Frequently Asked Questions

The treatment of edentulous jaws is the most demanding therapeutic challenge for dentists, both past and present. Complete dentures have never satisfied the desires of either patients or doctors. The advent of titanium dental implants has revolutionized dentistry and, for the first time, provided patients with edentulism and terminal periodontitis a fixed prosthetic restoration that they will not have to keep in a glass at night.

However, the mere presence of implants was not enough to ensure a perfect therapeutic outcome for every patient. Dentists did not have enough scientific facts to accurately determine the number of implants needed to reconstruct an edentulous jaw, so they arbitrarily determined this number based on experience with teeth. It started with six, then seven, eight, five… At one point, a group of authors proposed replacing every lost tooth with an implant, so they were placing 12, even 14 implants in a single jaw, but the results were extremely poor.

More than twenty years ago, Paulo Malo, together with the Nobel company, perfected the All-on-4 concept. This concept involves placing 4 implants in a single jaw in a way that maximally utilizes the patient's remaining bone. It is not enough to simply place 4 implants; the key is the angulation and strategy.

The key principles of the All-on-4 therapy for edentulous jaws are:

• The two posterior implants are placed at an angle so that their prosthetic portion, where the abutment screw is placed, is positioned as posteriorly as possible, somewhere in the position of the first molar or second premolar, and the tip of the implant is anchored in the solid part of the upper jaw near the nose. An implant placed in this way, at an angle of about 45 degrees, achieves excellent bone contact, is long, and does not compromise the natural cavity of the upper jaw, the maxillary sinus. Thus, the All-on-4 concept avoids complicated sinus lift procedures.
• The two front implants are placed vertically in the incisor region, so that their tips are anchored in the compact, solid bone of the nasal floor. This is a key step that ensures the stable position of these implants and allows for the secure attachment of the prosthetic restoration. In difficult situations, where cysts are present in the jaw or the bone is extremely thin, these front implants can also be placed at an angle, and this modification of the All-on-4 concept is then called the „M-Technique,“ because all 4 implants are angled and form the letter M.
• Fabrication of a fixed temporary restoration is mandatory. It is extremely important to fabricate the temporary restoration as soon as possible, secure it with screws to the placed implants, and allow the patient to chew softer food. Chewing on hard foods that could cause the temporary teeth to break is prohibited, as this could compromise the health of the implants.
• Both the temporary and final restoration is screwed onto the implants; it must never be cemented. It is extremely important that the All-on-4 prosthetic restoration can be unscrewed as needed for adjustments, cleaning, or replacement… It is recommended to unscrew it for cleaning twice a year, and to replace the screws that secure it every two years to prevent damage (These are the small screws that fix the prosthetic restoration to the implants).

The All-on-4 concept has proven successful for two decades with an impressive implant survival rate of about 98%, which is confirmed by many clinical studies, so it is no longer an opinion, but a scientific fact. No other concept offers what All on 4 does: a perfect aesthetic result, minimal risk of complications, a stable long-term outcome, and minimal financial commitment compared to concepts with a greater number of implants.

Veneers are a modern solution in cosmetic dentistry that has gained immense popularity in recent years. These thin, custom-made facings are designed to cover the front surface of a tooth, offering a transformative solution for various dental imperfections. Ceramic veneers are known for their exceptional durability and natural appearance. In this article, we will explore the benefits of dental veneers, their indications, and the materials used in their fabrication.

Advantages of veneers:

* Cosmetic enhancement: Veneers are primarily used for cosmetic purposes. They can effectively address a multitude of dental issues, such as discolored, stained, or misaligned teeth, and can change the shape and length of teeth, providing a significantly enhanced appearance.
Minimal tooth preparation or, in some cases, no preparation at all, depending on the initial condition and desired result. Unlike some other dental restorations, veneers require minimal alteration of the natural tooth structure. This means that less enamel is removed, thereby preserving the overall health and integrity of the tooth.
Natural Appearance: The veneers are custom-made to match the color, shape, and size of your natural teeth. This ensures they blend seamlessly with your existing teeth, creating a natural and harmonious smile.
Stain Resistance: Veneers are typically made from highly stain-resistant materials, such as ceramic. This means your new, improved smile will stay the same color for years to come.
Durability: Dental veneers are known for their durability. When properly cared for, they can last for a decade or more, making them a long-term investment in the appearance of your smile.

Dental veneers are a versatile solution for addressing various dental problems. Here are some common indications for their use:

* Tooth discoloration: Veneers can effectively mask severe tooth discoloration that does not respond to traditional teeth whitening methods.
Chipped or broken teeth: Veneers can restore the appearance of teeth that have been chipped or broken due to accidents or dental trauma.
* Misaligned teeth: Although they are not a substitute for orthodontic treatment, veneers can improve the appearance of slightly misaligned teeth by creating the illusion of a straighter smile.
Gaps between teeth: Veneers can close gaps or spaces between teeth, creating a more even and attractive smile.
* Irregularly shaped teeth: Teeth of unusual shapes or sizes can be transformed into a more aesthetically pleasing form with the help of veneers.

