BIOLOGICAL PROCEDURES IN ORAL SURGERY

We are proud to say that in our clinic, we use the most modern equipment and state-of-the-art regenerative technologies based on biological principles. One of them involves the use of the regenerative potential of the patient's own tooth, which has been extracted and used for bone regeneration. The second method uses the regenerative potential of the patient's own blood in healing. We achieve superior progress in healing and postoperative comfort with minimally traumatic piezoelectric surgery and ozone therapy.

The methods we use:

DENTIN GRAFT

This revolutionary method allows us to grind extracted teeth into a fine powder, chemically treat it, and use it for bone defect augmentation, either at the site of the extracted tooth or elsewhere.Dentin, which is similar in composition to bone tissue, is o fan autologous origin, making it an ideal material for bone regeneration.Dental grafting has several advantages over all other bone regeneration materials:

• there is no graft rejection

• healing is accelerated and predictable

• long-term graft stability is ensured

• it is stronger than natural bone

When do we use this method?

Ideally, we would use this procedure every time we extract a tooth to prevent the bone loss that occurs later during alveolar bone healing.The exception is the extraction of endodontically treated teeth, which are not suitable for this method.

Procedure

The extracted tooth needs to be cleaned of periodontal ligament, dried and treated with Smart Dentin Grindre, and only teeth that are not endodontically stuffed can be used.

Also, before grinding, the filling in the tooth needs to be removed. The resulting powder is processed and sterilized with Dentim Cleanser and PBS solution. After that, the preparation is ready for use. It can also be combined with other regenerative materials and PRGF technology from plasma.

PRGF TECHNOLOGY

PRGF-ENDORET® (plasma rich in growth factors) is the most advanced system for obtaining plasma rich in growth factors.The goal of the treatment is to isolate plasma rich in growth factors, stem cells, and fibrin material. The resulting preparation is used in the healing and regeneration of various tissues.

When do we use this method?

This is a 100% biological method, a biocompatible technology used in various areas, in sports medicine for the treatment of injuries, in orthopedics, ulcer and burn therapy, ophthalmology, maxillofacial surgery, aesthetic, and dental medicine.

Procedure

Plasma is obtained by extracting venous blood. Plasma, the liquid part of blood, is separated from the cellular component, red blood cells, leukocytes and other blood cells, by centrifugation. The isolated plasma has a pronounced effect on cell migration, growth and morphogenesis. At the site of application, a fibrin matrix is formed, with accelerated proliferation of new blood vessels and increased cell migration. The entire procedure reduces pain and inflammation.

The PRGF ENDORET® therapy has found wide application in implantology and oral surgery.

Practically any procedure that requires healing can benefit from this technology. From the simplest tooth extraction, alveotomy, implant insertion to more extensive procedures such as sinus-lift or cystectomy.

By using these technologies, our procedures become predictably more successful, healing is accelerated, and recovery for the patient is easier, shorter and less painful.

OZONOTHERAPY IN ORAL SURGERY

Ozone therapy has long been known and scientifically supported, and in recent times it has become a more popular method. High-frequency current in the device generator separates the oxygen molecule which joins with another oxygen molecule to form active oxygen - O3. Active oxygen, ozone, is a known disinfectant, but it also has other effects:

• eliminates bacteria, fungi, viruses

• improves blood flow

• activates the immune response

• activates growth factors and speeds up healing

All of these positive effects are visible in our daily work with patients.

PIEZOSURGERY

In all demanding situations, we use piezoelectric surgery in our work.

Piezoelectric surgery represents the pinnacle of technology in oral surgery and implantology. It is a new and modern technique that uses a piezoelectric device for processing bone tissue. The piezoelectric device is characterized by ultrasonic vibrations of 25-29 kHz, amplitudes of 60-210 micrometers, and power up to 50W. With this mode of operation, it is possible to selectively cut only hard bone tissue, while reducing the possibility of injuring soft neurovascular structures. With this modern surgical method, we can approach critical areas minimally invasively, with the least possible trauma.

We use the Piezomed W&H device for ridge expansion, sinus lifts, complicated extractions, implant explantation, bone block harvesting, and osteoplasty in periodontal treatment. All procedures can be performed precisely and safely, providing excellent clinical and biological results.

The value of piezoelectric surgery for our patients - easier and less traumatic procedures with faster recovery.

Dental implants

Dental implants are artificial replacements that are implanted into the jawbone to replace a natural tooth root. They are made of biocompatible material, which means that the body does not recognize them as a foreign object. Regardless of the reason for tooth loss, implants are an excellent long-term solution for replacing one, several, or all teeth.

