Tubero Pterygoid Implants

If you are looking for Pterygoid Implants in India you will find all the info you need on this page.For your convenience we have listed the topics below – if you still have some questions, please feel free to contact us.

Pneumatization of the sinus occurs when the teeth are extracted for a long time. 2 piece Cortical TTPHIL Implants are placed by taking support from the palate, tuberosity, and the pterygoid bone. In these kinds of cases where the sinus is pneumatized conventional grafting Implantologists will advise their patients for Indirect and Direct Sinus Lifting procedures or Bone grafting procedures for placing implants in the upper jaw molar regions.

Here at The Dental Specialists, we place Tubero Pterygoid Implants to avoid Sinus lifting and Bone Grafting and augmentation surgeries. We have been doing this for more than 13 years with more than 98% success rate.

Our director Dr. P. Venkat Ratna Nag, a key proponent of this method has published about this method in many national and international journals. We are one of the first dental hospitals in India to offer pterygoid implants. These are also referred to as Pterygoid implants or Pterygo Maxillary Implants or Tuberoid Implants.

Who Should Opt for Pterygoid Implants

Tubero pterygoid implants are indicated for patients who do not have enough bone for regular conventional implants. These implants are placed in the 2nd and 3rd molar region of the upper jaw.

How Pterygoid Implants Work

Due to their long path, the length of pterygoid implants ranges from 15 mm to 25 mm. Pterygoid implants take bicortical anchorage, due to which the axial loading is improved and posterior cantilever is eliminated.

The tuberosity of maxilla is composed of Type III and Type IV cancellous bone. The pyramidal process of palatine and pterygoid process of the sphenoid is mainly composed of dense cortical bone. Tuberopterygoid implants are placed in the Tuberosity region and then into the pterygoid plates to gain stability. The bone in the Tubero pterygoid region is cortical in nature. TTPHIL implants are placed by keyhole technique or flapless procedure ( No Incision- No Cuts)  and therefore there will be minimal bleeding.

We do not use Single piece basal Implants because of various factors. Diagnostic, Surgical, Prosthetic, Laboratory and Maintenance problems. Why not single piece basal implant?

Advantages of Pterogoid Implants

  • This Pterygoid bone never resorbs. Everyone has this native bone which can be utilized to place the implant.
  • These Pterygoid implants which we place at The Dental Specialists are 2 Piece Cortical Implants. These Implants are manufactured with the most advanced and strongest Medical Grade 5 Titanium recognized by CDESCO and have FDA clearance, Quality tested and hence there is never a breakage.
  • Implant screw loosening never happens because of the BIOLOCK connection.
  • Complete 14 teeth, 1st, and 2nd molars are replaced. Gives maximum chewing efficiency which is not possible in any other implant technique to date.
  • With Tubero-Pterygoid Implants, Sinus Lifting, Bone grafting, and Augmentation procedures can be avoided.
  • No Cantilevers are needed
  • 14 teeth can be given in the upper jaw  in the most distal part of the maxilla in full mouth rehabilitation procedures
  • Immediate functional loading can be done with Pterygoid implants
  • Due to keyhole surgery process, only minimal bleeding, and swelling

Pterygoid Implant Procedure

Your dentist will take a CT scan to determine bone density and bone volume. This TTPHIL Protocol is a Single Visit Implant process but sometimes the entire process can take 3 months for the bone to heal depending on the patient’s state of health. The scan allows us to give an option of whether to place or not to place the implants. Only after a clinical assessment, we are able to understand whether we can or cannot load the implants. But still, this graft less tilted pterygoid implant solution is much more predictable rather than choosing sinus lift or all on 4 procedures or single piece basal implants. We do not do single piece basal implants because of several disadvantages.

We follow the minimal 5-minute pterygoid implant protocol which is safer than any other protocol in the world.

The process is painless and it’s done completely flapless with a surgical guide to avoid manual errors. You should contact experienced dental surgeons to evaluate your condition before starting such a procedure.

Basal Single piece implantologists do the same procedure but with 10 to 12 implants. This might be cheaper but it is done manually and is not possible with guides. The only advantage is that they are cheap. This does not offer any surface coating and single piece implants have several serious disadvantages. We are forced to load the implants even if we are not happy with the stability.

Pterygoid Implant Case Study

Pre-operative Xray

pterygoid implant xray

This is a story of the patient whose daughter is an MDS, Prosthodontist who came all the way from Assam. The daughter insisted him to come to Hyderabad to undergo the dental implants. As she herself was a dental surgeon she took him to more than 5 clinics in Hyderabad.

Patient’s complaint: Missing teeth and unable to chew food and patient getting weaker. The patient got the opinion from several dentists and most of them suggested sinus lift and bone augmentation and grafting procedures.