In addition to ceramic, there are also composite veneers that can be made in the dentist's office directly in the patient's mouth or in a dental laboratory. This more economical veneer option can provide significant aesthetic improvements, but it also has its drawbacks. Unlike ceramic veneers, their lifespan is shorter, and they are more susceptible to discoloration, plaque buildup, and damage.

Veneers or facettes are an exceptional dental innovation that provide individuals with the means to achieve a beautiful and confident smile. Their versatility, natural appearance, and durability make them an attractive option for addressing a range of cosmetic dental issues.

Did you know that as many as 30% of the population suffer from some form of bruxism?
Bruxism is the grinding or clenching of the teeth, and it occurs both while awake and during sleep. It affects both children and adults and is equally common in both sexes during sleep, although it is slightly more common in women when awake.
It can result in joint and muscle pain, and to a lesser or greater degree, tooth wear.
It sometimes happens that patients are unaware they suffer from bruxism, and it is discovered late, when significant damage to the dental tissues has already occurred, making treatment complex and expensive.
The causes of bruxism are multiple and include:
– central or pathophysiological, which implies a disorder in the neurotransmitter system
– psychosocial factors, such as increased sensitivity to stress or the presence of depression
– peripheral factors, as a result of a dental occlusion disorder, although this has been proven to only affect bruxism in children.
Bruxism can be diagnosed with polysomnography with audio and video recording, as well as with a simple clinical examination by a dentist.
The latest studies have shown that pharmacological therapy is not overly effective in the treatment of bruxism, with the exception of botulinum toxin, which also carries its own side effects. Biofeedback therapy has also not shown significant success and still requires further research.
The most effective form of treatment today is also the simplest and involves the use of occlusal appliances, or splints made by dentists. They can be worn day and night.

Endodontics is the science of what is inside the tooth. Endodontic therapy involves treating the root canal of a tooth.
A tooth consists of enamel, dentin, and cementum, and inside is a soft tissue called the pulp or the tooth's „nerve.” In addition to the nerve, the pulp also contains blood and lymph vessels and connective tissue, which is important for the tooth's nutrition, growth, and development.
The pulp fills the root canal itself and extends from the crown of the tooth to the tip of the root, where it is in contact with the soft tissue surrounding the tooth root.
The most common cause of pulp inflammation, i.e., a toothache, is deep decay that completely destroys the dentin and turns it into a mushy mass with vast quantities of bacteria that cause pulpitis, i.e., inflammation of the pulp. A common cause can also be trauma, a blow that occurred years before the first symptoms and which led to a disruption of circulation in the pulp. Such teeth darken over time because of what is known as pulp necrosis.
When the pulp becomes diseased or injured, endodontic treatment is necessary – the treatment of the tooth's root canal where the pulp must be removed from the root canal.
Early signs of pulp inflammation are increased sensitivity to cold drinks, food, air… most often brief, shooting pains. As the process progresses, the pain is spontaneous, occurring suddenly and subsiding only to return after some time. With the development of an abscess, the pain becomes intense and throbbing, worsening with heat while being relieved by cold, and intensifying when the patient lies down.
In neglected or inadequately treated cases of dental pulp inflammation, microorganisms penetrate the tissue around the apex of the tooth, leading to apical periodontitis or a “process” at the tip of the tooth.
Endodontic therapy is a more or less complex procedure that consists of multiple phases and most often involves multiple visits.
The procedure itself first involves eliminating the pain by removing the pulp from the canal under anesthesia. Then, the canal itself is treated both mechanically and medicinally with various irrigation solutions and pastes to act on the bacteria present.
The “needle” endodontic treatment requires precision and involves cleaning the canal with either manual or mechanical instruments, along with abundant irrigation with various solutions to clean the canal space of bacteria.
All of this is done using a rubber dam to isolate the tooth; it prevents the tooth from coming into contact with saliva, protects the patient from unpleasant rinses, ensures a dry and sterile working field during dental procedures, and shields the soft tissues and tongue.
Determining the working length and preparing the canal to the very apex is of special importance, because inadequately prepared, short canals can be the cause of many problems. Apex locators are used to determine the working length.
Canal instrumentation involves the use of an endo motor with a built-in apex locator, along with state-of-the-art NiTi expanders and highly flexible instruments. This allows for the treatment of teeth with curved and tortuous roots, as these instruments gently follow the canal's anatomy due to their superelasticity.
Advantages of mechanical endodontics:
• Reduces channel processing time
• More comfortable and pleasant for the patient
• postoperative sensitivity is reduced
• achieves better cleaning and decontamination of the root canal
• Less strenuous for the dentist than working with hand instruments
• efficient processing of curved and bent channels
Between sessions, the tooth is filled with pastes that have antimicrobial properties. Depending on the situation, the medication is repeated multiple times as needed.
On the other hand, sometimes endodontic treatment can be completed in a single session.
When the area is completely debrided, there is no pain, no tenderness on percussion (tapping), no foul odor and no discharge, the tooth can be definitively “filled.”.
The definitive root canal filling is performed using a sealer paste and gutaperka cones. The tooth is temporarily sealed, and the patient is referred for a follow-up X-ray to verify the quality of the filling.
After a few days, the tooth is definitively restored, either conservatively with fillings or with a prosthetic restoration and crown, depending on the initial damage to the tooth.