Advantages of dental implants:

• Replacement for lost teeth

• Allowing normal chewing and speech

• Long-term solution

• Preserving your natural teeth as they do not need to be ground down for bridges

Indications for dental implants:

• If you are missing one or more natural teeth

• If you are unable to wear dentures

• If you have difficulty chewing or are unable to chew

• If your aesthetic appearance or speech has been compromised

Procedure

We are aware that many patients fear going to the dentist because of pain and unpleasant experiences. Implant placement may sound painful, but with the experience and advice of our doctor, we do everything to make the procedure as comfortable as possible.

Before the procedure itself, planning based on a clinical examination, CBCT analysis, and digital planning of future work is of utmost importance.

The process of placing one implant, without additional procedures, is simple and takes only 30 minutes. The procedure is painless because it is performed under local anesthesia.

After 4 months, a prosthetic superstructure is placed on the implant, onto which a crown is then placed. This solution is the closest to natural teeth and behaves as such.

Often, due to the lack of bone ridge or surrounding anatomical structures, additional procedures such as bone augmentation and sinus lift are necessary to perform implant placement, making the entire procedure more complex.

Also, good oral hygiene and the absence of general health contraindications are a prerequisite for the success of the procedure.

Recovery

After implant placement, depending on the extent of the procedure, mild swelling may occur, which subsides within 5-6 days. The accompanying pain is mild and passes with the use of analgesics within 2-3 days. It is necessary to avoid hard foods and to eat a soft diet for the next 15-20 days. After implant insertion, it takes an average of 4 months for the implant to osteointegrate. After that, a prosthetic work is made.

ALL ON 4 and ALL ON 6 techniques

Methods that are highly sought after by our patients are ALL ON 4 and ALL ON 6. This method is indicated in complete toothlessness or edentulism. It is based on prosthetic work that is fixed with screws on four or six placed implants.

In an optimal case, the implants can be immediately loaded, which is called immediate loading. The prosthetic work is made within 48 hours of implant placement, and the patients can function with it like with their own teeth. This is a prototype, which is replaced with permanent work after 4 months.

Immediate loading is not possible in all patients and in all situations, so delayed loading is used in those cases.

What is ALL ON 4?

ALL ON 4 is a therapy intended for patients without teeth or with dentures who want a new smile in a short period of time. The specificity lies in the fact that the teeth of one jaw are fixed on four implants, so ALL ON 4 represents a bridge that is fixedly attached. The method was created as a response of the profession to the inability to directly place implants in the posterior parts of the jaw. In this method, implants are placed in the front part of the jaw (where there is the most bone), and due to implantation at a certain angle, more bone is affected by it and thus is an ideal solution for toothless lower jaw.

What is ALL ON 6?

Just like with the ALL ON 4 method, ALL ON 6 represents a fixed prosthetic work on six fixed implants. As a rule, it is always better to have more carriers for prosthetic work, so this method is an excellent choice for patients who have lost all teeth in the upper or lower jaw. According to the condition of your jaw, our experts will assess which method is more suitable for you because in some cases, when there is a small amount, or poor quality of bone, there is a limited number of implants that can be placed. However, there is a solution for the lack of bone ridge - different bone augmentation techniques. We offer our patients a complete service to restore their smile, and the bridge placed on six implants is the one that makes the whole reconstruction stable and long-lasting!

What are the advantages of ALL ON solutions?

• Dental implants are a lifelong solution.
  
• The prosthetic replacement is a long-term solution.
• The entire jaw is fixed with teeth on just 4 or 6 implants.
• No additional procedures such as sinus lifts are needed.
• The feeling is like having your own teeth.
• Easy hygiene maintenance.
• They restore the natural appearance of the face and lost chewing function.

How to maintain oral hygiene after getting ALL ON 4 or ALL ON 6 implants?

The ALL ON 4 and ALL ON 6 methods involve fixing a dental prosthesis in one piece, so there are no gaps like in natural teeth. Therefore, the prosthesis should be cleaned as a single unit, and the cleaning technique differs from the technique used for natural teeth.

• Practice good oral hygiene

To maintain oral hygiene, brush your teeth with a toothpaste. It is also recommended to use an oral irrigator/water flossers to clean the basal side of the prosthesis that touches the gum line. Our dental experts can advise you on the best way to clean the prosthesis. 

• Full-mouth disinfection

It's also important to disinfect your mouth at least once a day with a mouthwash due to the specific nature of the prosthesis.

• Regular check-ups

Regular dental check-ups are essential, and you should visit your dentist at least once a year. The prosthesis can be removed and professionally cleaned during yearly check-ups if necessary. By maintaining good oral hygiene and getting professional cleaning, you can ensure the longevity of your smile.