At The Dental Specialists, treatment options like Zygomatic Implants  Sinus Lifts,  All on 4, Basal Single piece Implants and TTPHIL Protocol. The advantages and disadvantages of each were explained. Finally Patient insisted on the TTPHIL all tilt Protocol as there were no disadvantages of it. Sinus region was avoided by placing Tubero-pterygoid. Implants were placed on either side. 6 Implants were placed Bicortically and Immediate CAD CERAMIC teeth were given on the 3rd day.

TTPHIL Protocol recommends precise Flapless Guided Surgery.

Pterygoid with TTPHIL Guide


High Primary Stability because of the Bicortical Fixation. Keyhole surgery performed. No cuts No bleed. 

TTPHIL osseofixation- Bicortical Stabilization

No crestal bone loss. Vertical bone stability. 

ttphil implants

Are Pterygoid Implants Safe

In the hands of experienced surgeons, the pterygoid implants are completely safe. We have some of the best Implant surgeons. Dr, Venkat Nag, our Director is the Inventor of the TTPHIL Protocol and has been widely acclaimed as one of the top dental implant specialists in the world. Our multi-specialists team led by Dr.Venkat has been delivering implants with more than 98% success rate and a lifetime warranty.

For appointment Call/ WhatsApp : +919000021174/ 9177671117/ 9963511139 or mail us to


Basal Bicortical Implantology uses innovative immediate placement and loading with Biolock Screw Retained Technology to avoid Screw loosening and making the Implant abutment junction strong and secure . Basal Bicortical Implantology (TTPHIL – ALL TILT® ) principles are similar to Orthopedics and Traumatology.

The Basal bone provides excellent quality cortical bone for the retention of these unique and highly advanced hybrid basal cortical implants. Basal Implantology is also known as Cortical Implantology. This basal bone is more resistant to resorption and Infections. Hence Basal Bicortical engagement is better than an implant tip engaging the trabecular bone (which is softer) which does not have enough capacity to accept the loads. Inplant apex engaging basal cortical bone have better load and stress transfer giving better Biomechanics and Biology for long term success of Dental Implants.

What is a Basal Implant

TTPHIL BASAL BICORTICAL IMPLANTOLOGYBasal Implants are not much different. Basal implants are longer implants where the Implant Apex  engages the basal bone instead of alveolar soft trabecular bone. We use Hybrid implants greater ranging from 10mm to 60mm in most of the cases ( TTPHIL ® ALL TILT PROTOCOL), which engages the Basal bone that is more mineralized and has more density depending on case to case. 

Basal Bicortical Dental Implantology is an advanced dental Implantology which utilizes Basal bone and the cortical portion of the jaw bones for retention of the dental implants. ( Basal Cortical Fixation like Pterygoid Bone, Nasal Bone, Zygomatic Bone,  Body of the Mandible etc;)


The basal bone is more resistant to resorption. Hence Basal Bicortical engagement is better than an implant tip engaging the trabecular bone, which is softer and does not have enough capacity to accept the loads.

“Bone Quality is good in Cortical Basal Bone compared to the Trabecular bone” that is the key reason why we are able to do immediate implantation and loading/function for most of our patients across the world.

At the Dental Specialists we utilize tthe latest advanced  screw-retained technology, which is available in the crestal or axial two-piece implants. This technology helps in retrievability of the prosthesis ( Your teeth- Crown and Bridge) in cases of any complications like food lodgment, Gum shrinkage, Halitosis, Implant failure itself etc. We need to understand anything can happen any time. Complications can always occur at various stages: Surgical,  Prosthetic, Laboratory, Esthetic, by the Surgeon, Restorative dentist or technician.  We should be able to repair at your convenience.  That’s the advantage of going for screw retained technology. 

Why you should not go for Single Piece / One Piece / Monobloc Implants – Disadvantages. Why we stopped doing Single piece Cementable Basal Compressive Implants.


There are several disadvantages to using a single piece implant. Dental implant treatment has three parts Implant Fixture, Implant Abutment and Implant crown. Single piece implants can be used only in limited cases where the load or stress is less especially in the front lower teeth.

If you are considering a single piece implant, you must read 15 reasons why we do not use single piece implants in most situations

The video below shows the key difference between Single piece and Two-piece dental implants.


TTPHIL Technique – Permanent Teeth in 2-9 Days

The dental implantation procedure is the best treatment option among those for the replacement of teeth. But conventional Dental Implant procedure’s biggest disadvantage is the waiting duration after placement of the implant (between 3 months-12 months) depending on case to case. Patients undergoing these conventional procedures have to wait for a very long time before they can enjoy the benefits of Smiling, improved Esthetics, Speech and Chewing.TTPHIL technique is the perfect solution to overcome this. Read more about TTPHIL Dental Implants

Difference between Basal Implants and TTPHIL Technique for Implants

Comparison Terms TTPHIL Technique Single Piece Basal Implants ( BCS/KOS)  CONVENTIONAL
Number of visits Single 2-day visit to Hyderabad, India. CAD CAP Ceramic or Zirconia with screw access holes. ( Depends on case to case)

Inhouse CBCT facility to do precise Flapless 3DGuided Surgery

Permanent teeth in 3 Days? . Not always. First visit with metal acrylic teeth and later ceramic or Zirconia after few months. These polished basal implants take long time to Integrate? Does it Integrate is a million dollar question? Forced to load even if you dont get predictable primary stability. 2 visits or Single visit. First visit for taking CT to prepare surgical guide. 2nd visit after 4 to 6 weeks for permanent teeth.
Cost of implant procedure Affordable dental implant procedure. Customized CAD-CAM, CAD-CAP designed screw access abutments and Zirconia or CAD-CAM PFM crowns. 

we do not recommend cemntable bridge for full mouth prosthesis.

