„TotalFix+” – the full, immediate and fixed rehabilitation of the total edentulous jaw, with severe bone atrophy, using conventional and zygomatic implants.
Concept: original of the US Nobel Biocare manufacturer.
National premiere: the concept was introduced in Romania by Dr. Taner Chemal in 2013. From then until now, hundreds of our patients have benefited from indisputable advantages of this concept.
Alternative names: „All-on-4+” (US Nobel Biocare manufacturer);
Whom is it addressed to?
Patient who need implants and fixed teeth at upper jaw, but:
- no longer has any teeth (total edentulous) and wearing with mobile prosthesis or
- which has a terminal dentition (teeth are severely affected existing caries and/or advanced stages of periodontal disease)
- maxillary sinuses show very enlarged volume, ie air instead of bone (bone exist only in front region of the upper jaw).
Terminal dentistry rehabilitated immediately and fixed through the “TotalFix+” method
Immediate and fixed rehabilitation of the total edentulous through “TotalFix+” method
- Maxilla (upper) – severe atrophy in the middle and posterior area, under the maxillary sinuses there is less than 6 mm of bone; bone exists only in the I and IV area (incisor-canine and zygomatic) and there is none in II and III (molar and premolar).
- Excessively pneumatized maxillary sinuses (enlarged) both towards the inferior pole (crest) and anterior, in the canine teeth region (up to C or D positions).
What does the treatment offer?
The unique opportunity to come to the clinic without any teeth combined with sever maxillary atrophy and after 24 hours you can leave the clinic with implants and fixed teeth!
Even if your immediately teeth are provisional, they are fixed, aesthetic and functional.
With bone augmentation – because is missing posterior jaw bone (atrophy) is necessary to restore bone volume by special regeneration techniques like sinus or crestal augmentation and followed by inserting implants in axial position. Duration of treatment for completion of treatment in this variant varies between 12 and 14 months.
How many implants does the treatment require?
Depending on the case 2 zygomatic implants in the posterior area of the upper maxilla (distal support) and 2, 3 or 4 conventional implants in the anterior area (incisor-canine) where bone is still found
How are the dental implants inserted?
- 2 zygomatic implants that start in the posterior area of the maxilla, go through or beyond the sinuses and are anchored in the zygomatic bones (cheek bones), i.e. in the bone area IV;
- 2, 3 or 4 (depending on the existing bone volume and density) conventional implants that are inserted in the anterior area of the upper maxilla, in the incisor-canine area (bone area I).
Do the dental implants have anything special?
- Conventional implants – Yes, the quality! They must take over forces immediately after insertion and allow, under these circumstances, the biological integration in the bone. This means that their surface is a special one and the length can be of up to 18mm for a bone-implant contact surface as big as possible.
- Zygomatic implants – Yes, they differ primarily in size and design: lengths from 35 to 55mm and the body of the implant, depending on the sinus approach can be fully or partially covered with coils. Let’s not forget that they will be anchored in the upper area, in the zygomatic bones.
Each clinical case is unique! Each treatment plan is customized and requires advanced consultation. A correct treatment requires an accurate diagnosis! Precise diagnosis is supported by advanced investigations: clinical, laboratory and radiological.
- Advanced consultation (performed in the clinic)
- Blood tests
- Panoramic (2D) radiography (digitally performed in the clinic)
- Large FOV (field of view) dental tomography (performed in the clinic)
- Diagnostic special pictures (digitally performed in the clinic)
- Digital (CAM) or classical (cast) maxillary impressions (performed in the clinic)
- Static and dynamic recording of the occlusion (bite)/jaw movement – (digitally performed in the clinic)
- Surgical guide (digitally performed in the clinic)
- The approval of the ENT specialist (when the approach is through the sinuses and there are radiology signs of sinus pathology)
- The approval of the cardio specialist
- Chest radiography
What other components are there beside the implants?
Special screw, components and abutments named “multi-unit” and the denture.
What does the immediate denture entail? Is it temporary?
Temporary denture is fixed and not covers the roof of mouth (palate)!
The role of the temporary denture, besides the rehabilitation of aesthetics and the partial rehabilitation of functions, is to stick firmly but passive (no lateral tensions) the implants (a prerequisite in such rehabilitation works).
Yes, this immediate bridge is temporary, but fixed. Incorporates 12 or 14 teeth (from the first or second molar to its counterpart on the opposite side) covering the entire “aesthetic area”, because the posterior extensions are prohibited in this stage! For resistance increasing, denture it can be thickened on the inside or reinforced with metal. It has a very important role in rebalancing the wrong or lost bite (occlusion) in many situations and therefore will be monitored through regular checks by our specialists. It requires careful maintenance and sanitation, as prescribed by the doctor.
In some situations, this denture is performed before surgery, is balanced through periodic meetings until the time of surgery (the decision to perform the task before or immediately after surgery is taken by the medical team, depending on the clinical situation identified during advanced consultation).
