Implantology in immediate loading
Rejuvenate your smile in less than a week under sedation

extractive

PREAMBLE AND GENERAL INFORMATION
ON THE PROTOCOL FOR PLACING DENTAL IMPLANTS WITH IMMEDIATE LOADING
OF A SCREW-RETAINED IMPLANT-SUPPORTED DENTAL PROSTHESIS

 

the modern principles of implantology with immediate loading of implants replace those of historical implantology.

 

What are the principles of conventional implantology?

The main principle that has prevailed until now, is the following: During the bone healing period, it is recommended to avoid exerting stress (pressure) on the implants. 

This recommendation is supposed to guarantee optimal conditions for bone healing, which is called osseointegration. In this classic design, which is now outdated, the implants remain embedded in the bone, waiting for their osseointegration for 2 to 6 months. This is the major drawback of this technique. Because the patient must wait one to two quarters from the date of the installation, for put in charge of the implants. 

This long wait is not well accepted by patients. In particular, when they are not already totally edentulous, but their teeth have recently been extracted to be replaced by implants. The corollary result is a discomfort of mastication and/or aesthetics which can go as far as a certain desocialization. This new handicap is extremely difficult to live with because it is mortifying for the patient’s mental state as well as for his social and professional life and also for his love life.

This protocol is further complicated when tooth extraction is followed by bone grafting. This is because it requires two to six months of healing to accommodate implants. 

We can see, therefore, that in this conventional two-step technique,  now outdated, implant-supported prostheses are placed two to six months after the implants were placed. Only if the implants and the bone graft were done at the same time. On the other hand, this healing time is doubled or tripled if the bone graft was done before the implants were placed.

To compensate for the disadvantages of the de-socialization caused by edentulism: Various provisional solutions must be provided to patients during the healing time of both grafts and implants. 

A whole range of temporary solutions have been invented: such as complete or partial removable prostheses, resin bridges bonded to adjacent teeth (if any remain), temporary mini implants. These solutions are very imperfect because the aesthetic result is most often unsatisfactory and the masticatory function is very uncertain. Not to mention the inconvenience of a cumbersome mobile prosthesis that is always poorly supported and the multiplication of interventions in a “patient-combatant” journey that is like a marathon.

Moreover, patients who wish to integrate a total rehabilitation program of their mouth and smile with a “full bridge on implants” must expect a very significant financial expense. However, all these inconveniences go against the aspirations of comfort of the patients who return to the ancestral techniques of dental medicine and not to modern protocols. However, they carry the hopes of the patients. For they are the driving force behind their efforts to avoid the nightmare of dentures. But, since they are absent, at least at the beginning of the conventional protocol, which is difficult to accept, a very big disappointment sets in.

 

What are thehe principles of MCI immediate loading implantology seem to contradict the principles of conventional implantology.

The details of the complex multidisciplinary technique of immediate loading implantology will be developed in the chapters on ICM that follow, but we can already address the main principles.

The biological principles governing MCI protocols are similar to those applied in orthopedic surgery for the management of bone grafting by osteosynthesis or reduction of long limb bone bills by immobilization pins.

The main principle is the following : the scientific odontological community has realized that it is not the “stress on the implants” stricto sensu which generates a fibrous interposition between the implant and the bone tissue and thus the failure of the implant protocol. But it is the excess of micromovements at the interface between the bone and the implant that is responsible for the failure of osseointegration. 

In reality, the dental scientific community has only rediscovered what all orthopedic surgeons already knew and apply in all their immobilization surgeries of grafted or fractured bone pieces. This is the principle of osteosynthesis. Anyone who has had a limb fractured and immobilized has not, for the most part, been forced into a strict no-pressure position on that limb. The bone pieces are immobilized with screws or pins and/or a plaster cast. A very light pressure is acceptable but obviously shocks are forbidden.

It is precisely the application of the principles of osteosynthesis that gave rise to the immediate loading protocol or ILM: Immobilization of the implants with a protection against micro movements of more than 200 microns and a strict recommendation to maintain only a very slight pressure during mastication.

These rules allow the placement of implants with immediate loading by a resilient implant-supported dental prosthesis. We will see the details of our protocol later.

In our pro-active protocol, the immediate implant-supported loading prosthesis is the MCI Resilient Bridge. It is manufactured with a very elaborate cosmetic thanks to the biomaterials acrylic glass or PMMA on a metal frame. Both biomaterials are shaped with great precision using modern CAD/CAM technology.

 

This is how the new concept of MCI immediate care was born.

At the time of placement, all implants must be locked into native bone (i.e., original, non-grafted bone): 

This immobilization of the implant screws in the native bone is called “primary fixation” for a minimum torque of 35 Newton. 

All contiguousēs, they should be joined by a metal frame  metal framework:

This solidification of the implants between them will limit micromovements at the interface between bone and implant to less than 200 microns. This limitation of implant travel in the native bone corresponds to the principles of bone immobilization during a fracture with osteosynthesis screws or pins. This immobilization of the bone parts or of the titanium metal parts in the bone parts, will allow a bone healing which is called osseointegration.

Micromovements are fatal for the osseointegration of implants. But on the contrary, if the implants are immobilized by a framework which is, in reality, the skeleton of the implant-borne bridge installed immediately or a few days after the implants are placed, this will optimize the healing of the implants in the bone. 

After a tooth extraction, osteolysis, i.e. resorption of the alveolar bone, is systematically triggered. It is a physiological phenomenon. However, a loss of bone volume around the implants systematically leads to the loss of the implants. It is therefore essential to block bone resorption with bone grafts around the implants and all around the periphery of the operated jaw. 

Bone grafts are performed with either allogeneic bone grafts (i.e. of human origin) or xenogeneic bone grafts (i.e. of animal origin):

In the MCI protocol we do not use any other biomaterials than these. This is because these biomaterials can be enriched with the operated patient’s own tissue growth factors. These growth factors are found in blood platelets. We therefore systematically take blood samples from the patient and centrifuge the recovered blood pellets in order to make PRF in liquid or membrane form. PRFs, containing growth factors in supra physiological concentration, are placed in the patient’s surgical site. 

