygiene, history of periodontitis, uncontrolled diabetes and heavy smoking, coupled with compromised host tissues or immune response. The primary objective of surgical treatment in peri-implantitis is to get access to the implant surface for debridement and decontamination in order to achieve resolution of the inflammatory lesion.

Therefore, the above-mentioned risk factors should be monitored, and kept under optimal control. The standard of oral hygiene should be reinforced and general health status of the periodontal tissues around the remaining teeth should be monitored during the maintenance phase.

Shallow residual pockets should be monitored regularly and treated if signs of disease activity are noticed. If you are smoker this habit adversely affects your periodontal and peri-implant health & long-term prognosis for the treatment outcome. Therefore, you are constantly advised to quit smoking.

The Guarantee for your dental implant does not cover failure due to factors mentioned above and does not include failure due to illness, misuse or accidents.

Our clinic undertakes to warrant implant-supported crowns, bridges and prostheses against mechanical failure for two years subject to the following:

1. That you attend the surgery at least every 6 months for a full routine dental inspection.
2. That you attend the dental hygienist/ dentist regularly every 4 months (at least every 6 months) for professional hygiene and maintenance of the restorations provided.
3. That you undertake any remedial treatment regarded as necessary to maintain oral health.

Implants are guaranteed once for a year after insertion after which patients may opt for dental insurance available through an insurance service. The guarantee is subject to your compliance with the highest standard of oral hygiene and regular attendance for maintenance and reviews recommended every 4 months. Failure to do so will render any guarantee void.

Therefore, we strongly recommend all of our patients who have received implant treatment to undertake radiographic and other investigations on an annual basis to review the stability of the implant.

Leukocyte – Platelet Rich Fibrin or L-PRF™ is a bioactive blood clot extracted in the form of autologous platelet concentration.

Leukocytes, also known as white blood cells, are part of our immune system responsible for creating blood clots by matrix fibrin, chemo-attracting healing cells, and producing growth factors.

Like the blood testing procedure, a little sample of own blood is collected in a couple of tubes, spun in a unique centrifuge System (IntraSpin™) to separate and concentrate different blood cells types and active proteins.

The bioactive autologous platelet concentration is placed in the surgical defect and protected to platelets/Leukocyte-released growth factors within the L-PRF scaffolding fibrin clot, promoting and enhancing natural bone regeneration.

L-PRF™ promotes many types of tissue healing. L-PRF™ forms part of the solo or combined bone replacement graft material utilized in bone reconstruction, facial medicine, orthopaedics, skin burns, diabetic ulcers and many more medical regenerative fields.

L-PRF is chemically intact with NO added human, animal, synthetic, or ingredients.

Once your body L-PRF is produced, it will directly be placed within the surgical sites.

The L-PRF promote tissue healing by the act of platelets and leukocytes embedded in the fibrin meshwork by release high concentrations of growth factors over 14 days.

The IntraSpin™ System is an FDA-approved centrifuge system and protocol.

There are NO side effects or complications following L-PRF application since L-PRF is extracted from own blood, having NO additive agents involved to increase the risk for allergy or side effects.

The L-PRF products are placed in the sinuses, extraction socket, peri-implant, dento-alveolar, maxilla-facial defects to promote tissue healing.

As reported by several evidenced publications, the use of L-PRF™ is associated with reduced postoperative inflammation, pain, discomfort, recovery time, and enhanced tissue healing.