Abutments come with implants. Cheap because it’s acrylic or cemented bridge. Repairs are very expensive.  Have to change the whole prosthesis since its cemented. Expensive depending on prosthesis chosen. because of CT scan and surgical guide preparation and multiple visits.
Type of prosthesis Ceramic or Zirconia. The lab prepares in 1-2 days depends on case with CAD-CAM technology. Precise dental crown and bridges fabricated. We recommend zirconia if we have strong metal base like malo bridge. Zirconia do not have strength so can break in long term. Mostly Metal Acrylic or Composite  sometimes Ceramic or zirconia. No CAD CAM abutments possible.Tissue Colapse. Hence esthetics compromised. Metal ceramic Zirconia also given but no use because they have to be cut and repeated.  Acrylic/plastic- After 3 months replaced with Ceramic or Zirconia
Type of implants Active design implants with a combination of basal and pterygoid for immediate loading, no screw loosening because of Q-lock Morse connection(aircraft technology) Combination of Single piece Implants, Basal Implants, and Pterygoid Implants are used. No screw loosening and no crestal bone loss. Screw based implants used. Screw loosening is a problem
Temporary crown CAD-CAM Temporaries are given on day of implant placement. Given on day of implant placement Only manually possible because of direct impressions. Given on day of implant placement. Only manually done.
Permanent crown Given on the 2nd day Given on 3rd day Given after 2-3 months
Surgical technique Done with surgical template. Hence more precise. Tall and Tilted implants increasing the surface area for better osseointegration. Thin and narrow implants, Surface area of implants very less compared to TTPHIL Active design implants. Non Active design
Implants used Active (Germany) Switzerland Yes
FDA approval Yes No Yes
Screw loosening No because of Q lock Morse connection abutments used. No because implant comes with abutment Yes. Chances are there.
Bone grafting No because Tall and Tilted implants are used to bypass sinus walls or nerves. No. Small implants are used. Longevity questionable? Bone grafting done
Cantilevers No because Tilted implants and Pterygoid implants are placed. No. No- Sinus Lifting is done but waiting time for 3 to 6 months
Relative risk of failure No risk, lifetime warranty ( more than 4000 implants are placed for immediate loading) Smaller implants used hence less chance of integration Smaller implants are placed. Waiting period for 3 to 6 months

Read our article published by TIMES OF INDIA 


Full Mouth Dental Implants

Full mouth dental implants can be done either with a bone graft or with graft-less implant solutions.

Graft Solutions for Full Mouth Dental Implants

  • Vertical and Horizontal Bone Augmentation
  • Sinus Bone Graft- Direct and Indirect

Graft-less Solutions for Full Mouth Dental Implants

full mouth implant

Why implant placement is difficult in posterior maxilla (Upper Jaw)?

  • Takes More Time: Bone graft (6months) – Implant – 3months – Prosthetics. The whole procedure takes 9 to 12 months.
  • Multiple Surgeries: Multiple Anesthesias and Medications
  • More Investment: Bone grafts, Surgeon charges
  • More graft Rejections: Implant Rejection
  • Obliteration of functions of Maxillary Sinus: Imparting the resonance of the voice, Absorption of shocks to head, Filtration, Humidification, Warming of air, Lightening of skull, Regulating Intra nasal pressure.

This type of implant placements can fail because of the poor bone density in the upper molar region in the upper jaw. Most of the cases fail not just because of the bone quality but also because of the bone quantity. Because of the pneumatization of sinus, the bone available to place is limited and is less. Hence the dentists are forced to use shorter implants. Because shorter implants don’t have good bone-implant contact- BIC, the Osseointegration is less when compared to a larger or a taller implant. Also because of heavy loads in the molar region, any minor fault by the technician or the dentist will lead to implant failures in the upper back jaw region. Sometimes the implants fall into the sinus during the healing period. This needs an additional surgery to remove it, which could be traumatic to the patient.