This is a platelet autograft. It is crucial in the healing process since it provides both immune and scar cells. FRP allows for an immune and scar jump of almost a week compared to the natural healing process. It is therefore an optimization of the osseointegration of the implants in the native bone, of the healing of the additional bone grafts and of the healing of the soft tissues that will remodel around the implant-borne prosthesis in immediate loading.

 

What is the benefit of MCI for the patient?

The advantage of immediate loading for the patient is obvious: he or she receives an implant-supported prosthesis within a few days after the procedure instead of the four to ten months that are usually required. he receives an implant-supported prosthesis a few days after the operation instead of the four to ten months traditionally required.  

It is therefore very quickly and completely resocialized. The different surgical steps, such as dental extractions, placement of dental implants, post-extraction bone grafts and placement of PRFs, are all compacted in a single MCI procedure, called “one shot”, in the operating room. The optimization of healing and immunity through regenerative dentistry makes the postoperative period extremely light, if not almost non-existent. 

The implant-supported resilient bridge is of such functional and esthetic quality that it can be considered a definitive prosthesis. The result of this quality is that the patient benefits from a treatment that almost immediately restores all his aesthetic and functional needs in less than a week.

There are many reasons for total or partial edentulism: it can be due to a generalized aging of the teeth, a periodontal disease that has reached a near terminal stage, or an accident with a frontal impact. 

In all cases, the distress is twofold:

On the one hand, the physical distress induced by the physiological handicap caused by the loss of all or part of the dental organs in a brutal or unavoidable programmed way. And on the other hand, the psychological distress of being physically diminished to the point of being asocialized. This physical and psychological distress is increased when the collateral damage becomes professional and/or romantic. In any case, the consequences are dramatic for the patient, who sees his or her future in the short term tipped over into the nightmare of physical disability.

The ICM protocol solves all of these problems in a single intervention! 

At Smile Designer, our MCI team of implant surgeons, led by Dr. Weinman, is highly trained to solve all the difficulties that even complex clinical cases can present.

 

What is the interest of the MCI for the dental doctor implantologist ?

The interest for the surgeon is to treat his patient with a global solution that solves most of the inconveniences of all the protocols previously put in place. 

First, the dentist does not have to deal with the patient’s discomfort and all the grievances that go with it. Especially since these complaints are usually justified and unfortunately have no solution. In all classical protocols, the patients’ complaints are a situation of discomfort due to the instability of the provisional prosthesis, a generally absent aesthetics and an extremely random masticatory function.

The surgeon also finds in this protocol a solution to all the inconsistencies imposed by the classic protocol:

Indeed, starting from the general principle of osteosynthesis that a bone cannot heal if it is mobilized, what is the sense of “shaking” the post-extraction bone graft with a mobile dental appliance during mastication? 

Finally, for the same reasons, what is the sense of mobilizing the implants during mastication and the 2000 daily swallows?

Also, what is the sense of compressing the soft tissues with this same removable device which will create ischemia like a tourniquet would. That is to say, a lack of vascularization, while the blood supply is fundamental for healing? 

However, all these situations are present in the classic protocol recommended. This seem meaningless because it probably is?!

Fortunately nothing of that now exist in the MCI protocol!!!

In addition, immediate loading reduces the number of sessions and postoperative follow-up. The total processing time is drastically reduced and the practice time management is optimized. 

The surgeon can also boast aesthetic results that are far from the classic protocol since plastic remodeling of the inter-dental papillae   is now possible:

In post-extraction, immediate placement of an implant in an extraction site, combined with a bone graft, prevents resorption of the native bone. This allows to optimize the bone capital of the area but also and especially, to optimize the thickness of the gum around the implants. The regeneration of hard and soft tissues allows the creation of interdental papillae around the prosthetic teeth in exactly the same way as around the extracted natural teeth.

The greatest difficulty for the dentist is to find a structure specialized in implantology with an immediate start-up that can give him training and practice with a long experience to manage particularly complex and difficult cases. 

At Smile Designer, our ur MCI Team takes care of all the surgical part and the corresponding dentist takes care of the second set of MCI prosthesis, once thefirst   prosthesis in immediate loading is completely osseointegrated.

  

What are the keys to success for the MCI implant protocol

Success in implantology in general, and in the implementation of an immediate loading implant protocol in particular, is osseointegration, with no bone loss around the implants and, if possible, even a gain in volume after placement.

How to optimize osseointegration?

 

Osseointegration of implants, or more simply put, bone healing around the implant screw coils, depends on the management of many parameters, all of which are integrated into modern MCI protocols. 
The main objective is to minimize micromovements at the interface between the bone and the implant. To achieve this result, the mechanical stresses exerted on the implant must be optimized and fully controlled, as must the primary stability of the implants, which must be as high as possible.

The parameter of the primary stability of the implant: the optimization of the primary stabilization of the implant and the minimization of micro movements depends on two factors. 

The first parameter is the primary fixation, which depends primarily on the implant itself and its design:

This is why various manufacturers of implants have focused on the problem of immediate loading of implants. They have designed and manufactured implants with particular profiles of the implant screw turns whose aggressiveness is studied for, on the one hand, a better primary stabilization and, on the other hand, not to create a compression in the fragile zones of the bone, in particular at the level of the cortical bone with little vascularity. 

These two objectives seem to be in opposition and constitute a dilemma:

 Indeed,how to satisfy at the same time the obligation of an aggressiveness of the turns to better hang the implant in thebone and at the same time, not togenerate   mechanicalconstraints on the bone tissue in order not to create an ischemia which would be mortiferous for the vascularization and thus by way of consequence on osteo integration? A whole science and technological know-how has been focused on this dilemma. The implants of new generation were born. They are produced by different industries that have solved this problem. 

These are the specific implants that we have chosen in the MCI protocol at Smile Designer: 

The implants used in our MCI protocols are very specific implants. Not all implant brands manufacture implant screw designs suitable for use in MCI.

The length and diameter of the implants are no longer determining and limiting factors: 

The corollary of these new implant profiles is that short and/or narrow implants with highly optimized coil profiles are now used as successfully as long and/or wide implants. This aspect of the problem is extremely important since it limits the need to perform large-scale bone grafts and in particular sinus lifts, the operative risks of which are significant.

