Talk with Dr. Petar Duchev from Dental Clinic Petar Duchev
By Mariana Antonova
The practice of the clinic is directed exclusively towards aesthetic restorations, interdisciplinary approach in cases with total rehabilitation and implantology. Dr. Duchev is a member of the American Academy of Aesthetic Dentistry.
When one or more teeth are missing, we have three opportunities for “filling” the defect – a dental bridge, flexible denture or an implant. In our clinic we apply the latter as a main and leading contemporary treatment method. Placing an implant is a relatively fast and handy way for the patient to obtain new crowns. The contemporary implant systems make it possible to place an implant immediately after the extraction of a problematic tooth. And when more teeth are missing, it is possible to place between two and six implants at the same jaw at the same time. A fundamental principle of ours is to never file down healthy teeth in order to make a dental bridge, and we never place partial dentures since we believe they humiliate human dignity and do not correspond to basic health principles.
First – the right planning, which defines the end result of the treatment. During my first meeting with every patient, I make an imprint of their jaws and I work in the dental laboratory with my dental technician to prepare a wax model of the end result – teeth are modelled and constructions are planned. These teeth must be shown to the patients and discussed with them because they must be motivated.
The operation of placing the implants is not pain-related because it is always made under anesthesia. Still, there are some requirements to the patient. Before and after the operation s/he must not smoke and must observe the oral hygiene requirements very strictly. In case s/he has some accompanying health problems, s/he must inform the dentist about them at the beginning of the preparation.
The patients who hide information about their health are very few. Plus, the implantation can only start after we have made an intraoral X-ray, a panoramic one and a CAT scan of the head of the patient. These radiographs help me choose the most appropriate size of the implant and the best place to position it in order to achieve both good physiology and excellent aesthetics.
At the moment there are more than 400 companies on the market, selling different implants. We work only with three world brands that have won a reputation of being the best. They are ISO certified and each of their implants has a quality certificate. Besides, they are made of titanium alloy which is perfectly compatible with our organism. Every implant has two levels of packaging – an internal sterile one and an external transport one, thus contamination is virtually impossible. The implant has a factory- threaded external surface which ensures the future osseointegration. It is not touched at all, but is directly adapted to its bed that has been specifically prepared in the bone beforehand. During the next visit the implant stump is attached to the interior of the implant, and the crown is placed on top.
It sounds scary, but if everything is well planned, I place an implant within 20 minutes. It often happens that during a single visit to the clinic we both extract a problematic tooth and place an implant – with prior preparation, of course.
Here is why such detailed tests are needed – in order to be able to plan a possible bone insufficiency. The solution is the following: we add artificial bone matter and we wait for five or six months before we proceed to loading. During this period the patient has temporary teeth that socialize him/her and enable him/her to eat normally. After the period of osseointegration and periodic checks is complete, the implant is exposed and a so called “healing abutment” that shapes the gum is placed. After the 20th day an imprint is taken and the dental technicians prepare the permanent construction.
This is a subject I discuss with my patients as early as their first visit. I explain to them that the first six months after the placement of the implant are the most important. They must visit us for a check once a month, and once every 6-8 months afterwards. The postoperative hygiene of the wound is crucial, as well as the good oral hygiene after the loading. The right brushing and the periodic clinical hygiene ensure the long life of the implants.