To avoid such complications, we at The Dental Specialists do full mouth dental Implants with TTPHIL- ALL TILT ™ Protocol

TTPHIL- ALL TILT Concept Advantages

  • Life-changing for millions of failing dentition
  • Bicortical Basal Engagement of High mineralized Bone which is least resistant to resorption— Absorbing all the occlusal stresses – Reducing crestal Bone Loss – Osseo fixation concept
  • Immediate Function and comfort in just a few days
  • Optimal Implant Distribution- No Cantileverage effect- Best Biomechanics- Complications of Posterior cantilevers: Screw loosening, Screw fractures, Bone loss around the distal fixtures, Loss of Osseointegration
  • Fewer Implants – High Hygiene Maintenance Capability –No Bone grafting – fewer Rejections – Complete Graftless – Affordable
  • Evidence-Based Literature Orthopedics on Long Implants, Tilted Implants, Flapless Surgery, Onetime abutment concept, Splinted Screw retained Prosthesis

In most of these cases, there are no rejections but sometimes there are failures that one should expect and take the risk. In case, the implants are rejected you still have an option of the conventional flap opening invasive grafting procedures.

What is TTPHIL – ALL TILT TM Technique?

T – Tall implants measuring 16 to 57.5mm depending on the engagement of the Bicortical Basal bone support

T – Tilted implants placed at an angulation of  9 to 70 degrees ( MD or DM or BP or PB)

PH – Pin Hole – Flapless procedure

IL – Immediate Loading (Provisional Prosthesis in 2 hrs and Permanent Prosthesis in two days* in ideal cases)

Why Pterygoid Implantology

  • No bone graft is necessary. Bone density is very good in the pterygoid region. Moreover the resorption in these pterygoid plates area is very minimal.
  • Integrity of the sinus is preserved,
  • The architecture of the sinus (eg, septated sinus) is rarely a technical problem,
  • The outcome is predictably successful.
  • The anterior-posterior spread is maximized; there is no need for cantilevering.
  • The fixture is placed at an easy angle to restore.
  • There is little morbidity.
  • Tuberosity reduction or other tissueplasty can be done simultaneously.
  • Treatment time is shorter than with sinus grafting

Steps for using TTPHILTM Technique for Dental Implants

  • Patient Assessment Level- Reason for Visit, Patient Demands, Risk Assessment, Different treatment options in posterior maxilla- Implant Paradigm shifts- Graft and Graft less Solutions- History and Rationale of Pterygoid implants –Types of Pterygoid implants.
  • Diagnostic Level- CBCT, Panorama, RadioVisioGraphy, Diagnostic models Stereolithographic,
  • Pre Surgical Level – Evidence-based dentistry, Applied Anatomy, Radiographic PARP Classification, Biomechanics, Armamentarium, Implant specifications, Patient Undertaking
  • Surgical Level – Step by Step Protocol
  • Post Surgical Level – Pharmacology, Post operative Instructions
  • Prosthetic level- Screw retained – Cement Retained prosthetics
  • Maintenance level- Complications, Mistakes not to be done

Full mouth dental implant case study

Definitive Prosthesis for Full Mouth Dental Implants

  • Screw on Multi-unit Abutments Non-hex abutments. We do precise machined CAD CAM Screw retained technology to get the best passive fit. With this procedure, there will be NO SCREW LOOSENING.
  • Suitable occlusion- Group function Balanced or Lingualised occlusion is given at The Dental Specialists
  • Materials used: All prosthesis is done with only CAD-CAM. No manual processing is done at all. For precise passive screw-retained technology we have to use CAD-CAM technology only.
  • We at The Dental Specialists give different solutions to our patients based on their requirements.

1A) CAD MLS Framework – Porcelain Layering

1B) CAD MLS- Acrylic Wrap-around

1C) CAD MLS- Zirconia individual crowns

2A) Titanium Milled framework –Acrylic Wrap around

2B) Titanium Milled framework –VisualignWrap around Composite

2C) Titanium- Zirconia individual crowns

3A) PEEK framework – Zirconia individual crowns

3B) PEEK framework-   Visualign Wrap around Composite

Depending on Individuals and their requirement we need to give the prosthesis.

Different Types of Full mouth Immediate Dental Implants

Teeth Whitening

teeth whitening

What is Teeth Whitening

Teeth Whitening is also often referred to as Bleaching – it is a process used to brighten your own natural teeth without causing any complications.There will be no cutting or etching of your dental enamel. Tea,coffee,red wine,tobacco usage and the natural aging of the teeth turn them darker or stain them over time. A professional brightening is performed with the aid of active Oxygen which decolorize – -that is the distracting color pigments present in the tooth. After bleaching the gums are covered with a special rubber compound this is done in order to protect them from the bleaching agent.

When do you need Teeth Whitening

Teeth whitening is often needed in cases of heavy consumption of discoloring substances such as alcohol, nicotine, red juices, tea, coffee, Cola, red wine ,mustard or ketchup as well as poor oral hygiene. Our teeth are coated with enamel, the hardest substance in the human body.Enamel is almost entirely made up of a mineral called Hydroxyapatite, which is a network of calcium and phosphate ions bundled into tough crystalline rods to give bones and teeth the necessary rigidity.But in between those rods, there’s plenty of space for food, coffee, wine, all those big staining substances to set up shop.Regular brushing and flossing will take care of a lot of these foreign substances on your teeth.But once those stains settle in all cozy in the enamel, you’re going to need something stronger to dislodge them, that’s when you need teeth whitening. Teeth whitening is also often used as a part of smile design, which is a much larger treatment.