The parameter of optimizing the primary stability of the implant is also very operator dependent: 

The surgeon must have great dexterity and surgical experience to appreciate the bone density and preserve the implant axis. Choosing the axis of the implants is not a guarantee. This procedure is so delicate and difficult that there are many aids to surgical planning, such as digital 3D surgical guides or dedicated robotics to assist in surgical navigation. However, the surgeon is very much alone at the time of the operation: we do not operate a scanner but a person. While an implant simulation can be repeated indefinitely on a computer, during the actual procedure things are different and the error is irreversible.

The axis of the implants must be as relevant as possible:

In order for the surgery to be successful, the implants must all be parallel to each other to avoid parallaxes that generate shearing forces on both the metal of the implants and the bone structures.  Implants should be parallel but not in any axis. They should all be in the masticatory axis, as mother nature gave us our natural teeth. The mechanical principle is obvious: anyone who has tried to drive a nail into a wooden board knows that if he puts it in the wrong way either the nail will bend or the wooden board will split at the first blow of the hammer…

The primary stability also depends on the receiver :

The patient’s bone is more or less dense. There are four levels of bone density from D1 to D4. D4 is extremely soft and will be a very big challenge for an MCI. 

An unstructured patient’s biology does not allow the placement of an implant. That is to say that a biological check-up must be systematically performed, well before the surgery, in order to verify that there is no deficiency in particular in vitamin D.  But also, the biological parameters such as cholesterol and blood sugar must be perfectly normal. If there are metabolic parameters that are abnormal, then the anesthesiologist, in cooperation with the attending physician, must absolutely restore the patient to health, especially in the case of diabetes.

Smoking patients are not eligible for the MCI protocol : They must stop smoking. Because nicotine blocks part of the salivary secretions, in particular the nicotinic receptors of the parotid gland. Also, cigarette smoke creates a very important oxidative stress and an aging of the tissues. Everyone will have understood that there is no sense in trying to regenerate tissues on the one hand with regenerative dentistry and on the other hand to age them prematurely with tobacco! Finally, the tars contained in cigarettes clog the large arteries, but even more rapidly the small arterioles that are totally necessary for the vascularization of scar tissue at the time of implant placement.

At Smile Designer, in order to help patients who wish to be eligible for the MCI protocol but who are having difficulty quitting smoking, we have, with our anesthesiologists, developed a protocol of intravenous hypnosis combined with a drug treatment. The vast majority of smokers stop smoking.

 

The parameter of the forces exerted at the Os-implant interfaces

The second way to limit implant micromovements is to limit the pressures that are exerted by chewing forces on the immediate loading implant-supported prosthesis.
 

To limit the forces exerted on each of the implants, elementary physics gives us the first solution:

Everyone remembers the physics formula that says that pressure is equal to the force (in this case chewing force) exerted on the surface (in this case the surface of the implants). This universal physics formula you can experience every day when you go to your favorite supermarket with a bag of groceries. In this case, the weight of the bag is divided by two for each member of the couple. This will have the advantage that your fingers will be much less sheared by the handles of the bag.

This is exactly the same principle that applies to implants: the more the surgeon increases the number of implants, the more he decreases the stresses on each of the implants. This is why the ALL on 4 and ALL on 6 techniques are not included in our protocol. We prefer to put more implants in order to avoid stresses on each of the implants. These mechanical pressures will, on the one hand, act on the implants themselves. This means that the risk of implant fracture is increased. But also, these pressures will act on the surrounding bone tissue around the implant with the creation of an abnormal mechanical stress on the tissue which will only be resorbed in time.

In our MCI protocols, the minimum number of implants is six in the mandible and eight in the maxilla, and we always try to place a large number of implants, especially in the posterior molar areas. The specific difficulties of the maxillary posterior sectors are developed in the chapters below.

It is not enough to place a large number of implants, but the implants must also be distributed over the arch in such a way that each implant is loaded harmoniously in the process of dispersion of the masticatory forces, the so-called occlusal forces. I.e. the forces of chewing but also the forces of swallowing 2000 times a day

Another elementary law of mechanics gives us a second solution to limit the micro movements of the implants: 

Everyone has understood that if we want to make a barrier to prevent our favorite animals from escaping, it is necessary to plant stakes but it is preferable to connect them all together with a crosspiece, so that the force exerted on each stake is distributed through the crosspiece to all the other stakes. Whereas if we have individualized posts, then it is the force exerted on the single post that prevails. In this case, it is easy to “flake the daisy” and make each stake fall and this more and more quickly as the number of stakes decreases. 

It is exactly this principle of general mechanics that we are going to apply to the implants by connecting them all together by a metallic framework. This solidification will have a double effect: on the one hand, it will reduce the stresses at the bone interface of each of the implants and, on the other hand, it will neutralize the rotational forces of the implants and the prostheses on the implants

The third way to limit micromovements and stresses generated by the stresses on the occlusal indices on the implants and the resilient prosthesis the resilient bridge a plane to carry in immediate loading:

Everyone has understood that when you have good Pataugas soles, you can go far in the mountains and that conversely, going hiking with flip-flops is likely to end in drama. 

It is exactly these common sense principles that apply in our protocol: the immediate loading prosthesis must (like a good walking shoe) be sufficiently rigid not to deform during the function (masticatory) but also to absorb the shocks during its operation. Here again we can consider ourselves in a dilemma since the two qualities of our immediate loading prosthesis seem to be opposed! How to be both rigid and flexible? Rest assured that this dilemma has been solved thanks to very sophisticated technologies and materials that have nothing to do with the “resin prostheses”, even when reinforced, that we find in certain alternative protocols. 

The qualities of the PMMA acrylic resin resilient bridge will be developed at length in the following chapters. 

 

For osseointegration to have a future, it is imperative that the implants are not placed in any way.

