2016 was marked by an outstanding achievement: Dr. Aleksandr Nikolayevich Klinov of Atis Faber Clinic performed zygomatic (cheek-bone) implant surgery. It was a defining moment for local dentistry, which enabled anyone to receive treatment and get beautiful smiles and self-confidence, impossible to achieve through classical methods of dental implantation.
Dr. Klinov, head doctor of Atis Faber Clinic, has told us about the used implantology method, its advantages and pitfalls.
Implants for life
— Dr. Klinov, some people believe dental implantation to be nondurable, too expensive, ineffective and causing a lot of pain. Do you agree with this opinion?
There are different points of view on implantation. Those who feel strongly against it have had negative experience with it. That is why they choose removable dentures. We often face cases that require our specialists to fix or improve something for a patient who received treatment in another clinic. Luckily, the technology we possess allows us to deal with any sorts of problems.
However, I cannot agree that dental implantation is nondurable. I was privileged to learn from Professor Per-Ingvar Branemark who discovered osseointegration – successful implantation into bone tissue. He first performed an implant surgery that resulted in patient’s keeping his artificial teeth until his [patient’s] death 40 years later. So, if we are forced to remove implants it is only become the procedure was performed incorrectly.
To think objectively, dental implants are expected to last a lifetime. I am very skeptical about some doctors who say, “implants didn’t take” after the procedure, while, according to world statistics, implant success rate within 10 years of surgery is 97-98%.
The outcome depends on the surgeon’s qualification and on the patient’s attitude to their oral hygiene. It’s hard to believe but some people never even use a toothbrush making it impossible to maintain good dental health.
Not all at once
— How long does it take for a patient to get a healthy white smile if there are no contraindications for implantation?
Even in case a patient has little to no healthy teeth, our specialists can fix everything in one day. We are, after all, a clinic of advanced dentistry. We use such technologies as All-on-4, which involves installation of a prosthetic structure (teeth row) on four implants (two on each side of a jaw). The implants are installed at an angle ensuring the structure is steady and durable.
Despite the claims of other clinics, only Atis Faber has the original technology to perform All-on-4 procedure. Our clinic is unique in three ways. First, we are a Center that teaches modern implantation techniques to doctors from other establishments. Second, we are the only partners of NobelBiocare, a leading designer of implant structures, in Chelyabinsk and being a clinical expert and mentor I am the first to know about the latest technologies. Third, we use only authentic materials that have a lifetime warranty.
— Is it possible for anyone who has lost healthy teeth to restore them in one day?
Unfortunately, it’s not. Even the best specialists cannot always meet patient's needs. The loss of a tooth triggers ossifluence (resorption of bone tissue); in other cases periodontitis leads to complete loss of bone tissue that holds teeth. If there appears ridge deficiency implantation becomes impossible. Issues of the upper jaw are the most significant. They may be related to the size of maxillary sinus or dysplastic disorders, post-surgery complications or congenital abnormalities such as atrophic upper jaw.
— What should a patient do in this case?
One of the methods is bone augmentation, which is done to provide a place for further implant installation. It is a time-consuming process taking up to 2-4 years. After surgery a patient may experience periods of speech impairment and digestive function decline, pain, swelling, bleeding. Then follows rehabilitation. So as you can see it is not a simple procedure.
For patients who cannot go through stepped therapy in the process of bone augmentation and require restoration of upper jaw teeth there is an option of zygomatic implantation. It is an ultimately new method used in dental prosthetics and our clinic, along with the few others in the country, offers this type of treatment.
Zygomatic implants reach up to 52.5 mm (2.07 inches) in length. They are installed directly into the jugal bone, which, as a rule, is compact and dense. The implant gets fixed onto it and holds the missing teeth structure. In other words, the removable dentures we produce for a patient are fixed to a cheekbone as opposed to a jawbone.
I was first introduced to this procedure in 2006. I was watching Dr. Chantal Malevez, a worldwide famous maxillo-facial surgeon, during zygomatic approach. Back then I thought it looked like torture; however, in 2016 I initiated the implimentation of this procedure in our clinic. Before it, we weren't able to help some people using more classical methods and they were bound to live with no teeth. Zygomaic implants installation is the only chance for people with dysplastic disorders or congenital abnormalities to get a healthy smile.
— Tell us about the first zygomatic implant surgery in your clinic.
It was a complicated case. I was an assistant to a surgeon who came from St. Petersburg. A patient had a huge cyct, which, once removed, left no bone ridge on the upper jaw. There were no gums and the remaining teeth shifted dramaticaly making traditional prosthetic treatment impossible. We extracted those teeth, aligned the jaw and installed zygomas. We performed All-on-4 procedure on the lower jaw. The patient was given general anesthesia for five hours and in the end we restored his missing teeth.
— Are there any age restrictions for this procedure?
There aren’t any age restrictions, though there are certain general health requirements that have to be met. A patient must be strong enough to undergo this procedure.
— Is it hard to take care of this type of implants?
Not really, just regular hygiene is required as with any fixed dentures.
— Do you think other clinics will implement this procedure?
Not everyone can master this technology. It takes serious practice and consumes a lot of time and effort. Only highly qualified specialists can learn to perform it. Right now I am the only surgeon in Chelyabinsk who is trained to do it. I have work in emergency care hospital for more than 12 years. I have completed professional training in the most advanced dental clinics in the world: in Germany, Portugal and Los Angeles. As far as I am aware I am the only surgeon from Chelyabinsk who has studied in the Global Institute for Dental Education in Los Angeles. There I learnt to approach soft and bone tissue regeneration, studied the latest technologies, including application of human morphogenetic protein, which initiates bone growth. This method is espicially hard to master since, if out of control, it could lead to cancer. Treatments using morphogenetic protein are not authorized in Russia, but are successfully performed in South Korea, the USA and the Netherlands.
What is more, I am a certified maxillo-facial surgeon and I possess enough experience and knowledge to perform zygomatic implant surgeries. These procedures are complicated and there is a risk of complications associated with visual organ, neurology and otolaryngology. Cheekbone implantation is a grave surgical measure. A tiny mistake can lead to loss of vision or impair functioning of maxillary sinus, which is a part of respiratory system. It is vital to check that maxillary sinus is absolutely sound.
I am not trying to scare anybody, but want to draw your attention to the fact that zygomatic implant installation requires the highest level of qualification and professionalism from a surgeon. This is why it can only be trusted to certified surgeons with sufficient experience.
— In conclusion, what are the benefits and drawbacks of zygomatic implant installation?
The undoubtful benefit is that we can extract the remaining teeth, prepair the jaw, install the implants and manufacture the dentures in one day.
One of the drawbacks is the cost. The price of one zygoma comes to 50 thousand rubles, plus anesthesia, materials, equipment, work of assistents and other expenses. On the other hand, there is a lifetime warranty for these implants, which makes it a clever investment in your health.