What are the Different Types of Teeth Whitening

There are two ways of carrying out teeth whitening, the first option is the tray based night white ACP or day white. ACP gel is placed in a custom-made night guard which is placed for one hour to overnight for 7 to 14 days. Second option is surgery based otherwise known as light activated or power bleaching – this uses a combination of a hydrogen peroxide gel and especially designed allowed to accelerate the process.

Understanding the Teeth Whitening Procedure

The bleaching solution is prepared by mixing two phases which are then applied to the teeth before the bleaching process.The dentists perform a check for the teeth and fillings and if necessary a replacement of the fillings or a professional cleaning after the appropriate exposure time might be required. The bleaching solution is removed and the teeth are rinsed with water, at this time the gum protection is removed as well. Professional tooth bleaching may be performed safely every two years there is no doubt they will become brighter and how much lighter depends on your teeth base color. Depending on the degree of discoloration a brightening of about 1 to 14 degrees is possible the result usually lasts for 1 to 3 years or longer depending on your own good dental care as well as regular professional oral hygiene.

Hydrogen Peroxide Teeth Whitening

Hydrogen peroxide is a common agent for teeth whitening. It has the strength to bleach the teeth and can remain without being diluted by saliva.It helps remove surface stains and deep discoloration in our teeth. In fact many bleaching solution generally contains hydrogen peroxide which bleaches the tooth enamel to change it colour. A recent addition to the field is new light-accelerated bleaching agent containing lower concentration of hydrogen peroxide with a titanium oxide nano-particle based catalyst. Reduced concentration of hydrogen peroxide cause lower incidences of tooth hypersensitivity. The nano-particles act as photocatalysts and their size prevent them from diffusing deeply into the tooth. When exposed to light, the catalysts produce a rapid, localized breakdown of Hydrogen Peroxide into highly reactive radicals. Due to the extremely short lifetimes of the free radicals they are able to produce bleaching effects similar to much higher concentration bleaching agents within the outer layer of teeth where the nano particle catalysts are located.This provides effective tooth whitening while reducing the required concentration of Hydrogen Peroxide and other reactive byproducts at the tooth pulp.

Laser Teeth Whitening

Laser teeth whitening, which is often called power whitening is the most common way to solve the problem of dis-coloured teeth . Laser boosts the penetration of the bleaching agent into the teeth enamel effectively removing stains caused by coffee, nicotine and food products that have been regularly consumed. The whole procedure takes just about an hour and produces shade lightening of up to 10 times the initial shade and the two most commonly used laser whitening systems are zoom bright smile and sapphire zoom. The pH level of the system is between 7.5 and 8.5, the specific laser used to activate this bleaching system is Mercury metal halide that ranges from 350 to 400 nanometers britesmile uses its bright smile procedural gel for its laser bleaching system. This gel consists of fifteen percent hydrogen peroxide with a ph level of 6.5, an accelerator is added on the second and third treatment. To improve the whitening effect of the system it uses a gas plasma based laser or light emitting diode that have wavelengths ranging from 400 to 500 nanometer. This whitening system combines the use of their sapphire whitening gel with their signature laser sapphire plasma arc light. The gel is specially formulated to allow absorption of light in the blue end of the light spectrum once the gel gets activated by the laser it breaks down into reactive components that target the stain causing colored compounds on both gel and the colored stain compounds get activated and react with each other. Laser as optional include ultradent opalescence extra boost lightening gel which whiten the teeth more faster.

Zoom Teeth Whitening

Zoom whitening is an in-office bleaching process that is widely known for its ability to quickly brighten the dis-coloured teeth .It has advanced power and the fastest effective whitening system ever. Zoom advanced power is a complete system that gives immediate results and ensures lasting effects long after the whitening treatment. The power lamp was specifically engineered to activate zooms advanced formula whitening gel for superior whitening. It has the special light that penetrates the teeth to break up stains. Once the lip and gums are safely covered, the dentist will apply the patented zoom hydrogen peroxide whitening gel.The complete procedure takes one hour , the preliminary evaluation and teeth cleaning is recommended prior to the treatment.

Teeth Whitening Cost

Teeth whitening cost varies on the kind of treatment we go through.The biggest factor in teeth whitening cost comes down to where you want your teeth whitening done.The procedures are so much more affordable in an area where standard of living is lower. The safest and most effective way to whiten your teeth is to visit a clinic.On an average the teeth whitening cost from INR 15000 but may vary greatly depending on the dentist. The price include post treatment application in the form of take-home trays and continued teeth whitening treatments with an at-home whitener. There are whole range of home teeth whitening products like whitening toothpaste, whitening strips or over the counter bleaching trays, however a dentist can provide more advanced techniques to whiten up your teeth. It cost more but totally worth it. Professional dentists can use stronger bleaching agents or even laser teeth whitening to produce faster results and whiter teeth.