 
The placement of implants must comply with strict rules, first of all common sense, but also biological and mechanical rules

The rules of common sense are to follow what nature has shown us:

Implants replace natural teeth. The implants are simply placed in the place of the teeth and obviously in the ideal position that one expects to find. Unusual implant positions do not correspond to this principle. It is important that the implants are in the ideal axis of the teeth in the position where one normally expects to find a tooth. The placement of the implants must be symmetrical with similar burial of the implants on both sides of the medial sagittal plane. Finally, of course, the implants must be placed in the prosthetic corridor so that their emergence is not in the middle of a tooth or obliges the prosthetist to create dental malpositions that would be treated by an orthodontist in a natural situation!

The rules of biology or how to meet the principles of conservation of biological space:

In our MCI protocol we favor the immediate implant extraction technique. That is, we place the implants in a post-extraction site. But it is possible that in some cases the extractions were made in the past and the sites extractions have been cured for a long time.

The placement of the implants will depend on the morphology of the hard and soft tissues as well as their biological and healing quality as receptors for the implants. The aesthetic requirements will guide the surgeon in his protocol because some teeth are strategically very demanding in terms of aesthetics. And others, especially in the posterior sectors, have fewer aesthetic constraints. Conversely, the mechanical requirements for the replacement of posterior teeth are greater than the requirements on anterior teeth, which bear less pressure. In our MCI protocol, we specify that in the ALL on 4 and ALL on 6 protocols the occlusal forces are concentrated in the anterior sector, which in our opinion makes this protocol totally outdated.

When placing implants, the technique must take into account the conservation of the biological space: that is, all the tissues above the emergence profile of the implant that will constitute the biological joint between the external and internal worlds of the body. The biological space is constituted by the gingival sulcus, the epithelial attachment and the connective attachment. It is the border between the internal and external world of our body since a tooth is a bone that, in a way, crosses our skin-gum. Dental implants organize tissues similar to those of the natural tooth. An implant that is placed without respecting this biological space will automatically generate biological and bacterial disturbances in this neoformed space. This will result in bone resorption or osteolysis.

It goes without saying that the implants should not be glued together so that the tissue can heal. There is therefore a minimum inter-implant distance of approximately 3 mm. This is why small diameter implants are to be preferred over large diameter implants which now do not provide more primary fixation.

 

 

 

 

The implant-supported bridge in immediate loading: a range of prostheses of choice according to your requirements

The essential step for osseointegration of MCI implants is the Implant Bridge with Resilient Acrylic Glass Cosmetic on Metal Frame.

The bridge in immediate loading or MCI will be placed between 4 and 7 days after the procedure in the office or in the operating room. Please note that it is okay to place the bridge up to 10 days after surgery if additional time is required by the laboratory.

This is the minimum time required for the laboratory to produce a high-quality implant-supported bridge.

It is screw-retained implant-supported: i.e. fixed by permanent screwing on the implants. But it can be removed by unscrewing it in the cabinet if necessary.

The implant-supported screw-retained bridge is manufactured in a highly specialized dental laboratory equipped with CAD/CAM (Computer Aided Design and Manufacturing). It consists of a metal skeleton, made with the help of the latest generation of digital CAD/CAM.

This skeleton is covered by a beautiful cosmetic made of acrylic glass material, resilient and biocompatible. The acrylic glass material of the PMAA family is also sculpted using CAD/CAM technologies. Thanks to the aesthetic qualities of PMMA, the implant-supported screw-retained bridge mimics the aesthetics of natural teeth almost as well as a cosmetic ceramic bridge.

The only drawback is that PMMA material is “soft”. It is therefore less solid, less durable over time, with less chewing force and less aesthetic brilliance than cosmetic dental ceramics.

However, it is this “disadvantage” that is the decisive advantage that makes it possible to solve the technical and biological problem of shock wave absorption, which generates micro-movements that are fatal to bone healing, as we will see later.

It isimportant to understand that a full ICM bridge must replace your entire dental arch, i.e. all the teeth in the jawbone:

It is attached to the intraosseous implants that were placed to replace the roots of the extracted teeth. The corollary of this principle is that one should not make If there are a small number of residual teeth that are not strictly speaking suitable for immediate extraction, the protocol requires that these teeth be extracted to replace the entire dental arch.

This MCI bridge made of acrylic glass material material is a first version of very high mechanical, biological and aesthetic level of restructuring of your smile.

AFTER HEALING, YOU HAVE THE CHOICE TO REPLACE THE IMPLANT-SUPPORTED BRIDGE WITH A RESILIENT ACRYLIC GLASS COSMETIC BY AN IMPLANT-SUPPORTED BRIDGE WITH A CERAMIC COSMETIC ON A METAL FRAME

To live with the smile you want, we give you the choice.

The next step in your MCI implant treatment strategy will depend on your aesthetic and functional preferences in accordance with your personal situation.

We offer several prosthetic solutions, all of which are very satisfactory, but with a gradient of both aesthetic and functional performance.

There are three main cases:

  • If this first version of the MCI bridge in PMMA suits you and seems sufficient and seems sufficient, this one can be considered as definitive without final without retouching.
  • In case this first version of restructuring with a PMMA MCI bridge seems to you slightly inadequateor if an aesthetic or occlusal problem appears, then this PMMA implant-supported bridge can easily be reworked and corrected in the laboratory within a few days.

But only after complete osseointegration of the implants, i.e. 6 months.

We guarantee our MCI PMMA bridges against cosmetic defects for a period of 4 years, under normal use and in accordance with our recommendations.

Beyond this warranty, it may be necessary, over time, to clean, repolish and/or re-coat the worn acrylic glass.

This process requires 2 to 3 days of work in the laboratory for a cost of about 990 euros/CHF at your expense.

  • Because your aesthetic and functional desires are very demanding, this version of the MCI bridge in PMMA does not or no longer suits you, you wish to evolve towards a version of implant-supported bridge with a ceramic cosmetic with a more advanced ceramic cosmetic that is both functional and aesthetic.

In the latter case, a second version of the bridge, this time made of dental ceramic, will replace the first version made of PMMA. If your high aesthetic and/or functional requirements demand it, this first version of the implant-supported bridge with a resilient acrylic glass cosmetic can be replaced by a second version of the implant-supported transvissel bridge
made of ceramic
after a minimum of 8 months of healing.

To choose the smile you want, we give you time.

Most often, patients keep this first version of the MCI bridge in PMMA mainly because of financial constraints.

