- Sensitive gag response?
- Mouth too small?
- Have too much saliva?
- Extremely anxious?
- Lack of bone density?
These are common problems of implant patients that we can easily solve.
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Complex Implant problems we’ve solved
Since 2010, founder and leading implant dentist, Dr Pedro Gutierres has worked on hundreds of implant cases in London with exceptional circumstances and has earned a reputation in the industry for often making the impossible, possible and restoring patient smiles with implants even when they’ve been told “no” in the past.
Gag Reflex
What we can do:
- Behavioural techniques
- Pharmacological techniques
- IV or oral sedation
- Local anaesthetics to numb either the tongue, roof or soft palate
- Topical gels and sprays or doing nerve blocks to numb the tongue
IV Sedation from £500 to calm your sensitive reflex.
- Avoid dentures
- Form a fist around your left thumb and squeeze
- Nasal decongestant can help
- Breathe your nose
- Schedule treatment in afternoons
Hypersalivation
Implant surgery is assisted by surgical aspiration to minimize the risk of contamination to biomaterials.
More dentists will be involved to ensure a saliva-free environment to apply good aspiration.
- Dentures make you salivate more
- After dental treatments saliva can occur as your body treats it as a trauma
- Avoid dentures
- Drink a high amount of water
- Ask your doctor or dentist about certain medications
- After implant surgery swallow your saliva
Bone Loss
- Bone grafting and augmentations to rebuild up the bone in the jaw that has depleted.
- Bone grafts cost from £950.
- Additionally, we can avoid certain implant procedures that require bone and opt for innovative methods like All-on-4, which doesn’t require an abundance of bone.
Bone grafts are often the best way to go to ensure the mouth is stable, healthy and has the capacity to securely hold prosthetics.
Help maintain your jawbone health by:
- Taking calcium supplements
- Eat a healthy diet
- Replace missing teeth ASAP
- Visit the dentist often
Phobic patients
What we can do:
- Inhalation sedation
- Oral sedation
- IV sedation
- Certain relaxing techniques
IV Sedation from £500 will likely be your best option for implant surgery if you’re extremely phobic and cannot be calmed by regular relaxing techniques.
- Visit the practice before your procedure
- Familiarise yourself with the dentists, the rooms and smells
- Focus on breathing
- Distract yourself with music or TV
Complex Case Study
Patient: Mrs G.H.
- Aesthetic evaluation and shade assessment
- Removal and replacing of old restorations
- Adhesive cementation of veneer and placing of implant crown
Mrs. G.H. attended our practice with aesthetic concerns. She had done composite fillings on a central incisor and a ceramic crown on the lateral. The lateral was an implant placed as a teenager and the anterior work replicated her teenage dentition. This was causing anxiety issues when interacting socially.
After an initial aesthetic, clinical and radiological evaluation, the patient was informed regarding the performance of the existing fillings and expected outcome.
The patient was not happy with the size and shape of the existing central and lateral, so a decision was made to replace the existing restorations of the anterior upper right central incisor and lateral using ceramic indirect restorations.
The planning stage included study models, photographs and shade records were taken. A difference in available space was detected. The lateral to be restored had to be bigger than the contralateral. A decision was made to create and illusion of symmetry by carefully placing the transition lines1.
Impressions were made and a digital wax-up of the lateral and central was presented to the patient. The patient approved the shape and size2.
Removal of the existing central incisor composite restoration was performed and removal of 0,5mm to 1mm of tooth structure for a veneer was done. The tooth surface was polished using discs and the margins perfected with chisels. Silicon index guides were used to check if even space was available for the ceramic restorations3.
The stump shade was recorded using eLAb protocol and impressions were made after retraction cord was placed on the sulcus.
To optimize aesthetics and adhesion to dentin and enamel, an adhesive cementation technique using Lithium disilicate veneer was chosen for the central. A gold Atlantis abutment with a zirconia crown was chosen for the lateral.