Teeth Whitening at Home Vs. Professional Teeth Whitening

Practically everyone is looking to whiten their teeth these days. And most of them are looking for ways to use homemade, do-it-yourself (DIY) solutions that allow them to avoid paying for sometimes expensive services. The DIY teeth whitening solutions people follow are often recipes they found on the Internet to try to whiten their teeth. Unfortunately, it damage the teeth.

The information about DIY whiteners comes from a relatively young dental researcher at the University of Iowa (UI) who has focused work on teeth whitening, the effectiveness of DIY whiteners and their impact on teeth in a number of experiments. The particular formula was a combination of strawberries and baking soda.Using powdered turmeric and activated charcoal is another very popular, at home alternative teeth whitening strategy,commonly recommended online.In addition to the DIY home whitening, over-the-counter strips, a take-home whitener from the dentist, were all tested. Results showed that the DIY whitening method didn’t actually whiten teeth at all, although all the other whiteners did lead to significant softened the tooth enamel and may increase tooth erosion.

If you are looking for safe, effective, without causing any damage to teeth and gums, teeth whitening then, it’s important to talk to a dentist. At-home methods like this one are often ineffective or damaging. It is always better to go for conventional teeth whitening (bleaching) from a professional dentist or cosmetic dentistry specialist.

Zygomatic Implants

What Are Zygomatic Implants

Zygomatic Implants Hyderabad
Zygomatic implants is an advanced dental implant technique. As the name suggests these implants are fixed to the zygomatic arch. They are used as an alternative to the old conventional technique. Zygomatic implants are used in the upper jaw that is maxilla.

If the bone present is not sufficient enough for an implant placement then zygomatic implants can be placed successfully as these implants are longer than the traditional implants and are anchored into the jaw bone which is very close to the dense bone Zygoma. Hence these implants act as support to implant bridgework where there has been a substantial amount of bone loss from the upper jaw and traditional implants cannot be used on their own to support a bridge.

Zygomatic implants are also used as the alternative to the dental procedure, which required bone grafts for placements of implants, allowing the procedure to be completed in a single stage. Prior to implant surgery, a CBCT scan is done to assess the amount of available bone and to plan the treatment accordingly.

It is also important to make an anatomical study model of the jaw, which enables the dentists to visualize the precise shape of the jaw and cheekbone, and thus avoiding wide surgical exposure. Typically, two zygomatic implants are used along with other ordinary implants but where the bone availability is even more compromised, four of them may be used.

A fixed composite bridge may be given temporarily on the same day of implant placement till the fixation of a permanent prosthesis.

Difference between Zygomatic Implants and Regular Dental Implants

Other conventional implants are anchored to the jawbones but the zygomatic implants are anchored into dense zygomatic arch giving it strong anchorage.

Other conventional implants are possible only when a sufficient amount of bone is available for anchorage whereas these implants are longer and have dense anchorage, so can be placed in bone deficient areas.

Hence, it eliminates use of bone grafts thus enabling procedure to be completed in a single sitting and faster healing.

Earlier in order to solve the problem of bone deficiency, several bone augmentation procedures were developed. The bone was taken from a donor site (for example the hip), transplanted to the recipient site and then implants were placed. This procedure has to be done under general anesthesia requiring patients to be hospitalized for two-three days and some degree of morbidity related to the donor site was expected.

However, recently other synthetic bone grafts are used to minimize the rate of morbidity. But using bone grafts increases the healing time, sometimes patients might have to wait for more than 1 year before a fixed prosthesis can be delivered.

Furthermore, using bone grafts increases total treatment expenditure. Zygomatic implants are generally inserted through the palate to engage the body of the zygomatic arch.

When is this Required

  • The main indication for zygomatic implants is in the case of maxillary atrophy. If any individual requires a dental implant but the treatment is not feasible due to insufficient bone present then zygomatic implants can easily be placed.
  • Strong anchorage required for full mouth implant-supported dentures. In that case, zygomatic implants can provide good strength as it gets anchored into the dense bone.
  • Failed conventional implant placement.
  • To avoid bone grafting procedures.
  • Failed sinus augmentation procedures.
  • Resorbed ridge.

Most commonly, the zygomatic implants are combined with two to four anterior maxillary axial implants.

Advantages of Zygomatic Implants

  • You get a fixed prosthesis which satisfies both functional and aesthetical requirement within 24 hours or two to three days as compared to the conventional implant techniques that take up to 6 months.
  • Zygomatic dental implant enables a graft-less treatment option.
  • Early and easy healing.
  • Reduces the rate of days in hospital and morbidity rates by avoiding grafts and thus total expenditure also decreases.
  • They are longer than other dental implants.
  • Its length and anchorage provide better strength.
  • Zygoma implants are placed in a single surgical procedure under general anesthesia, giving patients a less painful and comfortable experience.
  • Only a day after the surgery, the patient will be able to bite and chew their normal food and continue his /her normal activities.
  • The new artificial set of fixed permanent teeth gives you a confident smile.

