Frequently Asked Questions

1.How many days/weeks advanced notice do you need before beginning my treatment program?
2.How many hours each day will I be at your facility? How many days are required to complete the treatment?
3.Why do you recommend the high noble metal porcelain crowns to restore my teeth?
4.What is a sinus lift? How long a period of time should I wait for the implant placement after the sinus lift?
5.Who is a candidate for dental implants?
6.What is the difference between two stage and one stage dental implants?
7.How the treatment proceeds?
8.What are the steps to follow after I make the decision to visit your clinic?
9.What are the options to replace the missing teeth?
10.What is a dental implant?
11.What material is used for dental implants?
12.How is the treatment?
13.What is the surgical phase?
14.How is the post-operative stage?
15.When will the new teeth be placed on the dental implants?
16.Is it a painful treatment?
17.Could there be a failure?
18.What does it happen if a dental implant fails?

1. How many days/weeks advanced notice do you need before beginning my treatment program?
We need to be notified at least 2 weeks before you come to Panama, in order to prepare for you a “day by day” itinerary and confirm your appointments.

2. How many hours each day will I be at your facility? How many days are required to complete the treatment?
Most of the dental treatments need 12 days for completion. During these days our lab technicians will be preparing the permanent crowns that will cover your teeth.

The hours during each appointment depend on the process; however, most of the time it takes between 2 and 3 hours.

3. Why do you recommend the high noble metal porcelain crowns to restore my teeth?
Grinding your teeth, an improper bite, age, fillings and tooth decay can all be contributing factors in the wearing down, cracking or breakage of your teeth. Dental crowns cover the entire visible surface of your affected tooth and add strength, durability and tooth stability.

4. What is a sinus lift? How long a period of time should I wait for the implant placement after the sinus lift?
Sinus lifts, sometimes called a sinus augmentation, is surgery that adds bone to your upper jaw in the area of your molars and premolars. Once the procedure has been done, you will need to wait about 6 to 8 months in order to be able to place the implants.
 

5. Who is a candidate for dental implants?
Candidates for dental implants need to have healthy gums and adequate bone to support the implant. This is the reason why we request your dental records and panoramic x-rays.

If your answer is affirmative to some of the following questions, you can be considered an ideal candidate to be treated with implants: •Have you lost one, some or all of your teeth?
•Do you have difficulties with your removable denture (bad retention, pain, etc)?
•Do you feel insecure when you smile, when speak or eat?
•Has a dentist told you that you have teeth in very bad shape?
•Is there an area in your mouth where the corresponding tooth never showed up?
6. What is the difference between two stage and one stage dental implants?
a) Traditional: Using the traditional implant process, placements in the lower jaw need about three months to heal while placements in the upper jaw need about six months to heal. Traditionally, the procedure has been performed in two steps. The dentist begins by installing the implant, which was left for three to six months to heal and integrate with the jawbone. During the healing period, the patient was given a temporary prosthesis until the permanent crown could be put into place. Traditional dental implants required patients to sacrifice much of their time and money to achieve the look and feel of natural-looking teeth.

b) One Stage Dental Implant: Osseo (bonding with your natural bone) integration begins immediately. No long wait for the bone to heal before placing the implant. There are no missing teeth in the mouth because we place your temporary crowns immediately on the post. The tooth looks natural while the implant is healing.

Although the integration of bone tissue and the implant device takes place normally, the physical characteristics of the implant device itself creates the solid infrastructure that enables immediate use.

7. How the treatment proceeds?
FIRST APPOINTMENT: The first step is to place the implants, once the implants have been placed, an impression is made. A very accurate model is made from this impression from which the lab will make the permanent bridge or the crowns. (Bridges and crowns are usually made of porcelain with a metal substructure. The porcelain gives it esthetics and durability and the metal underneath allows for strength and a good fit). When the impressions have been taken, a temporary tooth is made and it will be similar to the final bridge and / or crown, though not as durable. It is cemented with temporary cement for the days that the lab technicians will be making the permanents. The temporary keeps the teeth comfortable and keeps the teeth from drifting.

