Dental Implant Surgery
Teeth serve an important role in our daily lives as it affects our speech, our ability to eat well and the way we look. Its loss through disease or trauma sets in motion the loss of underlying bony support resulting in tooth loss. This in turn affects support for our lips and cheek leading to a more aged appearance. Failure to replace missing teeth often leads to the opposing teeth overgrowing and the adjacent teeth tilting resulting in areas of food trapping which in turn may result in gum disease tooth decay.
What are the different ways of replacing missing teeth
Traditionally, missing teeth were replaced by either removable plastic or metal based dentures, or fixed bridges made of either metal alone, or porcelain fused to a metal base. Developments in dental material science have focused on developing more aesthetic materials with adequate strength, such as all-porcelain and zirconia bridges. While all of these are still very much in use today, implant based methods of replacing missing teeth are increasingly preferred as it provides greater biting ability and a more comfortable and natural feel.
What are dental implants?
Dental implants are sterile titanium screws which are inserted into the jawbone as artificial roots to support and retain replacement teeth. It comprises 3 parts. The first part or “fixture” is placed within the jaw bone to replace the roots of missing teeth. The second part or “abutment” emerges through the gums and is used to carry the 3rd part, which may be a single crown or a bridge depending on how many teeth are missing. If we have lost all our teeth, we can use 4 to 8 implants in each jaw which when connected can support dentures or even a fixed bridge
How do Implants compare with alternative options?
When compared with removable dentures, they provide stronger support, firmer retention and are more stable. The implant supported and retained replacement teeth occupy less space and are more comfortable. They are also able to generate much stronger biting force. When compared with fixed bridges, they can be used even when more teeth are missing as they can provide stronger support over a longer span. They are also preferred when the teeth adjacent to the gap are weak or too small to provide sufficient support. Additionally, they provide an alternative to trimming healthy teeth.
Benefits of Dental Implant
Are permanent replacement for missing teeth
Has predictable and good long-term success rate
Prevents supporting bone from shrinking after tooth loss
Does not decay as it is made from Titanium
Able to generate stronger bite forces for better chewing and hence better digestion and nutrition.
Restores appearance thus creating more confidence and self-esteem Able to provide better support for lips and cheeks for a more youthful look
Types of Dental Implant
Dental Implants have been widely used for more than 40 years since the original scientific research was published. While many different implant systems are now available and are generally of high quality, our clinic prefers using implants from Nobelbiocare, Sweden and Straumann, Switzerland due to the extensive research and long track record. These implants come in different sizes and lengths and are generally at least 3.5 mm in diameter and 8 mm in length which differentiates them from “mini-implants” which should be used only as temporary supports or in very specific cases.
Are you suitable for Implants
Implants can be placed in most patients from age 18-80, even if you have lost your teeth for many years as we are able to regenerate bone in order to place implants as a foundation for your denture or bridge. Patients with health conditions should inform the dentist so that additional precautions can be taken, if required. Conditions which require attention include patients with significant heart disease, unstable high blood pressure, uncontrolled diabetes and patients on therapy for cancer. Surgery can still be performed after clearance from your medical specialist.
What is the surgical procedure like?
After giving some local anaesthetic, a small incision is made through the gums and a point of insertion decided. Drills of a predetermined length and with increasing diameters are then used to gently prepare the site to receive the implant. The implant is then rotated to the desired depth. The top of the implant channel is then covered with a temporary cap and the gums stitched either over or across after cleaning the surgical site and allowed to heal undisturbed for 3-4 months. A higher temporary cap called a healing abutment is often placed to avoid a second surgery to uncover the implant.
Is Implant Surgery Painful?
No, implant surgery is generally a minimally invasive procedure and in most instances the pain is minimal. If more major treatment is required, some post-surgical pain may be present. If you are fearful, we can arrange for you to have a complete pain-free experience either by performing the procedure under intravenous sedation or general anaesthesia within an operating theatre. The mix of drugs given will help you relax, sleep and eliminate pain. You will also usually be given a painkiller to take before the procedure so that you will be comfortable after the surgery.
How long does it take to recover from the Surgery?
After the operation, you may feel uncomfortable but this can be eliminated by taking the prescribed painkillers regularly. Some swelling and bruising is to be expected for a few days after the surgery. You can resume normal activity within a day but should avoid strenuous exercise and swimming. A normal or soft diet is advised and can be commenced after the numbness from the local anaesthesia wears off, usually around 2-3 hours after the procedure to avoid biting your lip or tongue inadvertently.
