The main part of the treatment takes place during your first visit. All extractions (if needed) and the implants are carried out simultaneously in a single session during the first day, under IV sedation (administered by qualified anesthetists). The average duration of the session is about 3 hours, it is painless under local anaesthesia. During the next days several follow ups take place. Usually on the 3rd day, the new teeth are cemented over the implants and you go home with new smile!
2. Second Visit (after: 6-18 months, duration: 8-10 working days, see example)
1. Recommended Slot Time Frame - 10 working days (15 nights)
2. Intensive Slot Time Frame - 8 working days (11 nights) *
* If your personal agenda is tight, we can offer you a short, but more intensive treatment time frame. Keep in mind that always is better to have more time for dental lab adjustments.
Temporary Bridges > Permanent Bridges (Procelain Fused to Metal)
After the first stage of the treatment, when the implants are already placed, there is a 6-18 months' healing period. A natural process of remodelling of the gum under the bridges starts. This can lead to the appearance of some gaps (between the gum and bridges). During the second visit they will be corrected with a new set of permanent porcelain-fused-to-metal (PFM) bridges. By that time, the gum will have already adjusted to the implants and taken a stable form. The new bridges are created to perfectly match this new gum line, thus covering the gaps. This assures that you get the best aesthetic results and the treatment is complete.
1 Flapless surgery method will be applied where possible. In some cases, it's not applicable. 2 The guarantee covers bridges and implants material defects. It's valid in our clinic in Sofia. Unfortunately, it is not possible to offer a guarantee for the medical service and success of the treatment, since dentistry practice and surgery are not an exact science and healing is rather an individual process dependent on the patient’s ability to recover. Nevertheless, we can usually offer help, either free of charge or at a significantly reduced price, if single implants or prosthetic parts need be replaced due to unexpected events. 3 This price does not include any bank transaction fees. Payment by card is subject to 2% surcharge.
DISCLAIMER: Please note that treatment plans are confirmed only after a thorough clinical examination at Smile Dental Services Clinic in Sofia. The extent of necessary measures in terms of surgery and treatment cannot be predicted, as this can only be determined when the treatment starts. We reserve the right to make alterations for medical and practical reasons.
Video Info About the Procedure
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Dental Implants Restorations Calendar 2017/2018 Full Mouth or Single Jaw Immediate Loading Procedures (according to Available Treatment Slots)
BOI & BCS implants are the most advanced system within the group of basal implants. In combination with other single-piece implants, they enable dental reconstruction for almost any patient. They are even suitable for people who have previously failed at implantation procedures due to insufficient jaw bones and bone recession.
What is basal implantation? Bones are composed of an internal spongy (cancellous) portion which is covered with a dense bone layer (corticalis). Each basal implant is placed in at least two points trough the corticalis (the so called bi-cortical support). The corticalis used for anchoring of the basal implants is a highly mineralized bone with a strong potential for regeneration. This ensures the highest level of integration of the implants and allows their immediate loading. Basal implants differ from crest (conventional) implants in the manner of placing, the manner of force distribution, but primarily by the planning and execution of the prosthetic construction and post-operative regime.
Single-Piece (Monoblock) Basal Implants KOS, BCS, BECES & KOS Series
The revolutionary shape and design of basal implants help in treating a wide variety of cases which the conventional two-three-piece crestal implants cannot provide. Many of the basal implants have a smooth surface which does not allow bacterial colonization on surfaces which often leads to peri-implantitis and implant loss. Peri-implantitis is the most common cause for conventional implants failure. This happens mostly because of the rough implant surface, as well as the interface problems between the multiple parts of the implant (implant-abutment link). The use of monoblock smooth-surface basal implants minimizes the threat of peri-implantitis by almost 98%.
98% less chance of peri-implantitis and implant loss
Conventional Implants Rough Surface
The rough surface of conventional (crestal) implants has a high likelihood of harboring bacteria which means a higher risk of peri-implantitis.
Basal Implants Smooth Surface
The smooth surface of basal implants does not allow bacterial colonization and eliminates the risk of peri-implantitis almost completely.
The Basal Implant System surgery has been used in dentistry for over 25 years. Because of the very little pain involved in flapless procedures, most patients accept dental implants more easily.
The flapless approach is applied where possible. In some cases, it's not applicable or not recommended.
Immediate Loading Protocol
Go home with teeth immediately after the treatment!
Basal implants are primarily designed for immediate loading. 72 hours straight after the implants have been inserted, our patients get their bridges loaded over the implants. There is no need to wait through a long recovery. With the help of our dental technicians, your new full set of teeth will be fixed in place within 3-5 business days.