What are the contraindication and complexities involved in zygomatic implants?

Contraindications include:

  • Acute sinus infection
  • Any pathology of maxilla or zygoma
  • Any underlying uncontrolled or malignant systemic disease.
  • The use of bisphosphonates
  • The habit of smoking.

Sometimes some complexities like prolonged bleeding, swelling, pain, or slight discomfort could be there which can be treated and controlled efficiently.

Other complications like haematoma or any other post-operative numbness could be felt which is also controllable.

So to avoid any such complexities proper history of the case should be done and all the investigations including radiographs, CBCT scan, and diagnostic models should be done properly.

Only a Specialists Job

Zygomatic implants are a highly specialized treatment and are done under general anesthesia, nowadays done under conscious sedation and Local anesthesia also under specialist supervision. These treatments are done only by dental implant specialists or by oral and maxillofacial surgeons.

Zygomatic Implants in India – a Case Study

The below PowerPoint is to explain the procedure and a case study of a patient who came to India from France to get the Zygomatic implants.  We did this procedure at The Dental Specialists under local anesthesia. It is a complete graft less solution and did the implants in and loaded it in just 7 days. She went back to her home town in just 7 days.

Tooth Erosion

Dental erosion is an irreversible loss of dental hard tissue like enamel or dentin caused by acidic foods and drinks dissolving away the surface of the tooth .Acids associated with erosion are usually dietary for example low pH citrus fruits, fizzy drinks, pickle, sports drinks and other sources include gastric acid from the stomach due to vomiting or gastroesophageal reflux disease GERD).

Dental erosion occurs at the tooth surface where the acid causes demineralization, that is minerals are lost.

Mainly subsurface minerals are lost in dental erosion. The enamel first becomes thinner and may eventually be completely lost if dental erosion continues after the enamel is lost.
Dental erosion then removes minerals from dentin. This happens more quickly than with enamel because the dentine is softer.Erosion also results from the loss of enamel, dentin and/or cementum due to the acids.

Causes of Tooth Erosion

  • The foods and drinks having acidic pH causes the loss of minerals from the tooth surface.
  • Citrus fruits and beverages.
  • Carbonated drinks.
  • Gastric problem like gastrooesophageal reflux disease.

Signs and Symptoms of Tooth Erosion

  • The eroded tooth is seen as yellowish discoloration on the tooth surface.
  • Loss of enamel and dentin is evident.
  • Sensitivity to hot and cold.
  • Tooth becomes brittle.
  • Compromised aesthetics.
  • Transparent cutting edges.
  • Concavity occurs in the tooth surface.
  • Tooth may form divots on the occlusal surfaces.

Prevention and Treatment of Tooth Erosion

  • Avoid food which are acidic in nature like citrus fruits.
  • Avoid beverages like beer ,carbonated drinks.
  • Treatment of acidityand other gastric problems.
  • Restorations of the lost tooth structures.
  • Root canal treatment should be done if there is pain and sensitivity.

Tooth Sensitivity

Tooth sensitivity is also known as Dentin hypersensitivity. It is felt as a dental pain which is sharp in nature . The pain is shooting and occurs for a shorter duration. It arises due to exposed underlying layer of tooth i.e dentin .The nerve endings in the exposed dentin are stimulated by hot or cold food which results in tooth sensitivity.

Symptoms of Tooth Sensitivity

  • The most common symptom is the occurance of pain on consuming cold or hot.
  • Clinically the teeth are seen attrited or grinded .
  • Enamel may be seen weared off or wear faucets are seen on tooth surface.
  • Dentin is expose which is seen as shiny yellow surface.
  • The pain is sharp and sudden.
  • The nature of pain is short and triggered by the stimulus.

Causes of Tooth Sensitivity

  • Harsh or faulty brushing resulting in cervical abrasions.
  • Habit of bruxism or grinding teeth vigorously.
  • Receding gums are another cause of sensitivity .
  • Enamel erosion due to the excess acid reflux.
  • Bleaching of the teeth.
  • Pocket formation in gums.
  • Exposed cementum layer of the tooth.
  • Dental decay.
  • Attrited teeth.

Diagnosis for Tooth Sensitivity

The tooth sensitivity can be diagnosed by its symptoms.Other ways to diagnose the sensitivity are:

  • Thermal test : it is done by using hot or cold water
  • Electrical pulp testers.
  • Air blow from three way syringe.
  • Probing by a dental instrument.

Prevention and Treatment of Tooth Sensitivity

  • Using desensitivity toothpaste.
  • Avoid harsh brushing.
  • Applying fluoride layer on the affected teeth.
  • Treatments of attrition should be one by fillings or placing varnish layer.
  • Using night guards.
  • Treating the abrasions by filling the affected areas.
  • And if at all the sensitivity does not subside the tooth has to be desensitized by performing root canal treatment.