A temporary veneer was made using self-curing acrylic.
Once the lab-made restorations were ready, thickness was measured on several locations and photographic records taken to check margins and aesthetics.
The patient returned after three weeks; the restorations were showed to the patient who approved for cementation. The provisional was carefully removed using a probe, the existing implant crown unscrewed, and the ceramic restorations tested and showed to the patient for final validation.
The ceramic central incisor restoration was etched using Hydrofluoric acid to increase adhesive bond strengths. Orthophosphoric acid was used to clean them, followed by an ultrasonic bath using distilled water4.
Silane was applied and the restorations and heated to increase adhesive bond strengths.
The teeth were cleaned with pumice and retraction cord and rubber dam was put in place. Adjacent teeth were protected using teflon tape and Enamel was etched using Orthophosphoric acid5.
Optibond FL adhesive system was used and heated composite (Filtek Supreme A1 Body) was used for cementation.
Contact points were adjusted prior to cementation, and after initial curing excesses were removed using scalpel blade and chisel.
Glycerin gel was used to cover the adhesive interface and a final curing stage was performed. Teeth were polished using pumice to remove adhesive excesses. Occlusion was checked and adjusted6,7.
The implant crown was placed and torqued as per manufacturer instructions.
Aesthetic evaluation and photographic records were taken.
The patient is able to clean and floss and the final restorations show no interference in excursive movements or speech pattern. The patient reports that the final result surpassed initial expectations.
- Bhuvaneswaran M. Principles of smile design. J Conserv Dent. 2010;13(4):225–232. doi:10.4103/0972-0707.73387
- Simon, Harel, and Pascal Magne. “Clinically based diagnostic wax-up for optimal esthetics: the diagnostic mock-up.”Journal of the California dental association 5 (2008): 355-362.
- Reshad, Mamaly, Domenico Cascione, and Pascal Magne. “Diagnostic mock-ups as an objective tool for predictable outcomes with porcelain laminate veneers in esthetically demanding patients: a clinical report.”The Journal of prosthetic dentistry 5 (2008): 333-339.
- Guess, Petra C., and Christian FJ Stappert. “Midterm results of a 5-year prospective clinical investigation of extended ceramic veneers.”Dental materials 6 (2008): 804-813.
- Magne, Pascal, and Urs Belser.Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Quintessence Publishing Company, 2002.
- Magne, Pascal, and Urs Belser.Restaurações adesivas de porcelana na dentição anterior: uma abordagem biomimétrica. Quintessence, 2003.
- Magne, Pascal, and Urs C. Belser. “Novel porcelain laminate preparation approach driven by a diagnostic mock‐” Journal of Esthetic and restorative dentistry 16.1 (2004): 7-16.
Best dentist for the job
Pedro Gutierres qualified at the prestigious Egas Moniz High Institute of Health Sciences in Lisbon in 2006, then completed a two-year advanced international education program at the prestigious New York University College of Dentistry before finally earning a Master’s degree in Implant Dentistry at Warwick University in 2011. Two years later, Dr Gutierres interrupted his professional activity and moved to Brazil, where he trained with some of the leading names in Implantology. He graduated from CETO and completed the APCD’s International Advanced Program in Implant Dentistry.
Arrange Your consultation
- X-rays included
- Free examination
Faster diagnosis and treatment
When you choose Maida Smiles and Dr Gutierres as your implant surgeon, patients should expect much more than quality care.
Our modern London practice has invested heavily in modern technology and diagnostic equipment that means we can assess and plan your treatment in much more detail. Patients also experience faster appointments without the need for gooey restorations or waiting for a dental laboratory to return their prosthetics.
Dr Pedro Gutierres
Implant Dentist
Dr Gutierres has undertaken extensive training to become an expert in surgical procedures for all implant-related oral surgery techniques, including sinus lift, guided bone regeneration and full mouth rehabilitation with a fixed prosthesis