Avoid Bone Graft & Sinus Lift
Save time, discomfort and money, get immediate results!
There is no need any more to go through long and painful procedures for bone augmentation - sinus lift and bone graft. Basal implants utilize not only the bone height but also the the bone width. That's why it is possible to treat cases where traditional systems recommend preliminary bone augmentation. Even diabetic patients, smokers and patients with severe gum disease CAN be treated with equal success.
CASE: Patient with severe bone loss (upper and lower) who was wearing full removable dentures for 25 years, succesfully treated in Smile Dental Services, without any preliminary procedure as bone graft or sinus lift. 5 immediate loading implants on the upper and 6 immediate loading implants on the lower jaw. The second X-ray was taken 1 year 3 months after the implantation session.
Patients with Diabetes
Less susceptibility to infections
Conventional dental implants are usually contra-indicated for use with diabetic patients. The main reason is that diabetes is associated with co-morbidities, including high susceptibility to infections, impaired wound healing, gingivitis, periodontitis and other related gum diseases and disorders. However, basal implants give very good results in controlled diabetic patients, simply because their smooth surface reduces the probability of sustained development of bacterial infection on their surface. What is more, the load-bearing area (basal cortical bone) is far-off from the areas of crestal alveolar bone where bacteria attempt to invade (in the case of conventional or crestal implants, also called bone, where they are anchored).
Implants load-bearing area is far-off from the area generally affected by smoking
Smoking is a well-known negative factor in implant restorations because it stops the blood flow to the oral tissue. This slows the healing process and leads to a higher risk of gingivitis and gingival recession which in turn leads to peri-implantitis. With smokers, the osseo-integration may be compromised, leading to the failure of the entire restoration. In the case of basal implants and immediate loading, the load-bearing areas are far-off from the ones affected by smoking. The early-stage loaded bridges also protect the gums from direct exposure to the smoke.
However, please keep in mind that smoking has a very cancerogenic effect on the surgical area. We strongly discourage smoking during the healing phase, at least for the first 3 days after surgery.
Patients with Severe Gum Disease (Periodontitis)
In patients with severe gum disease, conventional dental implants are contra indicated. This is mainly due to the higher risk of gingival infections causing implants failure. Usually such patients have multiple loose and mobile teeth which are painful. The inflamed gums bleed easily. However, smooth surface basal implants work entirely because they have less probability of developing bacterial infection and the load-bearing area is far-off from the gums.
These seemingly "hopeless" patients are very good candidates for full-mouth restorations with basal implants. Usually, during the procedure, all remaining teeth (the main source of infection) are extracted and replaced with implants. Within 3 days, even this type of patients get their new teeth loaded over the implants and can smile and eat normally.
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Why to choose Basal implants over conventional one?
Frequently Asked Questions - FAQ
DISCLAIMER: Despite the fact that fundamental medical principles are the same, every person and case are individual and there are always exceptions. That's why we kindly ask you to accept this information as a framework and general guidelines for your possible treatment, not as something fixed. We highly recommend you to always consult our medical staff regarding any questions you may have about your condition and health!
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 19% 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 non metal polymer. The process is guided by CAD/CAM computer technology.
The permanent bridges are made of high quality porcelain fused to metal (PFM), again guided by CAD/CAM computer based technology.
Recently we’ve decided to discontinue the use of zirconium oxyde bridges. The reason is that the excessive solidness of the core could be a problem if something happens with the implants below. The removal of the bridge sometimes means just cutting it. With zirconium this can be really a problem and may lead to additional damages of the otherwise stable implants.
Many people believe that zirconium is quite different in aesthetic from PFM but they don’t know that both types of bridges have the same visible layer - porcelain - the closest material to the human teeth enamel. The difference is the core. The connection between the porcelain and zirconium oxyde is weaker than the metal, which makes zirconium bridges more prone to fractures of the visible layer.
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.
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.
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.
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 about 8 working days. It is longer than your first visit because the production of the permanent bridges (porcelain fused to metal - PFM) is a much more time consuming process. It involves several stages in the dental lab and several follow ups 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 porcelain fused to metal 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.
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.
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).
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.
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).
We don’t recommend using any type of mouthwash. Usually, it is very active and aggressive towards the gums and could provoke further shrinkage. During the first several weeks after the implantation it’s good for the gums to rinse with salty water (add 1/2 a teaspoon of salt to a cup of warm water, not hot!).
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.