Fluoride Stains Removal

It is the most commonly seen discoloration of the tooth surfaces. These are the intrinsic stains caused due to excess of fluoride ingestion during the developmental stage of the teeth. Teeth effected by dental fluorosis are resistant to the dental caries comparatively.

Signs & Symptoms of Fluoride Stain

  • Visual changes occurs in the enamel.
  • Patchy appearance
  • Loss of lusture.
  • Whitish yellow to brown discolorations.

According to dean’s index the fluoride stains are classified according to the severity of signs and symptoms.
Mild : Small, opaque, paper white areas scattered over the enamel which is less than 25% of the tooth surface
Moderate : The whitish yellow patches are seen involving half of the teeth surfaces.
Severe : The stains progresses to brownish color and the tooth gives the pitted or corroded appearance.

Causes of Fluoride Stain

  • Ingestion of the fluoride rich water during developmental period of teeth.
  • Secondary causes could be prolonged usage of fluoridated mouth washes.
  • Accidental intake of excess of fluoridated tooth paste.
  • Public water fluoridation.
  • Fluoride supplements.

Treatment of Fluoride Stain

    Micro abrasion

  • Composite fillings can be done to remove the stains.
  • Veneers and crowns.

Tooth Stain Removal

Our teeth have a topmost layer called enamel which is thin and whitish in color. The second layer is dentin which is comparatively thicker and yellowish in color. As the dentin constitutes the main bulk of the tooth it imparts the yellowish color to the tooth. Deciduous teeth are whiter in shade than permanent teeth. Tooth stains also termed as tooth discoloration is abnormal tooth color. Your teeth can become discolored by stains on the surface or by changes inside the tooth.

The stains can occur either on the surface of the tooth or when the inner structure of the tooth darkens. The stains that occur on the surface of the tooth are called extrinsic stains teeth. The stains that occur due to the inner layer of the tooth getting darkened are the intrinsic stains. Age-related staining is a combination of extrinsic and intrinsic factors. Dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through.

Causes of Extrinsic Tooth Stain

  • Plaque that gets deposited over a long period of time hardens to form calculus. This calculus is yellow to brown in color.
  • Smoking
  • Tobacco consumption.
  • Certain food items like turmeric, red wine, tea or coffee.
  • Long-term usage of chlorhexidine mouthwashes.
  • Long-term usage of iron supplements.

Causes of Intrinsic Tooth Stain

  • A pharmaceutical drug like tetracyclines during pregnancy can result in discolored tooth of baby.
  • Exposure to metals like mercury, lead etc.
  • Fluorosis: is the condition that causes yellow or brownish stains if fluoride containing water is consumed during the developmental stage of teeth.
  • Trauma to the tooth.
  • Non-vital tooth: if the pulp is necrosed due to tooth decay or injury.
  • Certain systemic diseases like sickle cell anaemia.
  • Pathologic defects of teeth like amelogenesis imperfecta , hypo or hypercalcaemia etc.
  • The ageing process also results in darker coloration of the tooth due to the formation of repairative dentin.

Prevention and Tooth Stain Removal

  • Following proper brushing and flossing technique.
  • Avoiding stains causing food items, smoking and tobacco.
  • Preventing the consumption of tetracycline during pregnancy.
  • Dental bleaching could be done to lighten the shade of the teeth.
  • Scaling that is cleaning of your tooth should be done by the dentist.
  • Air polishing of teeth removes the stains and brings the lustre back.
  • Intrinsic stains can be corrected by veneers or crowns.

Wisdom Tooth Removal & Treatment

A wisdom tooth or third molar is the last tooth of the dental arch.It comes at the age of 17 to 28 years of age mostly.

It does not erupts continuously but rather it has the growth spurts. Normally there are four wisdom teeth one in each quadrants, but it is much possible to have any wisdom tooth missing. Impacted teeth effects other teeth in the when its erupting.Impacted wisdom teeth are classified by the direction and depth of impaction, the amount of available space for tooth eruption and the amount soft tissue or bone that covers them.

What Causes Wisdom Tooth Pain

  • Pain in the tooth .The pain may be radiating to ear and head.
  • Repeated infection of soft tissue covering the wisdom tooth.
  • Tumors or cysts.
  • If the wisdom tooth is impacted in the bone.
  • Pericoronitis
  • Angulated or horizontal eruption of tooth.
  • Damage to nearby teeth.
  • Gum disease.
  • Extensive tooth decay.
  • Trismus
  • Repeated cheek bite

Symptoms of Wisdom Tooth

  • Pain.
  • Redness of the tissue.
  • Swelling.
  • Pus or infection along the tissue covering the wisdom tooth.
  • Bad breath.
  • Enlarged lymph nodes.
  • Inability to open mouth.

Treatment of Wisdom Tooth

The wisdom tooth has to be removed necessarily if an individual is having any of the above signs and symptoms. If the eruption pattern is favourable but the tooth is impacted below the soft tissue it is treated by operculectomy. It could be mannual or by laser.The wisdom tooth is removed surgically under anaesthesia if the tooth is tilted or if there is any cyst or tumor or infection.