Since this first version of the MCI bridge in PMMA is very comfortable, patients have plenty of time to make financial arrangements.

There is no problem keeping this first version of the MCI bridge in PMMA for several years.

As we have just specified we are so confident in our product that we guarantee it, for normal use, for four years.

If you want to move quietly and stress-free, but safely, to a ceramic MCI bridge, the quality of our products gives you all the time you need to organize yourself personally and financially.

You can enjoy your new smile during this period of reflection, imagining how to perfect it even more.

Because most of our patients obviously want to upgrade their smile to a second version of the implant-supported screw-retained bridge with a cosmetic ceramic covering.

This second version of implant-supported prosthesis is the ultimate in its kind, both for obvious aesthetic reasons and for functional reasons of masticatory power and biological tolerance.

But it cannot be considered before 6 to 12 months.

It is necessary to wait for the perfect osseointegration of the implants in the bone of your jaws and the restructuring of the bone grafts and soft tissues.

Why is the first version of the resilient MCI bridge in PMMA a must?

There are two requirements for implants to heal in the bone, which seem to be a real dilemma. That is, two contradictory premises with no apparently compatible solution.

The first requirement for healing:

On the one hand, implants screwed into the soft (cancellous) bone of the jaws must be protected from micromovements of more than 200 microns.

Hence the need for a very “rigid” implant-supported bridge to lock the implants in the bone and allow bone healing, which is called osseointegration.

This “bone immobilization” is the basis of the biological principle of bone healing by osteosynthesis.

It is used in orthopedics: the orthopedic surgeon screws orthopedic pins into a fractured long bone (arm or leg) to fix the mobile fractured bone pieces. He adds a “plaster” as a possible complement.

In MCI implantology, the equivalent of our “cast and pins” is the MCI bridge itself, which immobilizes the implants in relation to each other, much like a fence rail immobilizes the posts.

The second requirement necessary for healing:

On the other hand, it is imperative to protect the implants from the shock waves created by the hard clash of teeth against each other during chewing, teeth grinding at night and also during our two thousand daily swallows.

Hence the need to make the “bridge teeth” out of a “soft and flexible” material!

The combination of 3D digital machining technologies with new generations of dental biomaterials in metal and acrylic glass are the solutions in MCI

The combination of this resilience of the acrylic glass (PMMA) and the rigidity and absolute passivity of the metal framework protects the implants from shock waves and mechanical movements of more than 200 microns of deflection that are fatal to the osseointegration of the implants.

Acrylic glass (PMMA) is more ductile and absorbs the shocks of chewing much better than dental ceramics, which are much harder and transmit the shock waves to the implants and thus to the still healing bone.

Why can the first PMMA bridge be considered permanent?

The great aesthetic and mechanical qualities of acrylic glass (PMMA) allow it to be considered as an immediate permanent solution.

Even though, of course, dental ceramics remains the most cosmetic and biocompatible material, resistant in the long term.

As a rule, the choice to keep the first PMMA bridge is mainly guided by financial considerations in order to save the cost of a second ceramic bridge after eight months, even though it is better in every respect.

If you wish to have the most successful and definitive solution, then this first version of the bridge can be replaced by this second ceramic version: an implant-supported bridge with a ceramic cosmetic

However, it is necessary to wait for the final healing of the implants (called osseointegration).

This means that you must wait at least eight months after the first operation and the installation of the resilient MCI bridge.

BEWARE OF SHOCKS:

The hard, repeated shock waves from chewing on the MCI bridge version with ceramic cosmetic material are reflected along the bridge structure and implants.

This is mortifying for the development of neoformed bone tissue along them and therefore impairs the osseointegration of the bone around the implants and leads to failure.

For this reason, it is necessary to wait between 6 and 12 months for bone healing and bone and gingival remodeling around the implants and the MCI bridge structure before opting for the ceramic version of the MCI implant-supported bridge.

It is also necessary to have a strictly soft food that can be chewed between the fingers.

Why are the ICM implant protocol fees high?

You have already been informed verbally during your consultations of all the basic points listed above and/or you have read all our written information on the subject of MCI implant placement here :

https://www.jeromeweinman.com/implants-et-greffes/mise-charge-immediate-mci/

You have therefore understood that the technical nature of our “MCI” protocol is extremely demanding, both in terms of surgical skills and training and in terms of choosing the best prosthetic materials, the latest generation of high-performance implants and the most advanced bone biomaterials.

It is an original protocol that takes the advantages of the previous historical versions and erases most of their drawbacks.

It is constantly updated with the latest advances in science and technology.

It is also the result of a philosophy and a personal ethic: “to surpass oneself… the race that never ends”.

The counterpart of these performances is an intransigence on the indications, on the operative conditions and on the good compliance of the patient.

It is also, and above all, the work of an entire team specialized in MCI thanks to the synergistic skills of great talents: nurses for the phlebotomies necessary to make the PRFs, specifically trained operating assistants, anesthesiologists to perform the preoperative medical checkups and general anesthesia or IV sedation, and prosthetists specialized in the manufacture of MCI prostheses by CAD/CAM.

So it’s all these high-level specialists that you pay.

It is therefore common sense that these requirements at all times and in all areas cannot be accommodated by the “low cost”.

Overview of fees for MCI dental implant placement with an implant-supported bridge

The chapter on fees will be developed later in the MCI protocols for the mandible and maxilla.

Here is an overview:

MCI fees

We apply a fixed price for dental extractions, bone grafting, blood sampling and the manufacture of PRF membranes, the placement of implants followed by the placement of the implant-supported bridge in immediate loading

Indeed, the work to be done is so complex that it is too variable to be quantified a priori, despite the preliminary examinations and 3D computer simulations.

As the protocol is almost the same in the maxilla and the mandible:

The applied is EUR 24,800 (twenty-four thousand eight hundred euros/CHF).

It includes all the surgical procedures (extractions, bone grafts, blood samples for the fabrication of PRFs) necessary for the placement of the implants (regardless of the number of implants needed) and the placement of the first MCI bridge, called “resilient”, with an acrylic glass (PMMA) cosmetic covering.