ALL ON 4 or ALL ON 6 therapy is recommended for patients who:

• Want a fixed dental prosthesis and have lost all or most of their teeth
• Have been using a complete denture for a long time
• Have experienced significant bone loss, especially in the posterior part of the jaw
• Have severely damaged teeth that need to be extracted
• Cannot wear a complete denture due to gag reflex or denture movement
• Cannot preserve their remaining teeth and include them in the prosthesis. In such cases, the remaining teeth are extracted immediately before implant placement.

1.SINUS LIFT

Sinus lift is a routine oral surgical procedure used to raise the bottom of the maxillary sinus to create enough bone height for dental implant placement.

After upper posterior teeth extraction, bone resorption and sinus floor lowering can occur. Some people naturally have very prominent maxillary sinuses, so extraction only worsens the situation. In such cases, there is often only 2-3 mm of alveolar ridge thickness left, making implant placement impossible.

By artificially raising the sinus floor, we create a new bone height (8-13 mm) and width that can be used for implant placement simultaneously or after 4 to 6 months.

Procedure

Prior to the procedure, planning based on a CBCT scan is mandatory.

The procedure is carried out under local anesthesia and is painless. Access to the sinus is made through the oral cavity, where a "window" is created through which the sinus membrane is separated and lifted like a tent from the bone. Artificial bone material is then augmented into the space beneath the membrane, and the access site is closed with a collagen membrane and then sutured.

In some cases, it is possible to simultaneously implant dental implants, while in others, the sinus lift is a standalone procedure and implants are placed later. Postoperative antibiotics are prescribed, and mild swelling and pain can occur for up to 5 days.

2. WISDOM TOOTH EXTRACTION (ALVEOLECTOMY)

Wisdom teeth are our third molars, and not everyone has them. They do not cause problems for most people, while for some, they can cause difficulties.

Wisdom teeth are extracted only if there is an indication for it.

Most commonly, there is not enough space for tooth growth in the back of the jaw, or the teeth are impacted in hard cortical bone in their direction of growth. This position of the tooth prevents normal growth, and the tooth only partially grows out. Often, a pocket can form around the tooth, which can become inflamed several times a year. This inflammation is called pericoronitis and is an indication for extraction.

The procedure is called alveolectomy because we remove the alveolar bone around the tooth.

Other reasons for extracting wisdom teeth are usually orthodontic in nature, existing cysts related to wisdom teeth, or resorption of neighboring teeth.

Procedure

The procedure itself is not painful because the area around the tooth must be adequately anesthetized. Your oral surgeon has enough knowledge and experience to achieve sufficient analgesia during the procedure. Postoperative pain is treated with analgesics/pain killers.

Extraction usually takes 30-45 minutes and rarely take significantly longer. This depends on the degree of tooth impaction, the availability of the operative site, and the anatomical shape of the root. The most important thing is gentle and atraumatic work.

You can eat after the anesthesia wears off. It is necessary to avoid hot food and drinks. It is best to consume cold or lukewarm food with softer consistency (bananas, soup, eggs, ice cream...). It is recommended to avoid carbonated drinks. A follow-up examination is scheduled for seven days, when we also remove the stitches.

3. CYSTECTOMY

In the bone area of both jaws, as well as in soft tissues, cyst development is possible. By definition, a cyst is a pathologically hollow formation filled with liquid content, lined on the inside with epithelium. It can develop for various reasons due to: chronic infection or trauma to the tooth, disturbances in tooth development and eruption, as a remnant from inflammation around a residual root or from residual inflammation after tooth extraction. It is diagnosed based on an orthopantomogram or CBCT scan. Often it doesn't give any symptoms until it grows large enough. Small cysts on average are up to three centimetres in size, while those larger than that are classified as large cysts and have a different treatment protocol.

Symptoms that may appear include:

• pain, swelling, and redness around the tooth

• change in tooth colour

• pain when biting

• fistula above the tooth root

As the cyst grows, it displaces surrounding structures and destroys bone. Therefore, it is important to recognize the cyst in time and remove it completely.

Procedure

Cystectomy is an oral surgical procedure performed under local anaesthesia and is not painful. The cystic tissue is completely removed and sent for PHD analysis.

Follow-up examination and suture removal are done after seven days.

(Dr. Jozinović, an oral surgery specialist, will explain the whole procedure to you in detail and what you can expect after the procedure at our clinic.)

4. APIECECTOMY

This is a surgical procedure that removes the top of the endodontically treated root of the tooth with the surrounding inflamed tissue.

For various reasons, a portion of endodontically treated teeth still show signs of inflammation in the apex area, that is, the top of the root. Even if the root canal filling is revised, chronic inflammation is still possible. Inflammation is diagnosed based on symptoms and CBCT scan.

Procedure

During the procedure, the top of the tooth root where the pathological process is located gets exposed. The top of the root is removed together with the inflammatory process, and the entrance to the root canal is closed with biocompatible material. The wound is sutured, and the sutures are removed at the follow-up examination after seven days.