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"I can proudly state that these were the first 19mm implants to be used in Portugal"
OralMED Dental Medicine clinics were the stage for a procedure using 19mm trans-sinus implants, marking the introduction of a new implant in Portugal.
The OralMED Health Group continues at the forefront of innovation. This time through the hands and experience of Dr. Diogo Simas Rodrigues, Dentist at OralMED Dental Medicine clinics, accompanied by Dr. Nuno Cintra, specialist in Oral Surgery and Director of the Scientific Council of the OralMED Health Group.
We spoke with Dr. Diogo Simas Rodrigues and Dr. Nuno Cintra to better understand what made this procedure a premiere in Implantology and Oral Surgery. compreender melhor o que fez deste procedimento uma estreia em Implantologia e Cirurgia Oral.
What does the technique consist of?
Dr. Diogo Simas Rodrigues - It consists of placing angled implants through the maxillary sinus to reach bone structures with sufficient thickness for anchoring and primary stability of the implant. Using the lateral wall of the nasal fossae, which is part of the upper maxillary bone, and part of the lower wall of the maxillary sinus. Thus, it is possible, without leaving our field of specialty, to place the implant in its ideal position for total fixed rehabilitation of a maxilla whose anterior wall of the maxillary sinus occupies a very anterior position.
Conventional angled implants are placed immediately in front of the anterior wall of the maxillary sinus at an angle of approximately 45°, so that they can exit in the area between the first premolar and the first molar.
When the anterior wall of the sinus is in a very anterior position, it is not possible to place the implant to reach this ideal position. In this case, trans-sinus implants are an excellent technique to achieve this.
Dr. Diogo Simas Rodrigues - C.P.: 06450
Why opt for this technique in this specific case?
Dr. Diogo Simas Rodrigues - In this case, as with many others, the anterior wall of the maxillary sinus, on both sides, occupied a very anterior position. This would compromise the ideal exit position of the implant in terms of rehabilitation, which would not occur in the ideal interval.
Additionally, the patient had a gummy smile, which implied a significant reduction osteotomy. This, in turn, along with the position of the anterior wall of the maxillary sinus, made the available operative field reduced, thus making it impossible to place the implants in their ideal position using the conventional All-on-4 technique. By crossing the maxillary sinus and using the lateral wall of the nasal fossae, whose anatomy was previously studied through a computerized axial tomography (CT), it was possible to place the posterior implants in a favorable position and with sufficient primary stability to immediately load the implants by placing a temporary fixed prosthesis on them.
This type of case is often resolved using more invasive techniques, with a higher risk of associated complications. And that, indeed, go beyond our field of specialty. Sometimes, some of these techniques require at least two surgical interventions. And they do not allow for immediate placement or loading of the implants, requiring the use of a removable total prosthesis as a temporary solution.
Why is this case so innovative?
Dr. Nuno Cintra - This technique is not new, having been used successfully for a long time by other colleagues using other types of implants. What's new is the implant used. We used 19mm long implants with a specific design for this type of technique, manufactured by an Israeli company for which I am a consultant. For some time, I have been requesting from some brands the production of long implants with certain characteristics that, in my opinion, are essential both for the placement and for the success of this type of intervention. Among these, I highlight the internal connection, conical body, deep and sharp double threads that allow for self-drilling and self-locking, ensuring greater primary stability. The blunt apex allows for safe insertion considering the anatomical structures involved. Furthermore, this implant was developed in two diameters: 3.75 and 4.2mm.
Some brands already have long implants in their portfolio, namely 18, 20, and even 22mm, but none with this design, which allows us to maximize primary stability both in the lateral wall of the nasal fossa and in the remnant of the lower wall of the maxillary sinus, without compromising or damaging it during preparation and placement. I can proudly state that these were the first 19mm implants with these characteristics used in Portugal and most likely in the 40 countries where this brand is implemented.
What conclusions did you draw after placing these implants?
Dr. Nuno Cintra - One thing is the technical design and development of the implant, which was done taking into account my experience with the use of other implants of the brand with similar characteristics. Another, completely different, are the conclusions to be drawn after its use. This intervention requires knowledge and mastery of other surgical techniques, including exposure, detachment, and elevation of the Schneider membrane, placement of angled implants, and handling of soft tissues for perfect closure of the operative field, in an intervention that took about four hours. During this, and although the main objective was the patient's health and well-being, we were able to identify some aspects in which it can be improved, both in terms of preparation of the surgical field, implant placement, and even in relation to the implant itself. These are very important aspects for the result of the intervention and, undoubtedly, for the development of the system, as well as for the improvement of the technique.
What will be the gains for the Patient with this treatment?
Dr. Nuno Cintra - For the patient, the main gain is the fact that we managed to overcome all the anatomical limitations they presented with a single relatively simple intervention, within our field of specialty. Thus fulfilling the patient's expectations of performing a total fixed rehabilitation, without having to undergo several surgeries or more complex techniques, with a higher risk of associated complications.
About the OralMED Health Group
The OralMED Health Group is the first Portuguese group specialized in Dental Medicine. With over 11 years of experience and a leader in the sector, it already has more than 60 own clinical units, three dedicated laboratories, and an integrated contact center, the first specialized in Health in Portugal.
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