Interventions outside the MCI package:

What is not included in the package are optional or related procedures: such as any sinus lift procedure, any related dental care, the anaesthetist’s fees and, if applicable, the operating room fees in a private clinic.

The important point of the advantage of compacted interventions:

If you decide to have several procedures done simultaneously in one operation (for example, both upper and lower arches and/or sinus fillers), then the operating room fees in the surgical clinic and the anesthesiologist’s fees are lumped together and therefore more advantageous.

Anesthesiologist and operating room fees in the clinic are flat-rate and unique if both procedures are performed up and down at the same time.

On the other hand, these fixed fees, even if less important for smaller procedures, are multiplied by the number of interventions if they are separate.

Our policy regarding possible medical reimbursements
by your private insurance

At the beginning of the treatment, we do not provide any other document than a costed treatment plan.

This document is for the patient’s use only.

We never provide a document for our patients’ private insurance regarding your MCI protocol because it is an a priori estimate of your clinical case.

The question of calculating your hypothetical reimbursements before the procedure is not our concern.

Once the interventions are done and healed, safe from postoperative hazards, we will give you a paid invoice.

If necessary and according to your specific recommendations, we can include the codes of the CCAM in France or Lamal in Switzerland.

We have already mentioned our difficulties in quantifying very precisely the work to be done for the MCI protocol.

The per operative complexity and all the hazards that can occur during the operation or postoperatively, makes it impossible to promise an exact number of implants to be placed, the volume of bone grafts to be performed, etc.

That’s why we charge a flat fee regardless of the amount of work involved.

Furthermore, the possible reimbursements are so minimal in relation to the expenses incurred that we strongly advise our patients against making their decision to undergo surgery contingent on a hypothetical financial return.

For our patients, it is a choice of a new slice of life:

Your new smile will condition the rest of your life.

Your personal hopes and choices to smile happily are far superior to any other considerations.

It is therefore up to the patient to take the personal step of approaching his insurance company with this document or the summary that he will have made personally and under his strict responsibility.

Implant surgery and in particular oral surgeries performed in order to equip the patient with an implant-supported prosthesis that replaces the major part of the dental arch in immediate loading are considered as cosmetic surgery.

It is a comfort medicine that is a choice made by the patient.

As a result, this type of medicine is not generally covered by the classic insurance reimbursement conditions.

We can discuss at length whether this type of intervention is the result of periodontal or carious disease, that is not the debate here.

We listen to the patient to solve his medical problems, but in no case, we engage our responsibility to solve the problem of his private insurance.

In France, so that you can get closer to your French insurance, here are the CCAM codes below.

In Switzerland, a specific document can be given to you upon request.

In France :

Almost all of the procedures performed in our “MCI protocol” are “non-reimbursable” by the French Social Security , because they are either classified in the nomenclature as “non-reimbursable”, or they are “out of nomenclature”.

However, once the surgery is completed and healed, and protected from postoperative hazards, we will provide you with a paid invoice in order to assert your rights with your mandatory or private insurance.

We will be able to include the CCAM codes in France

We do not provide other elements than the CCAM codes below, because the final number of implants cannot be guaranteed a priori before the operation.

For your information, here are the CCAM codes for the following surgical procedures:

  • Root planing : HBGB006, Root planing on a sextant

non-refundable

  • MCI All on 4 : LBLD004 Placement of 4 intraoral implants in adults ;
  • MCI All on 6 : LBLD025, Placement of 6 intraoral implants, in adults ;
  • MCI All on 8 : LBLD038, Placement of 8 intraoral implants, in adults ;
  • MCI All on 10 : LBLD294, Placement of 10 intraoral implants, in adults ;
  • MCI All on bi max : LBLD261, Placement of 11 or more intraoral implants ;

non-refundable

  • Bone grafting for 6 teeth: HBBA002, Additive alveolar arch osteoplasty on a sector of 4 to 6 teeth;
  • Bone grafts for more than 7 teeth: HBBA004, Additive alveolar arch osteoplasty on a sector of 7 or more teeth;

non-refundable

  • Installation of FRP membranes

Out of nomenclature

For your information, here are the CCAM codes for the following prosthetic procedures:

Made in Switzerland :

Implant-supported bridge in MCI: HBLD 030, Implant-supported full denture

In Switzerland:

None of the procedures in the MCI protocol when performed in Switzerland are reimbursable in Switzerland or in France.

However, an invoice will be given to you after the intervention so that you can claim it from your private insurance company in case you have a private reimbursement.

However, this reimbursement should not, in any case, influence your decision because we can absolutely not guarantee this return of money which therefore cannot be an element of your decision to be operated.

YOUR INFORMED CONSENT AND YOUR SIGNATURE ON THIS CARE CONTRACT:
THE INFORMATION YOU NEED TO VALIDATE

Following your previous consultations, possible gracious conversations and the analysis of your clinical case according to the radiographic elements, either in visio-consultation on Doctolib and/or in person at my office, you have asked me to make a proposal for a costed treatment plan for the placement of dental implants in Immediate Care to replace your teeth condemned in the short or medium term, following carious and/or periodontal pathologies

The organization of appointments is subject to your acceptance, modification or rejection of the therapeutic procedures proposed here.

Of course, you have the possibility of proposing adjustments and/or modifications to these treatments. You just have to send us your remarks, questions or particular requests in writing by return of this e-mail or by telephone or by Doctolib in video.

We can schedule a meeting to discuss together, in order to design a new proposal that takes into account your remarks.

This text will take up all the themes we have discussed, but selecting those that we have prioritized in our previous conversations.

We have already discussed the formalization of protocols following the judicialization of medicine in Europe. You will therefore not be surprised by the requirements listed below that condition the start of your care.

In the absence of a specific recusal on the points mentioned below we consider that they are acquired and that you give your consent by default to the interventions.

If you have any comments, questions or concerns, you should respond to the following points:

  1. Regarding acceptance of dental work under I.V. sedation if you fear dental work (or gag reflexes):

Without a specific answer from you, we consider by default that you have understood the interest of intravenous sedation techniques in the office to treat your teeth despite your stomatophobia. You can choose to be sedated by an anesthesiologist or not at any time.

