Implants for patients with bone loss
Boneless patients are considered complex cases to treat in implantology.
They lack bone to sustain a dental implant and their restorations require special dental implants and bone augmentation procedures. These procedures allowed the implant rehabilitation in situations that implant placement would be contraindicated in the past. Atrophic maxilla can be due to various factors from bone loss, tumor resection or other genetic disorders and syndromes. Fabrication of a prosthesis with adequate retention and stability for patients with an atrophic edentulous maxilla presents a significant challenge. The aim of rehabilitation is not only to provide a cosmetically acceptable appearance, but also to restore oral functions, such as deglutition, mastication, and phonation.
Dr. Eduardo Crooke´s long trajectory of specialisation of dental implants and teeth over implants together with his advanced training in boneless restorations with complex bone regeneration has been rewarded with 3 gold medals by Malaga´s Dentistry College. He is an international reference in the field of advanced surgery using guided and GPS controlled procedures that results in painless and minimally invasive treatments. This technology together with his training on special dental implants, allows him to maximise the existing bone and avoid the need for bone grafts.
Implant-supported fixed prostheses have been proved to have high success rates in restoring facial esthetics, speech and function in these individuals. The presence of inadequate bone quantity poses a potential problem for implant placement necessitating various bone augmentation procedures. Implant placement in grafted bone has shown success as good as implants placed in native bone. After a CBCT scan and an implant study, we will be able to determine the need for bone grafts and the type of dental implant needed, whether it is short, mini, zygomatic, longer, etc.. Sometimes it can be solved with atraumatic bone grafts at the same time as we put the implants, shortening the healing times.
The treatment times vary from 3 months (with teeth in a day and final smile in 3 months), in the most of cases, to one year. Always looking for the minimum visits for the patient.
Missing teeth can lead to boneloss of the lower jaw
3 Steps of Zygomatic Implants
1 – Digital Planning
- 3D STUDY, DIGITAL SCANNING AND SMILE DESIGN
- SMILE VISUALIZATION Before accepting treatment!
- TREATMENT PLANNING, for zygomatic implants it is usual to use guided surgery, maybe we will need at least two days to plan the surgery.
2 – Surgical Phase
- Extraction of your damaged teeth using a PRGF (plasma rich in growth factor) we use your own blood to create plasma making your heal faster and more comfortable.
- Digital impressions with an intraoral scan so the lab can start working on your temporary teeth. This will be ready in the next 24 hours.
There are 2 types of treatment
The patient still has some bone in the front of the jaw bone: 4 conventional implants in the anterior maxilla and 2 zygomatic implants placed posteriorly. This is the most common, it has been used successfully for restoration of atrophic maxilla. This procedure is performed under local anesthesia and conscious sedation, the anesthesiologist attend to our consultation in the dental clinic. The patient is awake, very relaxed and the time passes faster.
All On 4
A patient suffering from total bone resorption. We place 4 zygomatic implants, two in the anterior posterior position and 2 placed to fuse them. Placement of anterior conventional implants without grafting will be extremely difficult in severely atrophic premaxilla. In such situations, quadruple zygomatic implants can be used for the restoration of the edentulous maxilla. (quad zygomatic implant technique). This procedure is performed in the hospital with general anesthesia.
3 – Prosthetic Phase
In the two cases, we can offer the patient fixed temporary teeth in the next 24 hours to the surgery and in 3 months to finish with the definitive ones. In Crooke Dental Clinic laboratory we have developed a unique and personalized dental implant material for the prosthesis using monolithic zirconia absolutely free of metal.
All the design is done with digital flow and made by specialised engineers, giving our patients the best smile.
Why to choose Zygomatic implant?
- Non-graft treatment
- Zygomatic implants avoid complex bone graft procedures (no need for a 9 month treatment)
- 25 years of zygomatic implant success
“Thanks to Dr. Eduardo Crooke’s vast experience the Zygomatic implant is an alternative and record time fixing solution. “
Crooke Dental Clinics are one of the first ZAGA Centers to be certified in Spain
Bone grafting procedures have few limitations like unpredictable resorption of the bone graft, and delayed placement of the implant for the graft consolidation time. Treatment concepts with zygomatic implants have evolved as an alternative for bone augmentation procedures.
What are Zygomatic implants?
They are one of the longest implants that are normally used in the mouth (around 45-55 mm versus the conventional 10 to 15 mm) and are placed as conventional anchored implants but slightly up, in the zygomatic bone.
When is it appropriate to use zygomatic implants?
- Severe bone resorption of the maxilla.
- Usually in patients who have many years without teeth.
- Patients who have suffered an aggressive periodontal disease.
- Patients who want to avoid the healing of bone grafts
- Patients who have lost bone because of different pathologies.
What are they?
The most usual size of implants is around 10mm, when the size is equal to or less than 8mm are considered short implants.
When is it used?
Placement of implants ≤8 mm of length was found to be a predictable alternative for the rehabilitation of atrophic posterior regions, avoiding all the disadvantages intrinsic to bone augmentation procedures.
Its use is subject to the anatomy of the patient, since he can not place implants of regular size (10 mm or more). We use short implants and dental grafts to avoid possible complications and not to damage sensitive anatomical structures (nerves, sinuses, etc.).
Its advantages include a surgical technique with low morbidity and rapid bone healing compared to regular-sized implants. It avoids bone grafts. The use of short implants in oral rehabilitation is certainly a simpler, cheaper and faster treatment.
Bone Graft / Gum Graft
We can perform a Bone Graft and use regular implants.
In a bone graft procedure the surgeon will use a special bone grafting biomaterial, and graft it onto your jaw bone. Maybe you will then have to wait, most likely several months, while the graft creates enough new, strong bone to make sure that the implant will be stable and secure. It is possible if you only need a minor bone graft that the procedure might be able to be done at the same time as the implant surgery, but your dental specialist will make the final decision. A successful bone graft allows your jaw bone to be strong enough to support your dental implant.
In Crooke dental clinic we usually combine this technique with PRGF to get a faster and better healing. When we have lost volume, specially in anterior areas, maybe we need to combine or substitute the bone graft with tissue graft to have the better final results.
Guided Bone Regeneration
Vertical and horizontal. Also guided tissue regeneration. This is the most complex treatment in bone regeneration, also the less common because of the improvement and development of the last years we can avoid it in a lot of cases.
We can recover the lost bone in some area, vertical and horizontal. We are going to draw on xenografts (bone from some animals or cadavers) with collagen membranes that act as a barrier to allow bone regeneration, or autografts, taking bone from the same patient from other areas of the mouth. In this way, part of the lost bone can be recovered to allow the placement of dental implants. The doctor is going to advise you looking for the best results in each case.
The time of healing after this treatment will be at least 6 months.
This adds bone to the whole jaw creating volume and improving the aesthetics of dental implants.
The bones that make up your face are hollow and contain air spaces known as sinuses. The sinuses that sit above your upper back teeth are known as the maxillary sinuses. When an upper posterior tooth is lost, the floor of the maxillary sinus drops down into the space formerly occupied by the root of the lost tooth. In order to place an implant, it is sometimes necessary to put the sinus floor back up to where it originally was by adding a bone substitute. This procedure is called a sinus floor bone augmentation or a ‘sinus lift’.
This treatment can be atraumatic or not. It depends on the existing patient’s bone. The big difference is the timing of the treatment, if we do it in an atraumatic way we could place the implants in the same moment, if not we need to wait for 6 months before putting the implants.