Same Day Teeth Replacement
Rationale for immediate tooth replacement
Losing a tooth, especially one of our front teeth can be very distressing for most patients. In addition to the effect on appearance and confidence, it affects our speech and on the long-term, the gums and the supporting jawbone will also shrink. A common request from our patients is to get a replacement for their missing tooth immediately, hence the advent of protocols for "same day teeth replacement". This could be done by partially loading the implant on the day of the surgery, or more commonly by using the adjacent teeth as temporary supports.
How long does it take for healing after tooth extraction and implant surgery
Teeth extraction and implant surgery are fairly routine and painless procedures and you will feel back to normal in just a few days. However, it takes around three months after tooth extraction for the bone to reform before placing an implant. In addition, it takes a further three months for the bone to grow around the implant in order to anchor it firmly in the jaw. During this waiting period, removable dentures, or temporary bridges made of plastic are used to prevent direct forces on the implant allowing the implant to heal.
Can this waiting period be shortened
Yes, it is possible to reduce this waiting period as implants can often be placed immediately into extraction sites for patients with missing front teeth. This reduces the waiting times significantly. In general, we are able to place implants to replace our front teeth on the day of extraction as there is usually adequate bone around and beyond the tooth socket to stabilise the implant. For back teeth, it is not always possible as there is usually insufficient bone after removing the tooth. Very often a bone graft will also be needed and is therefore a more technique sensitive procedure.
Immediately Loaded Implants
If the implant lies firmly within bone, it is possible to even allow partial loading immediately after the surgery. In combination, with the latest computer assisted techniques, it is possible to deliver aesthetic looking temporary teeth in selected cases within 3 hours after the surgery. The patients are however advised to avoid chewing on the implant, especially in the initial weeks after the surgery when the original bone anchoring the implant would have been resorbed with the new bone yet to form.
Is immediate loading of implants a new technique
No, the first controlled study of successful immediate loaded implants was published in 1997 after a successful 10 year study. Our lead clinician has been placing immediately loaded implants since early 1999. The success rate of immediate implants are comparable to that of implants placed using conventional protocols but is more technique sensitive as it requires the dentist to determine if the initial stability of the implant is sufficient for immediate loading. Done selectively, it is a useful option for patients with no other remaining teeth to anchor a temporary denture or bridge.
Face - Treatment Options
Common problems and their solutions
While everyone has a different perception of beauty and have different skin type and unique problems, the common issues faced are the management of facial lines and wrinkles and saggy skin on the face and neck. Many also wish for a smoother skin or a more slender jawline. Thanks to the advent or technology, numerous non-surgical options are available though our clinic also has a certified day-surgical centre for those who prefer a surgical approach. The main treatment modalities are listed below:
1. ANTI-WRINKLES - BOTOX®
ANTI-WRINKLES - BOTOX® & DYSPORT®?
The concept of "lunchtime treatment" for modern-day women are actually injections of a highly purified protein derived from a neurotoxin and is commonly used to smoothen and soften frown lines and wrinkles temporarily.
WHAT CAUSES FACIAL LINES & WRINKLES?
As we age, our skin loses its underlying supporting tissue known as collagen. This is made worse if we have had prolonged sun exposure, or habits such as frowning or squinting. The constant muscle contraction results in the formation of facial lines and wrinkles which deepen over time. BOTOX® & DYSPORT® resolves this by preventing the muscular movements which accentuate these lines.
HOW DO BOTOX® & DYSPORT® WORK?
Our doctors inject small amounts of BOTOX® and DYSPORT® on specific points to prevent repeated muscle contractions. In so doing, the muscles relax thereby temporarily preventing the establishment of frown lines, crow’s feet and lip lines. This produces a visibly smoother appearance that can make you appear younger. Both BOTOX® and DYSPORT® are established, FDA-approved brands and are used to treat the following issues:
Forehead – Wrinkles and furrows that form between the eyebrows as a result of frowning can be visibly lessened
Crow’s Feet – These form at the corners of our eyes giving us an aged look
Masseters - As a result of teeth grinding habits, our cheek muscles get stronger and thicker. Selective injections can reduce the bulk of the muscles, giving rise to a slimmer jawline
Chin Dimple – While some view this as a unique look, others dislike its presence. This can also be eliminated or masked.
Gummy Smile – When too much of your teeth show when you smile, injecting small amounts into the muscles of the upper lip can temporarily relax them, reducing the amount of gum visible between upper lip and upper teeth.
Bunny lines – These are the small wrinkles that appear on both sides of the nose when you smile or crinkle your nose.
WHY IS BOTOX® & DYSPORT® POPULAR?