  1. Regarding acceptance of the anesthesiologist’s fee:

Without a specific response from you, we will assume that you agree to pay the anaesthetist’s fees directly. Knowing that these are qualified “out of nomenclature” or “non-reimbursable” and by default totally non-reimbursable, neither by the social security, nor by your mutual insurance.

  1. Concerning the acceptance of the choice of the program your dental care stricto sensu :

Without a specific response from you, we will assume by default that you have understood all the alternative treatments that have been presented to you and that you have already rejected them in our conversations in favor of those listed below.

  1. Regarding the “information you received”:

Without a specific answer from you, we consider by default that you have read and understood all the information on my website www.jeromeweinman.com (or other equivalent) and/or that I have given you, in writing or verbally, all the information, about your health condition and treatments (including alternatives) necessary for your “informed consent”.

  1. Regarding your “informed consent”:

Without a specific response from you, we consider that you accept the principle of these treatments and give your permission to perform them to treat your teeth at the time you choose.

Your return email and/or the signature of this contract of care which specifies your authorization to practice, triggers the countdown of your legal period of retraction of 15 days.

  1. Concerning my fees and those of my fellow dentists or doctors who assist me :

Without a specific response from you, we will assume by default that you have received complete, plain language and fair information about your care and that you agree to pay our fees in full.

Knowing that these :

– Are all in ” free fees”, which implies that you have rejected all other care options deemed “reimbursable” at the social security rate and/or the various baskets with their caps in France or Switzerland.

– Almost all of them are classified as “out of nomenclature” and/or “non-reimbursable” .

They are therefore only refundable neither by the French social security system nor by your private insurance, either because they are not included in the French nomenclature, or because they are included in the list of “non-reimbursable” treatments, or because the practitioners who perform them are not subsidized.

  1. Under no circumstances will your theoretical reimbursements from your mandatory or contractual insurance policies be taken into account in your decision to entrust us with your medical care.

Consequently, we are in no way concerned by this last point of your hypothetical refunds.

– An invoice will be sent to you after processing in France or Switzerland.

– You will be given a social security form in France after treatment, only if the procedure performed has a corresponding code.

It is your sole responsibility to assert your rights with your mandatory or private insurance.

An insufficiency of your supposed reimbursements does not imply any responsibility of our firm.

In case of cancellation or postponement of your intervention which results from your decision, apart from imponderables such as an accident, or a transport strike etc.

Any cancellation on your part of the intervention, within a delay of less than one week and whereas the expenses for the installation of your operation were already provisioned, will involve a retention on the fees which will be refunded to you.

This deduction is 1000 € flat rate or the real expenses if the amount invested and not recoverable is higher.

In case of cancellation by the surgeon for a major reason: such as an accident, death, transportation strikes or illness, the fees will be fully refunded without deduction.

In case of impossibility for Dr. Weinman to ensure the surgical follow-up following an illness or an accident or a death.

Dr. Jerome Weinman works with a team of trained practitioners.

They will be able to take care of the patient at any time in his place if a major imponderable occurs and this without additional fees.

THE FIRST THEME OF YOUR CARE:
INTRAVENOUS SEDATION AND GENERAL ANESTHESIA
FOR THE MANAGEMENT OF MCI SURGERY, STOMATOPHOBIA AND GAG REFLEXES

DENTAL CARE UNDER GENERAL ANESTHESIA

STOMATOPHOBIC OR OVERBOOKED?
SLEEP...
WAKE UP WITH A NEW SMILE

our zero peuR zero pain COMMITment:
YOUR dental care under general anesthesia

If you are a person suffering from stomatophobia (see : www.peurdudentiste.com ) the first point to take into account is your phobia of dental care and your desire to be treated under intravenous sedation thanks to the presence of an anesthesiologist.

On my website you will find all the information on the different sedation techniques used in the dental office by narco-hypnosis.

Click here for more information: https://www.jeromeweinman.com/soins-dentaires-sedations/

You should note that dental care practiced in the office under sedation such as narco-hypnosis are not registered in the current texts of the French social security nomenclature and therefore they are not reimbursable.

Concerning sedation techniques in a surgical operating room in a clinic: it is summarized in general anesthesia.

You have in the previous link the explanations on this technique.

To help you become aware of the time scale of work to be done to restore a complete arch with modern and sophisticated techniques here is a time/work ratio:

It is estimated that the average working time for each surgical procedure is one to three hours.

This is the minimum required for good quality care.

For example:

  • The placement of 6 to 8 implants with immediate loading following extractions and a complete bone grafting protocol with the addition of PRF (including blood sampling) is 1.5 to 4 hours, if the case is particularly complex.
  • The opening of the sinus and the bone grafting to fill the bottom of the sinus (sinus lift) for the placement of intraosseous implants with the addition of PRF (including blood collection) is 1 to 3 hours, if the case is particularly complex. See here the explanations: https: //www.jeromeweinman.com/greffes-osseuses/sinus-lift-comblement/

The operating times of these procedures are of course added up in case of multiple complex surgeries in “one shot” (compacted surgeries).

In this case in implantology:

If we consider that your two dental arches (jaws) are likely to receive implants in immediate loading with a right and left double sinus lift: you can see that the number of working hours is close to a minimum of 5 hours and a maximum of double.

However, more than 5 hours of intervention is not feasible in conditions of comfort and safety for the patient in a dental office under IV sedation.

In the operating room, in a clinic, under general anesthesia, there is more flexibility in the total duration of the procedures because of the increased comfort and safety.

However, everything will depend on the opinion of the anesthesiologist and your ASA score: that is to say the risk category in which you find yourself according to your age, your physical condition, and possible comorbidities.

Consequently, if the total of the interventions implies a too important operative time, they will have to be carried out separately.

Anesthesiologists recommend limiting the operating time for very long procedures under general anesthesia in the operating room for comfort and non-vital treatments to a maximum of 5 to 6 hours for safety reasons.

Cardiovascular fatigue, which is emphasized by the legal recommendations of the learned societies of anesthesiologists, contraindicates cosmetic surgery procedures (assimilated to implantology) beyond this 5 to 6 hour limit.

Moreover, depending on the clinical risks (ASA classification) and your age, it is recommended not to multiply general anesthesias, especially close together.

