Dental implants

Immediate loading

Upper jaw

For immediate loading in the upper jaw we almost always use the Nobel Guide system for computer aided implant insertion. It is a system that helps us place the implants exactly where is the bone without having to see the bone. It gives us the possibility of placing implants in cases where the amount of bone is critical.

To do this we make a CT-scan of the patient. From these CT-data we create a 3D reconstruction of the jaw inside the computer. With the software of Nobel Guide we simulate the operation in the computer and make sure that the implant is completely surrounded by bone.

The data of the CT-scan and the position of the implants we send to Sweden. After 8 working days Nobel Biocare sends us a drillguide that we can fixate on the jaw of the patient during surgery. Without exposing the bone we now can place the implants inside the jaw of the patient exactly the same way as we did before in the computer. The system is so precise that even a temporary bridge that has been manufactured by our dental technician prior to surgery fits on these implants. The patient can chew immediately after surgery. However, it will take about 4 month for the implants to be 100% connected (osseointegrated) to the bone. After this osseointegrationphase has passed the temporary bridge can bereplaced by a final one.

Lower jaw

In the lower jaw very often Nobel Guide is not needed as a larger bone volume is available. A bridge will be prefabricated that can be connected to the implants immediately using a so-called quick-bridge system. This temporary bridge should be replaced by a definitive one after 4 months.

Protocol for Nobel Guide February 2008

For your information we show you below all the steps that have to be taken to prepare a surgery using Nobel Guide.

• Minimum 3 months after the last extractions patient visits Agave Clinic. An impression of the upper jaw will be taken using the old prosthesis. Also an impression of the lower jaw using alginate and a waxbite are taken (day 1).
  
  
• End of the next day the patient can pick up the rebased old prosthesis at Corona Dental (day 2).
  
  
• The day after fit in wax of the scanprosthesis at Agave Clinic.
  Scanprosthesis will be sent back to Corona Dental that day to finalize it. Patient receives an appointment at USP hospital for the CT-scan and a consultation in Agave Clinic in 2 days . In the instructions form will be referred to the CT-protocol and is stated that the patient will receive the CT-data on diskette immediately (day 3).
  
  
• On day 5 the patient picks the scanprosthesis up at Agave Clinic. At that moment we make a bite-index and intra-oral pictures (one from the front and one from below showing exactly the relation between the frontteeth of upper and lower jaw) that we mail to Corona Dental. Patient goes to USP hospital for the CT-scan with scanprosthesis and biteindex.
  
  
• Immediately afterwards the patient comes to Agave Clinic for delivery of CT data and scanprosthesis. The patient can return home now.
  Scanprosthesis, countermodel and biteindex are kept in a box with name and birthdate of the patient clearly visible on the outside.
  
  
• We make the planning in the computer using Nobel Guide and send this to Sweden. Corona Dental receives an E-mail saying which implants we're going to use, so they can order the parts for the bridge.
  
  
• As soon as the drillguide will be in Marbella the patient receives a date for the OR from our patient coordinator minimum 2 weeks later (so before that we don't give a date for the OR). Drilguide, countermodel, scanprosthesis and biteindex will be sent to Corona Dental together with a complete filled out instruction form that also tells the date of surgery.
  In total this procedure takes about 6 weeks, but the patient shouldn't count on that. We sometimes will need more time. Implants and bridge will be placed minimally 4 1/2 months after the last extractions. When exactly the surgery will be performed we can only say after the drillguide has arrived.