Full Mouth Restoration Treatment Package with Basal Implants

We don’t need a Panoramic X-ray in advance. The basal implant system is very flexible. In 99% of the cases of single jaw or full mouth restoration the reconstruction can be performed immediately without any preliminary procedures like bone graft and sinus lift.

Nevertheless, if you wear full dentures for more than 10 years it's better to send us a Panoramic X-ray prior your visit. Keep in mind that we don't need expensive 3D scans - Panoramic X-ray is enough!

The final decision to go for a full jaw/mouth restoration or just placing several implants is taken after thorough clinical examination and scan assessment. Nevertheless, keep in mind that the overall approach of full jaw/mouth restoration have many advantages over the "filling the gaps" one. There are several reasons for that:

• The surgeon has more options to position the implants and choose the best areas of the bone. This assures optimal implant anchorage. This is not valid in “filling the gaps” approach. In this case the surgeon is limited to operate only in the area of the missing tooth where the bone quality is not always good.

• Immediate loading protocol can be applied successfully only when big sector is being restored. This way, even at the first stage of the treatment, you get all the aesthetic and functional benefits of this protocol. Sector restorations of small segments do not allow immediate loading to be performed.

• Several implants connected with a bridge work as a system. Thus, the durability of every single implant is improved. The bridge acts as a splint which strengthens also the implants. Single implants are much more vulnerable and liable to strong chewing forces in the mouth and can more easily fail.

It is important to point out that a full jaw/mouth restoration doesn’t mean extraction of all teeth. Those that are with good long term prognosis will be preserved, treated and will become an integral part of the construction.

The prices of full mouth/single jaw restoration packages are fixed and do not depend on the number of implants. We offer an overall solution not a number of implants.

The treatment packages contain enough implants - up to 20 for full mouth and up to 10 for single jaw restorations. The number of implants that you will get highly depends on the condition of your bone. Many times the decision is taken even intraoperatively, during the procedure. Anyway, just to satisfy your curiosity, the most probable number of implants that you will get is about 6-8 per jaw.

No, the number of implants is not equal to the number of crowns. First, you should know that there is a difference between an implant and a crown. Implants are the base. They are artificial substitutes of the roots of your own teeth which are being anchored into the bone. The crowns are the visible part over the implants.

In restorations of full jaw/mouth with implants the recommended approach is circular (superstructure) bridge to be used instead of single crowns. There are many reasons for that. The main point is, that it is not always possible to put an implant at the corresponding position of every tooth - it depends on the bone. Another point is, because single implants are much more vulnerable and exposed to the big chewing forces than several implants covered by а bridge - the bridge in this case has a role of а splint which strengthens the implants. The average number of teeth that you could expect to have on your bridges is 12 units (for every bridge). In some cases with severe bone loss it could be 10. Usually, these numbers are enough to have aesthetics and function restored.

It may look as the jaws are two separate parts in our mouth but they work as a whole system. If we have a problem with one of the jaws, often there’s an ongoing problem with the other one too. To achieve best long term results of the restoration, it is important to balance the chewing forces. If not, overloading of the implants and failure of the treatment are possible.

For example, you have missing teeth on your lower right and want to have an upper jaw restoration. This situation will lead to unilateral chewing pattern with possible overloading on your top left implants. You will chew on the left side only because of the missing antagonist on your lower right.

Sometimes this balance can be achieved without treatment of the opposite jaw. However, many times treatment and restoration of the both jaws is necessary. And that’s the reason why many times we recommend full mouth restoration, despite the fact that the opposite jaw is seemingly fine, with the “minor” problems only.

If there are teeth with good long term prognosis and stable roots, there’s no need to extract them. In this case usually a root canal treatment is performed. This means that the nerve of the tooth is removed, the root is being cleaned and filled to prevent any further infection.

Then these teeth become part of the construction under the bridge. If later on a problem occurs, usually it can be treated through the bridge. The only problem that needs the bridge to be removed is the extraction of a tooth. In this case, if the bridge could be removed intact it can be used again. Otherwise a new bridge has to be created. However, the expected life of such tooth is years and that’s why we consider leaving such a tooth a better choice rather than replacing it with implant.

The direct answer to this question is - yes, it is possible. However, this is a decision to be taken in a discussion between doctor and patient and must be informed. It is not always only a matter of money - there are several matters to be taken in consideration:

• duration - if restoration of the second jaw is done at a later stage, the treatment period as a whole is doubled - one more visit is necessary. Travel and accommodation expenses as well double, as the out of office period.
• balance - the jaws have to be matched in order to have the correct bite. If the jaws are done separately, this could be a certain limitation in finding the best balance between them.
• aesthetics - the outlook of the both jaws will be different in the period while the second one is not being restored yet.
• money - you would have to pay 2 x single jaw restoration packages which is about 8% more expensive than the full mouth restoration.
• personal - anyway, there are always specific medical issues that have to be taken into account.