It’s simple and fast with minimal downtime making it an ideal lunchtime procedure as you can resume most normal activities as soon as you leave the clinic. The actual process takes only 10-15 minutes, The results can be seen as quickly as 24 to 48 hours, though it takes up to two weeks for more severe frown lines. The resulting effects can last up to 4 months.
2. SKIN BOOSTERS & HYDRATION - PROFHILO® & REJURAN®
Hyaluronic acid is the component in our skin responsible for maintaining the moisture which gives skin its natural tone and texture. As the result of aging or prolonged sun exposure, much of this is lost and the skin needs a replenishment of hyaluronic acid to hydrate and boost its appearance.
How do you keep your skin glowing
The use of moisturisers as part of our daily skincare routine is important. However for that extra glow, replenishment of our skin's hyaluronic acid through direct injections can help you regain that youthful appearance immediately. Rejuran and Profhilo are two FDA-approved skin boosters which can provide the solution.
Profhilo is a concentrated form of hyaluronic acid and relatively long lasting. It remains for 4 to 6 weeks when injected but its action continues for 6 to 9 months after as it also stimulates the production of collagen and elastin, elements critical for skin tone and support. This provides the skin with a "boost", revitalising sagging tissue and gives a tightening and lifting effect to the skin.
As aging and exposure to sun and pollution causes our skin to lose its natural hyaluronic acid, likewise, the skin's moisturising and lubricating ability is much reduced leading to dryer skin without a natural glow. Profhilo is a hyaluronic acid-based solution which replenishes the loss, so in addition to being a skin booster, it also hydrates our skin, improving skin tone and health.
WHY CHOOSE PROFHILO®?
Rather than merely replacing volume or creating a volumetric lift like other traditional dermal fillers, Profhilo stimulates the body to produce 4 collagen types to restore both skin and fat layers to their natural state. It also hydrates the skin by replenishing lost hyaluronic acid
In addition, as it is not viscous and has high spreadability, it can produce its results without giving an artificially enhanced appearance. This makes it ideal for imp.roving elasticity and tightening areas such as the neck, around the mouth and hands where fillers are unsuitable.
Rejuran is a skin rejuvenator formulated with a powerful anti-ageing retinol, c-PDRN® growth factors, and peptides. This multi-benefit serum encourages the skin to produce its own collagen which smoothes lines & wrinkles and evens skin tone. It also boosts cellular turnover for a more youthful, radiant complexion.
Scientists working with Rejuran used naturally derived collagen-stimulating polynucleotides to develop a powerful skin-repairing compound that stimulates skin regeneration, helps in initiating wound healing and collagen growth, decreases inflammation and protects the skin against free radical damage. It is most effective when injected into the skin though it is also available as a cream.
WHY CHOOSE REJURAN®?
Rejuran binds easily to water molecules and hydrates the skin effectively. Its powerful skin-repairing abilities diminish the appearance of lines and wrinkles, increase dermal thickness, fade facial scars and discolouration, boost natural collagen production, reduce inflammation, improve texture and tone, and restore youthful skin.
3. DERMAL FILLERS
WHAT ARE DERMAL FILLERS?
Dermal fillers are gel-like substances made from stabilized hyaluronic acid that are injected under the skin to restore lost volume, smooth lines and soften creases, or enhance facial contours. Hyaluronic acid is a naturally-occurring substance that is already found in our skin, keeping it plump and hydrated. We use FDA-approved dermal fillers from Restylane, Juvéderm and Teosyal.
BENEFITS OF DERMAL FILLERS:
Aging or even sudden weight-loss may cause the tissues supporting the cheeks to lose volume or elasticity and sag. Dermal fillers can counteract sagging temporarily, and give a natural-looking uplifted appearance.
Dermal fillers can be injected into the chin to create more definition or a more proportionate appearance.
Aging or the loss of tissue tone results in prominent folds on both sides of the nose. Fillers can reduce these deep furrows, provide a temporary skin lifting and smoothing effect along the nasolabial folds.
WHY CHOOSE DERMAL FILLERS?
Dermal fillers provides the "bulk" effect if required to enhance our facial appearance. It increases skin volume, "fills up" thereby reducing facial lines and wrinkles giving you a more youthful look. Made of hyaluronic acid, it gives you a natural, long-lasting and desired look, but is non-permanent and hence reversible and repeatable.
4. NON-SURGICAL FACE LIFTING
As we age, our facial tissues lose volume and sag. Traditionally, a surgical procedure is required by a plastic surgeon to pull or "lift" the tissues either upwards or backwards in order to achieve a more taut youthful appearance. The surgeon will skilfully hide his incision lines along the hairline or natural creases in our skin so that the scar is not obvious.