What does the permanent denture entail?
Permanent denture is fixed and not covers the roof of mouth (palate)!
Permanent denture is made of 12 (common) or 14 teeth. The denture is fixed by screwing and is locked by prosthodontist (prosthesis specialist) according a special algorithm, using a special torque wrench (this is why these demanding and expensive dentures should not be handled and cleaned by inexperienced doctors). It will be easily removed by unscrewing whenever needed or for regular professional cleaning.
The permanent denture has 2 components:
- A structural strength (supporting structure):
- Metallic that can be manufactured by casting (chrome-cobalt) or cad-cam milling (titanium);
- Made of high-performance polymers that behave similar to human bone and is creamy white (aesthetic);
- Zirconium (robotic milling);
- An over structure (teeth):
- full ceramic (porcelain without metal);
- zirconium or zirconium-ceramic;
Price of permanent denture may be fixed only after dental implant osseointegration (about 6 months), depending on the clinical situation at the time, the complexity and the material it is made. (check the price list)
Do the temporary or permanent denture cover the palate (roof of the mouth)?
No, neither the temporary nor the permanent dental implant dentures cover the palate!
Does the dental denture include the artificial “pink” gum at the base of the teeth?
In general, because we are talking about vertical bone atrophy, they do require compensation.
This can be done as follows:
– either through vertical bone additions (which besides involving inherent risks they considerably extend the treatment duration and dramatically increase costs) or
– using the artificial gum, which is not seen when the patient is talking or laughing, but only if the lips are retracted willful..
Do the sutures remain under the denture?
Yes, the sutures are generally non-absorbable and the visible parts will be removed after approximately 2-3 weeks. The temporary denture can be removed only after the first month, by the prosthodontist (prosthesis specialist) who unscrews the denture, inspects the healing and removes the rest of the sutures
Where is the treatment conducted?
In conditions of maximum safety and comfort, in one of the implantology rooms, which are designed and function like an operating room. We will never insert the dental implants in the common treatment rooms, where microbial load can be too high, and the conditions are not conducive to a safe treatment for full mouth rehabilitation (extensive surgery).
Who performs the treatment?
- The surgical stage will be performed by one of the 4 specialized doctors that are experienced in such advanced treatments: Dr Chemal Taner, Dr Dumitru Ovidiu, Dr Vasileios Panagopoulos or Dr. Chemal Olgun. The IV (intra-venous) medicine sedation (sleeping anesthesia), completing the loco-regional anesthesia and the monitoring of the patient during surgery will be performed by our ICU (intensive care) specialist, Dr. Fono Adrian.
- The prosthetics stage falls under the responsibility of the experienced prosthetics specialists: Dr Curt-Nazar Varol, Dr Rusu Mihaela, Dr Popescu Dragos.
- The technical execution: depending on the complexity and type of the work, the technicians Zoltan Elekes (Brasov), Milos Miladnov (Timisoara) or the technicians in the Euroteknika laboratories (France) or the Nobel Biocare laboratories (Nobel Procera).
What does the Implantodent treatment include?
- Stage 1: free shuttle from the airport to hotel, panoramic radiography (2D), dental tomography (3D), diagnosis pictures, diagnostic and treatment plan, professional cleaning of the oral cavity, (possible) pre operational diagnostic models and dentures, pro implant surgeries, dental implants, blood concentrates-platelet reached fibrin (PRF), surgery aftercare in special rooms, free shuttle from the clinic to hotel and back, prescription, immediate and fixed temporary denture, the special oral hygiene package, checking X-rays (tomography and panoramic), laser physiotherapy sessions, regular sessions for the occlusal balancing of the immediate denture.
- Stage 2: permanent fixed denture, digital occlusal (bite) recordings, diagnostic models and dentures, the permanent denture, protection mouth guards, oral irrigator (shower).
- Additional: invoice, medical services contract, implant passport and international guarantee, conformity certificate both for the temporary but also for the permanent prosthetic systems.
What prices (costs) are entailed by the Implantodent treatment?
- Stage 1: „4TotalFix+” – 9000 eur and „2TotalFix” – 7000 eur; or „All-on-4+” – 12000 eur and „All-on-2+” – 9000 eur (check the price list)
- Stage 2: based on the complexity and the materials used in the permanent work, its price varies from 2500 to 8000 eur/maxillary arch.
What costs are not included in the treatment?
The cost of the IV sedation-analgesia (sleeping anesthesia) and of the sometimes necessary biomaterials (bone substitute and barrier membranes) for possible bone repairs (post extraction alveoli, remaining cavities in the bone, bone dehiscence, etc.) that are required simultaneously with the implant insertion.
We remind you that the initial price does not include the cost of permanent prosthetic work. The fees for this work varies between 2500 to 8000 euro / maxillary arch and is established with the prosthesis specialist depending on the clinical situation when changing the work, and of course depending on the material recommended by the specialist and agreed by the patient.