Once the implants are integrated into the bone successfully, if proper care is taken, they should last for a lifetime. Of course, our body changes all the time and that’s why nobody can guarantee specific length of time, but in general they are supposed to last for a lifetime.

The temporary bridges are made of high quality long term provisional polymer. The process is guided by CAD/CAM computer technology.

The permanent hybrid bridges are made of high quality permanent polymer and are reinforced with metal frame. The proccess is based on digital impression taking and is guided by CAD/CAM computer based technology.

If you decide to come for treatment at our clinic, you need to pick up an available slot from our restoration calendar. You will receive a written confirmation from us that the slot is put on hold for you (you will as well see your initials under it with status - pending) and you can proceed booking your flight tickets. When you get them, you should forward the flight reservations to us as a confirmation of your intention. Then you will be officially included in our calendar.

It is advisable at least to coordinate your accommodation with us. This will help you avoid inappropriate hotels and areas. We can offer you several proven hotels and apartments on a walking distance (or at least with good subway connections) to the clinic. They offer special rates for our patients. When we have your flight tickets as a confirmation and your room preference we can make a reservation in your favor. You would not be charged in advance for that. You can pay for the accommodation at your check-out time with your card or in cash in EUR or Bulgarian Leva.

We also offer free transfers from and to the airport.

During the first visit, the main part of the treatment takes place. Usually the job is being done for up to 4-5 working days. For example, if the dental work starts on Monday/Tuesday, you can leave Bulgaria next Saturday.

Usually we start with a fresh scan assessment, general health checkup, discussion of the treatment plant with our doctors, clearing the payment.

The extractions and the placement of the implants are performed the same day, in a single session. Then several follow ups take place. On the 3rd day usually, the new teeth are cemented over the implants. The temporary teeth are non-metal long term provisional bridges. Temporary bridges are necessary to be used, so that the implants have time to fuse well with the bone and the gum line to get stable form.

Payment has to be cleared before the treatment starts, after your acceptance of the treatment plan.

The clinic's base prices are in EUR. All prices of medical services are final and are exempt from VAT. They do not include bank fees or other transaction costs - they are at the patient's expense.

Depending on the chosen method of payment, it can be done immediately before the treatment itself (payment in cash or by card) or a few days before, if payment by bank transfer is chosen.

Bank transfer
The clinic accepts bank payments in BGN and EUR. Please note that with international transfers there is a technical time of about 1-3 working days before the payment itself is confirmed by our bank, so it is good to order the transfer according to this period.

With card
We accept payments with the following types of cards (debit/credit): Visa, Master Card and Diners Club. When paying by card, there is a 2% additional commission (our bank's fee). Please make sure in advance that the daily payment limits at the POS terminal correspond to the amount of the upcoming payment.

Cash
We accept cash payments in BGN, EUR, GBP, USD, CHF, CAD, AUD. Prices in currencies other than EUR are determined by the clinic's official price list (published on the official web page) on the day of payment. It is updated once a day according to changes in exchange rates to EUR.

The clinic issues tax invoices. If you would like us to issue one, please let us know at the time of payment, but no later than 5 working days.

Yes, we provide oral or IV conscious sedation which helps you to feel relaxed during the implantation session. Type of the sedation depends on your general health and level of anxiety. The sedation is included in the price.

Oral or IV conscious sedation is an excellent choice for people who fear of the procedure. Though sedatives do not cause sleep, they usually dull the senses. This means that most patients cannot remember the pain, smells or noises associated with the procedure.

Most of the drugs used in sedation dentistry are classified as benzodiazepines. Benzodiazepines reduce anxiety, muscle spasms, insomnia and seizures.

The surgery and the implant placement is usually performed under local anesthesia. This type of anesthesia is absolutely enough not to feel pain during the surgery. To avoid further discomfort after the surgery we’ll give you additional painkillers.

The extractions and the placement of implants are performed simultaneously in a single session. Usually, its duration is about 3 hours.

In most of the cases where mass extraction is required the teeth are affected by gum disease and are already weak. Extracting teeth in "bad shape" usually is much easier than healthy teeth. Anyway everything is very individual but when well managed with painkillers in postoperative period, usually our patients don’t report great discomfort even after mass extraction.

After the procedure you should be in a good general condition and you would be able to walk alone. However, you will be accompanied to your hotel by a staff member or our driver if your hotel is not on walking distance.

During the first several days after the surgery you should consume liquid or pureed/strained food. Some of the hotels (like Crystal Palace) we work with are aware of the special needs our patients have and would blend meals from the menu upon request. It’s also recommended to avoid hot food. Over the next few days you will slowly progress to more solid food.

On the first day of your treatment the implants would be placed and usually on the third day the temporary bridge is cemented. So, during this period you would have some time without teeth which you could spend resting. During that time the wounds from the extractions/implants will recover a bit before the cementation of the temporary bridges.

The stitches we use are biodegradable. The manufacturer gives up to 3 months for resorption. Usually this happens earlier but it's very individual. If it feels uncomfortable, you can always ask for appointment with your local dentist for early removal after 14 days.