While this is still the most effective method, many patients seek less aggressive procedures, such as minimally invasive "thread-lifts" and non-surgical machine-based techniques with little or no downtime. The most popular such machines use high intensity focussed ultrasound (HIFU), radio-frequency (Thermage) or lasers with various wavelengths.,
A. RADIOFREQUENCY TREATMENT - THERMAGE & VENUS VIVA DIAMIOND POLAR
Thermage® is a non-invasive therapy using radiofrequency (RF) to smoothen, tighten and contour skin for a more youthful appearance. No surgery or needles are required, and all it takes is a single session to achieve the desired skin rejuvenation effect which lasts for up to 12 months. There is no downtime though numbing cream is usually required for greater comfort during the procedure.
As we age, the collagen in our skin responsible for skin tone and texture breaks down resulting in sagging skin, furrows, grooves, fine lines and wrinkles. Thermage heats the deeper layers of skin stimulating the collagen and promoting new collagen growth over the next few months, firming our tissues and tightening our skin over time.
VENUS VIVA DIAMOND POLAR
Venus Viva uses radio frequency to gently create enough thermal effect to induce collagen remodelling with no ablative heat damage to the layers of the skin. Its patented technology produces uniform heat under the skin’s surface and also increases blood flow and oxygenation to the skin, reducing pain and inflammation while it firms and provides the desired lifting effect.
It is suitable for younger patients who want to maintain their skin or have a more defined contour, and as a complement to other skin resurfacing procedures. It is a quick and easy procedure with no down time, and gives a radiant afterglow, making it an ideal treatment before an important event. Although some results are visible in just one session, multiple treatments are recommended for optimal results and continued improvements.
B. HIGH INTENSITY FOCUSSED ULTRASOUND (HIFU) - ULTRASKIN & SYGMALIFT
High-intensity focused ultrasound (Hifu) concentrates beams of ultrasound energy on specific areas at depths of between 1.5 and 5mm beneath the skin to stimulate new collagen and elastin in order to tighten and firm up saggy tissues. Depending on the manufacturer, the energy can be delivered at different intensities and depths giving rise to either more immediate single session results, or to more gentle progressive improvement over a period of 3-6 weeks.
In general, higher intensity equipment requires closer supervision and is handled by doctors. Our clinic uses the Ultraskin HIFU system. If you prefer a less intense treatment, you may opt for the Sygmalift HIFU system in which our therapists can help you achieve a similar effect painlessly over a 3-6 week period.
WHAT IS ULTRASKIN HIFU?
Ultraskin HIFU is a non-surgical facelift treatment using ultrasound to stimulate the deeper layers of our skin, lifting and tightening loose and sagging skin on the neck and face. This contracts and shrinks the collagen fibres for an immediate face-lifting effect and stimulates our skin to promote the regeneration of its elastic fibres.
WHY CHOOSE ULTRASKIN HIFU?
Ultraskin HIFU is a safe, non-invasive procedure with no downtime. It rejuvenates the skin and brings back elasticity lost as we age. Beyond the immediate tightening effect, the results improve over time with the triggering and remodelling of our skin’s collagen fibres as part of the healing process. It can also melt fats due to its deeper penetration.
WHAT IS SYGMALIFT HIFU?
SygmaLift uses fractionated high intensity focused ultrasound in combination with a cold laser of wavelength 635 nm. It is pain free when compared to other systems but multiple sessions are required to achieve a similar effect and is ideal for patients new to aesthetic procedures as there is no need for any numbing cream. You may return to your normal routine immediately after treatment and no special aftercare is required.
HOW DOES IT WORK?
SygmaLift is able to focus at precise depths ranging from 2-5mm to provide face lifting and can stimulate the breakdown of fat in areas such as the chin and cheeks. It is also able to target lesser depths of between 1-2 mm where the skin is thinner such as on the forehead and around the eyes and mouth. In combination with a cold laser, the rate of collagen formation is increased while there is a reduction in redness and inflammation.
HOW FAST CAN I SEE RESULTS, AND HOW LONG DO THE RESULTS LAST?
You will notice visible skin tightening and lifting after the treatment and progressively within 40 days as your skin continues to generate collagen, allowing you to have more youthful skin day by day. One treatment per week over 3-6 weeks is recommended with each treatment taking an hour. The skin tone will continue to improve and can last up to 12 months.
Book an Appointment
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Surgical procedures can only be prescribed after a detailed consultation with a Doctor / Aesthetic Physician.
Medical history, pre-existing health conditions and other factors will need to be taken into consideration.
Patients are required to make an appointment at +65 6708 8000 or by clicking "book appointment"