Be careful not to eat hard or sticky foods with the temporaries, since they are not as durable as your permanent bridge or crowns. If your temporaries do come off, it is important to have them re-cemented to prevent teeth from drifting.

SECOND APPOINTMENT: Once the bridge or crown is done (7 days after the first appointment), it is fixed with a permanent cement.

FINAL APPOINTMENT: Between 12 to 24 hours after the permanent crowns placement, you will be scheduled for the final appointment for final adjustments and where the doctor will make sure there are no problems.

8. What are the steps to follow after I make the decision to visit your clinic?
First of all you should decide on the date you wish your procedure to begin, bearing in mind our two week notice policy period. We will then prepare a preliminary day by day itinerary, you will then have the dates needed to purchase your airline tickets.

9. What are the options to replace the missing teeth?
The first option is place an artificial titanium root (dental implant) that will support a porcelain crown. The next option is the bridge, which consists on trimming the neighbor teeth, to make porcelain crowns on them fixed to another crown that will replace the lost tooth. The third is a removable denture, which is retained by hooks, and stabilized by a plastic or metallic structure that covers the palate or the tongue zone. The patient can remove it from the mouth.

10. What is a dental implant?
Dental implants are small titanium cylinders that work as artificial dental roots, once they are placed inside the jawbone. This way the artificial teeth can be anchored in these new roots contributing to recover a beautiful smile, as well as a comfortable speaking and chewing. Dental implants will allow us to chew with total comfort, and to smile and speak with the same security than with our own teeth. With the use of the dental implants, there is no need to touch, trim or injure the neighbor teeth, to replace the missing tooth.

11. What material is used for dental implants?
Along the history of dentistry and medicine, many materials have been used. At the present time, the only material considered valid for dental implants is titanium.

12. How is the treatment?
The treatment consists on two stages:
a. Surgical phase
b. Prosthetic phase.

13. What is the surgical phase?
The surgical treatment consists on the placement of the artificial roots or implants inside the jawbone. It is performed with local anesthesia, and is painless. Sedation and general anesthesia are options for nervous patients. The duration of the intervention is from one to two hours.

14. How is the post-operative stage?
It is not painful. The following day of the intervention the patient will have a slightly inflamed area in the face. Painkillers, antibiotics and anti- inflammatories are prescribed for a short period.

15. When will the new teeth be placed on the dental implants?
The time between the surgical phase and the placement of the crowns varies depending on the case.

The range varies between seven and ten days, to give time to the implant to integrate or fix to the bone. More time could be waited if the patient asked so (i.e. because of a trip).

16. Is it a painful treatment?
No, it is not. A treatment with implants demands a surgical intervention, but pain and all the other implications can be perfectly controlled.

17. Could there be a failure?
In spite of the excellent clinical results obtained with implants (93 to 97% success rate) there is a 3 to 7% rate for failure. No other dental treatment has such a high success rate for long terms.

18. What does it happen if a dental implant fails?
If an implant fails, it is possible to substitute it for another one to solve the problem after the jaw has healed.