During the second visit we switch from temporary to permanent bridges. The second visit usually happens 6-18 months later and it takes not less than 10 working days. It is longer than your first visit because the production of the permanent bridges is a much more time consuming process. It involves several stages in the dental lab and several follow ups in the clinic during your stay.

After the implants are placed, at the first stage of the treatment, there’s a 6-18 month healing period. During that time a process of remodeling of your gum will start. It is natural and can’t be avoided anywhere /regardless of the clinic/. This shrinkage usually causes the appearence of some space between the gum and the bridges. It may bring some discomfort regarding the cleaning process, but it’s preferred by most patients compared to the option to wear full removable dentures like in traditional method of implantation with postponed loading. After the 6th month usually the most substantial shrinkage is over and you can start planning your second visit. Of course, if you feel that your gums are still remodelling, you can wait several months more, this is not contradictory.

At the second visit the gaps that have appeared are corrected with a new set of permanent bridges. The new bridges are created to fit well your already stable gumline. Аt this stage you get the best aesthetic results.

Keep in mind that throughout our lives there is a continuous process of gum shrinking and nobody can guarantee that your gums would not shrink further more.

Usually our advice is to start planning your visit after the 6th month when you feel that your gums are not changing as before. Average time for planning is 2 months in advance. For the summer period we advise to consider 3-4 months in advance in order to avoid unnecessary high tickets expenses.

During the removal of your temporary bridges there are two possible scenarios. In case they are unloaded easily and remain intact, they can be loaded again after taking the impressions. There's also a chance that the bridges break and it's not possible to use them again. In this case you will have to stay for about a week without teeth until the final bridges are loaded.

If you are not able to complete the treatment in recommended 6-18 months period and you don't experience any problems usually is fine. You have to be aware however that after this period we can't guarantee any more the temporary bridges against material deffects, because they are supposed to be changed with permanent ones.

We can't guarantee also that the cost of the second stage of the treatment would remain the same as initialy quoted. In such cases we apply our current price for second visits which is officialy quoted on our website.

Guarantee covers material defects of the bridges and the implants. It's valid in our clinic in Sofia. A guaranty of the medical service and success of the treatment can not be offered, since the practice of dentistry and surgery is not an exact science and healing is quite individual process, which depends on the patient’s ability for recovery.

Nevertheless usually we help either free of charge or at a significantly reduced price, if single implants or prosthetic part must be exchanged due to unexpected events.

In case of a guarantee event, please note that all travel and accommodation expenses are at the patient's expense.

The guarantee can be limited or even invalidated if the following happens:

• Oral hygiene is neglected.
• Dentist's instructions are not followed.
• The gum tissue shrinked or the bone is naturally reducing.
• Substantial amount of weight loss or weight gain within a short period of time.
• A general illness is present which has adverse effects on the chewing organ (e.g. epilepsy, osteoporosis, after-condition excessive X-rays or chemotherapy).
• Inappropriate selection of the color and shape of the dental crowns by the patient (during the preparation period, patients are given the opportunity to choose their color preference however, Smile Dental Services - Bulgaria cannot be held responsible for the decision of the patient if decide later that they do not like the color or shape.
• Damage caused by accidents, sports or any third party when another dentist carries out treatment on a guaranteed work without our approval/ knowledge.
• Damage caused by extreme stress (grinding at night, grip of the teeth, eating of excessivly solid foods).
• Smoking or drug abuse.
• Guarantee for root canal treatments can't be offered.
• If our clinic is not notified in reasonable time frame for the problem (usually 7 days).

It is advisory for you to keep an eye on your implants and the stability of the bridges after you have had the restoration. If you notice that any implant becomes loose, sore or painful, or you exhibit any other symptoms as construction movement, you should contact us at the earliest opportunity. Keep in mind that the construction movement doesn’t always mean problems with the implants - it may be just a detachment. However, this has to be fixed without delay because any construction movement may provoke further problems with the implants.

Although not a common issue, it could happen that the temporary bridge gets detached. In this case, please contact us. Usually you have two options. The first is to catch the next flight and visit our clinic to glue it here. In this case, medical service will be free of charge. The second option is to find a local dentist to do it. In this case you have to pay the medical service by yourself.

The bridge could get damaged by accident in the same way as the natural teeth. If you have such a problem, please contact us to determine the extent of the problem. Usually in such case you have to visit us to replace or repair the bridge. If covered by the guarantee, the medical service will be free of charge.

Aftercare is very important if you wish to have long-lasting implants. Implants don’t require any special cleaning. You can take care in them the same way like for natural teeth. It is recommended to use soft brush after every meal or at least twice a day (morning, evening).

Regular check-ups (every 6 months) after the initial treatment are recommended so that the implants are regularly monitored. If the dentist should discover an issue at an early stage, we can plan appropriate treatment to remedy the matter. You can visit your local dentist also for routine check-up. If you have any questions or difficulties, you can contact us.