Maida Smiles (W. London)

Tel: 020 3974 1777

Complex Implant Cases

  • 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.

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
salivating and dry mouth


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
Dental Implants

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
iv sedation

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

“I had had an implant carried out by Pedro – he is highly skilled an expert in his field and puts you at ease from the minute you walk through the door. His kind, easygoing manner leads to a great experience, if that can be said about a visit to the dentist. I would highly recommend Maida Smiles…” Read review.

Therese O’Connell 01/18/202

“Dr Pedro and his team provided a seamless experience for my implant treatment. Each step of the process was easy to navigate, from the extractions to getting temporary dentures…” Read review.

Roni Omikorede 12/21/2022

Complex Full Arch Rehabilitated Cases

Clinical cases resolved by the incredible All on 4, implant surgeon Dr Pedro Gutierres.

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.

  1. Bhuvaneswaran M. Principles of smile design. J Conserv Dent. 2010;13(4):225–232. doi:10.4103/0972-0707.73387
  2. 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.
  3. 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.
  4. 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.
  5. Magne, Pascal, and Urs Belser.Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Quintessence Publishing Company, 2002.
  6. Magne, Pascal, and Urs Belser.Restaurações adesivas de porcelana na dentição anterior: uma abordagem biomimétrica. Quintessence, 2003.
  7. 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

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.

photo of dr pedro and patient

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

Christina J
Christina J
23. March, 2023.
I've been receiving orthodontic treatment for about a year now with Dr. Ines and she's a wonderful mixture of highly skilled and professional, very thorough, and gentle in her approach. She is also super personable and I always look forward to my monthly appointments with her. She's made such a big improvement to my teeth and I'm very happy with my treatment so far -- I highly recommend Dr. Ines. I've also had other treatments with Maida Smiles and always had a great experience, especially with my wisdom teeth removal (by Dr. Pedro) that went very smoothly without any issues. The team's treatment coordinator/dentist nurse Cinthia is also always super kind and helpful if you have any questions or want to understand treatments.
Angelica Sacrepaye
Angelica Sacrepaye
15. March, 2023.
I had the lovely Dr Shankar for a 4 month Invisalign treatment. I mainly had overcrowding that needed sorting out after having had braces as a teenager and not wearing my retainer. Dr Shankar was delightful and has a lovely energy about him that made me feel very comfortable throughout the whole process. He explained processes well and also gave good advice to help me make informed decisions. I would highly highly recommend him to anyone in the Maida Vale area!
George Batchkala
George Batchkala
14. March, 2023.
I had 2 wisdom teeth (on the same side) removed by Dr Pedro. I had a much better experience than I expected. One month later, I have completely recovered without any complications. Absolutely recommend!
André Tiago
André Tiago
3. March, 2023.
I was recommended to start my treatment at the clinic and I couldn't be more pleased. It has been 6 months since I put my braces on and I am being followed by Dr. Ines and Dr. Cíntia. I can already see great changes and can't wait for the final result. Excellent professionals. The whole environment is very calm which makes you comfortable. 100% recommend Maida Smiles Clinic.
Claudia Castellani
Claudia Castellani
3. March, 2023.
Following a friend’s recommendation, I brought my eldest daughter to Dr Ines do Carmo for orthodontic treatment. Ines has been brilliant throughout the treatment; she is incredibly passionate about her work and this is reflected in her skilled perfectionism and the amazing results she achieves for her patients. From the start, Ines’ warm and friendly manner succeeded in putting my apprehensive daughter at ease. She was also forthcoming and thorough in her explanations of the treatment, and happy to share her extensive knowledge. My daughter now has an even lovelier smile thanks to Ines. I highly recommend her and will be bringing my younger children to her for their orthodontic treatment.
Carla Parreira
Carla Parreira
3. March, 2023.
It was my first time in the clinic and I had a great experience. The staff is very friendly. Samantha was very helpful with booking the appointment and fast replied to my messages. I had an appointment with Dr. Ines do Carmo. She is lovely. She explained all the treatment and the best option for my case. Cintia was helping Dr. Ines with the appointment. Cintia is very friendly. Dr. Ines and Cintia took care of me and made me feel welcome during the consultation. I will continue my treatment in the clinic. I recommend the clinic and especially Dr. Ines do Carmo.
Maria Moreira
Maria Moreira
2. March, 2023.
It is my good fortune to have found Dra inês at Maida Smiles Clinic and to have her as my orthodontist. My complex orthodontic treatment, as an adult, defies all laws of physics, but Dra Inês has the most amazing professional expertise and compassion to help and change lives, and she is helping me massively. In each consultation, Dra Inês moves one-step forward to improve my bite, my oral health in general and my smile! I will be forever grateful to Dra Inês for her outstanding care, professionalism and support she provides in each visit, in such a caring and friendly way. I warmly recommend Dra Inês and Maida Smiles Clinic to anyone who os considering orthodontics.
Adrian de Haro
Adrian de Haro
1. March, 2023.
We were on a short trip to London and my wife's implant got loose. We called Maida Smiles and they immediately saw her. They kindly sorted the issue out and my wife was extremely satisfied with the kind, friendly and professional service. Thanks Dr Pedro.
Igor Zinatulin
Igor Zinatulin
26. February, 2023.
I can’t thank enough Dr Pedro Gutierres and Maida Smiles’ team for guiding me through a multiple teeth extraction operation I had at the clinic recently. I’m a very anxious patient and everyone at Maida Smiles went above and beyond to accommodate my questions, asks and concerns. The operation itself was painless and positively uneventful, healing was quick and after-care second to none. Never thought I’d say this to myself but I’m looking forward to my next dentist appointment at Maida Smiles.