C L I N I C    E X P R E S S     D e n t a l    O f f i c e MORE ABOUT IMPLANTS AND FULL MOUTH RESTORATIONS... How many teeth can be supported by dental implants? All the common forms of tooth replacement, such as bridges or dentures can be replaced by dental implants. If you are missing one natural tooth, then one dental implant is normally all that will be needed to provide a replacement. Larger spaces created by two, three of more missing teeth do not necessarily need one dental implant per tooth, however the exact number of dental implants will depend on the quality and volume of bone at each potential dental implant site. Occasionally, it is even possible to join natural teeth to dental implants with a conventional bridge. In the upper jaw, bone density is generally poorer than in the lower and if you have no teeth at all, most treatment providers will want to place a minimum of 6 dental implants to support a complete arch of 10 or more replacement teeth. In the lower jaw, the bone towards the front of the mouth is often very strong and as a direct result, fewer dental implants may be needed than are required to treat a whole upper jaw. A simple treatment plan to provide 10 or more teeth in the lower jaw might be possible with as few as 4 dental implants, although it is still more common to use 5 or 6.
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The procedure goes normally few steps. In the first step an X-ray is taken to see if there is enough bone and to look at the bone quality. One can do this by taking a big x-ray called OPG , but mostly a dental scan or CT-san is taken to see the area in full 3D . They recently often do that with the guide of specialized computer programs. The latest development is a computerized prefabricated guiding model , so the surgeon can do a guided surgery. In a second step the implant is brought into place.. The patient gets normal a local anaesthesia and the implant is placed is less then 20 minutes . Opening the gums is not necessary anymore, just a little hole is punched through it. When the canal is almost as large as the implant, the implant is screwed in If required, some stitches are placed and the gums are closed. Whenever more implants are placed , usually this done in the same session. When this procedure is done, in some cases the implant is covered by a healing cap that sticks through the gums and can be visually detected. This is called a “one-phase” healing procedure. When the implant is fully covered with gums the healing abutment is placed after a second surgery phase a few weeks later, the healing time , meaning the time that the bone needs to fully osseo-integrate the implant, is about 2 months for the lower jaw and four months for the upper jaw.
All-On-Four Dental Implants All-on-four dental implants is where the entire edentulous upper or lower arch is restored with a fixed restoration anchored by four implants. In all-on-four, a fixed temporary restoration is placed on the same day of surgery similar to teeth in a day concept. In all-on-four, the dental implants are placed in the front part of the jaw avoiding the need for bone grafting, sinus lifts, nerves, second surgery and other vital structures. Two of the implants are placed near the front midsection of the jaw while, the back implants are angled to avoid vital structures and to provide for a favorable restorative mechanics. All–on–Four is a good option for patients who have battled with gum disease for a long time and have reached the point where the remaining teeth must be removed. These patients can have the teeth removed and implants placed along with a fixed temporary restoration on the same day. The result is very well received by these patients and at times it’s emotional and dramatic as their lifetime struggles with bad teeth are resolved in a short period. Limitations of all-on-four dental implants All-in–Four dental implants require the presence of a considerable vertical space “arch height” for adequate restoration. If the space is not adequate, bone removal to reduce the height of the arches is required thus creating more space. In some patients bone removal may not be possible as they may exhibit a minimal amount of existing bone which is just enough to retain the implant. In these cases other alternatives must be explored. Advantages of all-on-four dental implants: There are several advantages of all-on-four over other fixed full arch restorative options - - Less costly than other full arch fixed restorative options - There is no need for second surgery such as bone grafting and sinus lifts - Greater measure of safety by avoiding vital structures - The simplicity of this concept produces higher level of predictability with less complications Implant Supported Dentures The addition of at least two dental implants per arch to support dentures can increase the degree of retention significantly. Retaining dentures with dental implants allows for much more chewing and biting ability of tougher foods like meat, lettuce and apples. There are several ways by which dental implants can support and help retain a removable denture: Removable dentures with two dental implants Two dental implants are the minimal number of implants that can be used for retain full upper or lower dentures. These two implants are usually placed around the eye teeth position. Using three or four dental implants to retain full dentures allows for even higher degree of retention and stability. More importantly it eliminates the unfavorable fulcrum forces on the bone. These forces are associated with using two dental implants to retain full dentures. More importantly, using more than two implants on the upper arch allows us to eliminate the denture coverage of the roof of the mouth. This allows for the tactile feel of food against the roof of the mouth which translates to a much more enjoyable eating experience   see more.. Dentures Supported by Two Dental Implants Dentures supported by two dental implants Removable dentures with three or more dental implants Dentures supported by Four Implants Denture Supported By Four Implants Bar retained dentures supported by dental implants In certain cases we may utilize a metal bar that connects the implants to retain full dentures. Clips or other attachments can be fixed into the dentures and bar to retain and secure the denture on top of the bar
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