Dental implants via guided implant surgery

WHAT IS A GUIDED SURGERY?

This method consists of being helped by a "guide", called surgical guide. Your dental implants should of course be placed in your jaw, but their axis, shape, length or type will depend on the prosthesis that will be fixed on them, and how it will be fixed (sealed or "screwed").

The surgeon will have previously discussed your case with the dentist who will make the prosthesis on implants, and you will be explained the advantages of each type of prosthesis.

Computer science and digital imaging technology have evolved in recent years, it now allows us, thanks to VIRTUAL models (images), to:

• Choose the type of dental implant
• Determine the exact position of the implants
• Place the implants and the abutments on them
• Virtually manufacture the prosthesis on implants and virtually place it in the mouth

Once all this is done (the computer simulation), we make from your dental casts or from your removable prosthesis, a RADIOLOGICAL guide.

This RADIOLOGICAL guide is placed in your mouth during a radiological examination called DUALSCAN, and will allow the elaboration of your VIRTUAL SURGICAL GUIDE (on computer)

The images will be sent digitally to Sweden and your surgical guide will be sent to your doctor from Sweden within 5 working days.

Once the guide is received, it must be checked in your mouth (the doctor will contact you), then you'll keep the guide (carefully in the special packaging provided for this purpose).

You will then agree on the surgery's date with the surgeon, and bring your surgical guide for the operation.

HOW MUCH DOES IT COST?

The surgical guide is not reimbursed by the health insurance

Its price varies from 750 euros to 1000 euros depending on the number of implants to be placed and according to its complexity.

TESTS PRIOR TO THE SURGERY:

The surgical procedure is performed under local or general anesthesia and is generally an out-of-hospital procedure, as a day-patient at the hospital or in a private practice (you get in and out of the hospital the same day). It can, when it is more complex, require you to stay overnight.

If you wish to have a private room, please inform the anesthesiologist and the surgeon as soon as possible and complete the administrative formalities specific to hospitals for private rooms (those rooms must be booked in advance).

In case of general anesthesia: blood test and an appointment with the anesthesiologist are necessary.

In case of local anesthesia: prophylactic antibiotherapy is necessary (1 to 2 antibiotic tablets 2 hours before surgery as advised by your surgeon).

THE ACTUAL SURGERY:

After performing a local anesthesia and having checked that everything is well numb and that you don't feel anything, the surgeon places in the mouth the surgical guide.

The latter will be attached to the teeth, if there are any, or attached via small hooks called "anchor pins" to the jaw.

He then removes a very small circle of gingiva, exactly corresponding to the diameter of the dental implant to be placed, then places the implants one after the other after using the corresponding drills.

The advantage of the guide is that the axis of the drill (thus the implant), its depth, as its diameter have already been perfectly calculated and established. The surgery is then simplified. The other advantage is that the practitioner doesn't have to take off the gum, making the surgery less traumatic. Also, stitching is not necessary.

The whole surgery is painless. Wound checking about 2 weeks after the surgery, depending on the surgical procedure.

POSTOPERATIVE RECOVERIES AND INSTRUCTIONS:

Directly after the surgery, you can feel that your lip, chin or tongue are swollen and numb. This is simply due to the effects of local anesthesia, which usually wears off within hours.

You will need to put ice on the cheeks (cold pack) to reduce the swelling. The swelling of the cheeks appears gradually and reaches its maximum 48 hours after the surgery. The swelling varies from a patient to another: some swell more than others. In some cases, a hematoma may occur. All this is of course temporary.

A minor bleeding may occur in the operated areas, but it stops quickly.

A temporary mouth opening limitation can also occur, but it is temporary. Physiotherapy sessions will be exceptionally prescribed if necessary.

Postoperative instructions:

• Do not smoke (smoking slows down the healing processes and increases the risks of postoperative infections)
• In case of immediate prosthesis, do not remove it during the following 48 hours, otherwise it will be very difficult for you to put it back because of the swelling. After 48 hours, you can remove it, rinse it, and reposition it with COREGA if necessary.
• Brush your teeth from the following night, after each meal, with a soft-bristled toothbrush. Good postoperative oral hygiene is essential and a guarantee of healing.
• Soft, lukewarm or cold food for 2 days after surgery (creams, soups, pasta...)
• Apply cold ice on the cheeks for 2 days after surgery, then progressively return to a normal diet, 3 days after surgery.
• In case of bleeding, bite on a gauze or on a tea bag (better), for 30 minutes: the tea has hemostatic properties. Do not spit, it stimulates salivation and increases stress and therefore bleeding.

Postoperative medication:

Carefully follow the prescription and dosage.

OPERATIVE RISKS AND COMPLICATIONS:

Any surgical procedure, even performed in the best conditions of competence and safety in accordance with the current scientific data and the regulation in force, carries risks of complication, although they are very rare.

Hemorrhagic complication:

Very rare during the surgical procedure, it can exceptionally require a transfusion of blood or blood derivatives.

Infectious complication:
Very rare, the dental implant can generate a rejection that is called peri-implantitis (1 case out of 200 on average). It occurs more often during the month following the surgery, especially for SMOKERS who don't follow the rules of postoperative hygiene. Please do not smoke and thoroughly brush your new teeth.

In those rare cases, the practitioner will have to remove the infected implant, wait for bone healing (4 to 6 months) before placing a new dental implant. In all cases, your practitioner guarantees you the implant, and the costs of the new implant as well as the surgery to fix it will not be your responsibility.

Nervous complication:

A partial or total loss of sensitivity (hypoesthesia or anesthesia) of the lower lip, chin, and lower incisors on the right or left side may occur when fixing implants. This is due to the lower dental nerve, which is responsible of the sensitivity of the lower lip and incisors, and which can be very close to the implants sites.

These disorders generally disappear within a few weeks, or more rarely, a few months after surgery. A permanent loss of sensitivity is extremely rare. This is the reason why the practitioner will have performed a CT scan before fixing the dental implant(s). The surgical guide also reduces the risk of nerve damage: STOPS are placed on the guide and on the drills to prevent them from going too deep.

Rarely, an elongation of the lingual nerve which goes along the inner side of the mandible may occur and cause a loss of sensitivity of half the tongue. Disorders disappear within a few weeks to a few months. A permanent anesthesia is exceptional. The mobility of the tongue is never affected.

Dental complications:
An increased sensitivity to cold or chewing of the teeth next to the implants is exceptional. It is then generally temporary.

It is extremely rare for a tooth to be devitalized after a dental implant, when a safe distance between the dental implant and the root of the adjacent tooth is respected.

Joint complications:
The occurrence or aggravation of a pre-existing dysfunction in the jaw joint (TMJ) may occur. For example, a crack and/or pain in the TMJ, or a mouth opening limitation can rarely occur. They are also usually temporary and will be treated by your surgeon, who's familiar with this kind of conditions.

In all cases, your surgeon operates and provides immediate postoperative follow-up, but also short, medium and long-term follow-up. He is trained to operate but also to manage all the possible and rare complications of surgery.

Follow every one of his postoperative advices, and know that if you have a question or face any problem, your surgeon will help you and knows how to perfectly handle the situation.

Upon admission to the hospital, the following documents will be required:

• ID card,
• Supplemental insurance documents, if you have one,
• Signed informed consent (available here),
• Admission documents specific to the institution.