On the other hand, under intravenous sedation such as narco-hypnosis or diazanalgesia there is much more flexibility in the rhythm of the interventions.

The comfort is comparable, but only if the operating time does not exceed 2 to 3 hours and only for minimally invasive procedures.

Consequently, during classic dental care or small oral surgery, the semi unconscious sedations such as we practice in the office with our anesthetists, which we call “narco-hypnosis”, puts you in a level of psychic disconnection enough to perceive nothing of the care given, nor even of our presence, nor of the passing time, nor of the smells, nor of the characteristic noise of the instruments of the dental office.

On the other hand, for much more invasive procedures such as implant surgery and the MCI protocol, we recommend operating under General Anesthesia, in the operating room of a surgical clinic, in order to secure the patients during the long and difficult MCI procedures.

Let's go over some important points
to explain the protocol of intravenous sedation

Although I have already explained everything to you verbally in our conversations and you have read my articles on the subject in my websites or equivalent,

Semi-conscious sedations or intravenous sedations by narco-hypnosis:

This type of sedation is an “artificial sleep”.

This level of sedation, which remains in the zone of “artificial sleep” and not of an “artificial coma” as for a general anesthesia, is lighter and more adapted to iterative dental care.

This disconnection is more than enough to manage fear and pain during dental care, even surgical procedures such as dental implants.

This is why I offer this technique at my office.

It can be repeated almost as many times as necessary (subject to the preoperative consultation by the anesthesiologist) with intervals between operations that can vary from overnight to one or more weeks, depending on the clinical case.

It is a medical procedure that is systematically performed by an anesthesiologist trained in this type of anesthetic technique.

On my website you will find all the information about semi unconscious sedations as we practice them in the office with my anesthetists, which we call “narco-hypnosis”:

https://www.jeromeweinman.com/soins-dentaires-sedations/sedation-semi-inconsciente-hypnose-diazanalgesie/

General anesthesia:

The protocol of sedation by deep general anaesthesia, in clinic, is reserved for specific heavy surgical interventions and/or for fragile patients or with heavy comorbidities.

As for example classic :

Implant placement with immediate loading (ILI) with the addition of invasive surgeries grouped in a single surgical step called in “one shot whose invasiveness is too important to be performed in the office, in safety, on a patient with cardiovascular or metabolic pathologies or aged over 50 years.

As I explained to you, general anesthesia (GA) is an “artificial coma”.

This is a wonderful technique, but it can only be conceived, without danger, for relatively short operating times, of about 5 to 6 hours, in the operating room, in a surgical clinic.

General anesthesia is not a suitable sedation protocol for recurrent procedures such as successive dental surgeries, but for a specific heavy surgical procedure.

General anesthesia is not without risk and consequence:

The repetition of general anesthesia and the use of halogenated gases and drugs necessary for the intubation of the patient in a relatively short period of time, can generate a stress of the organism, especially cerebral, with sometimes memory loss and fatigue.

This type of major sedation should be reserved for major surgery on fragile patients. For example, implant placement and bone grafting with immediate loading over an entire arch.

If the patient has risk factors (comorbidities) such as coronary risk, then the intervention time will need to be optimized to the minimum.

Semi unconscious intravenous sedation as described above is an “artificial hypnotic sleep” and much more suitable for a series of dental or surgical procedures called “iterative”.

If it appears from the analysis of your clinical case that your implant treatment requires several small, fragmented and iterative procedures, then this type of semi unconscious intravenous sedation in the office makes sense.

It is also possible and relatively frequent that an operative program begins with a first intervention under general anesthesia in a clinic for an MCI protocol and continues with other lighter interventions under narco-hypnosis such as sinus lift grafts and complementary implants.

Legal and medical information: You will receive specific documents by email concerning sedation:

  • A sedation information document for you to read and sign;
  • A medical questionnaire that you must complete and sign;
  • An “informed consent” form that you must read and sign to give your authorization in principle to practice these sedation techniques.

Anesthesiologist’s fees in the office:

The fees are to be paid directly to the anesthesiologist:

  • A fixed price of 550 euros/CHF for a session under simple sedation, whatever its duration, but not exceeding 3 hours.
  • A fixed price of between 500 euros/CHF and 2,500 euros/CHF for a half day of surgery under medicated hypnosis.

Consultation fees are not included in this package.

The amount of the consultation fee is the decision of the anesthesiologist.

The fees of the anesthesiologist in the office in the operating room in a surgical clinic:

The fees are to be paid directly to the anesthesiologist:

They depend on the duration of the intervention.

But, in general, they are between 1,500 and 2,500 euros/CHF, depending on the duration of the surgery.

Consultation fees are not included in this package.

The amount of this consultation is the decision of the anesthesiologist.

The fees for anesthesiologists in Paris and Geneva are equivalent.

The operating room fees in Paris and Geneva are equivalent.

They are between 1,500 euros/CHF and 3,900 euros/CHF depending on the type of intervention to be defined on a case by case basis.

THE SECOND THEME OF YOUR CARE:
YOUR IMPLANT SURGERY WITH IMMEDIATE LOADING
WITH A FULL IMPLANT-SUPPORTED BRIDGE

ONE SHOT IMPLANTOLOGY

YOUR TEETH ARE LOOSE OR LOST?
REDO YOUR SMILE IN A FEW DAYS

Replace your diseased teeth
thanks to the high technology of our protocols
of implant placement with immediate loading

We have already analyzed your clinical case during our previous appointments and we will detail here the care for which you are eligible.

We have duly selected them, classifying them by category.

All the points of difficulty mentioned have already been objectified by the radiographic elements that we have seen and analyzed together, during our appointments in visio-consultation on Doctolib and/or in person.

All the treatments I practice are described on my website www.jeromeweinman.com with illustrations of clinical cases I have done.

We assume by default that you have understood and accepted the analysis of your case that has been made, unless you explicitly state otherwise.

  • By default and unless you specify it in a specific and clearly expressed answer by email, we act that you have read all the information in my website www.jeromeweinman.com (and/or another equivalent) on the topics presented here, that you have understood the explanations given in writing or verbally and that you have no reservations about this care being practiced to treat your clinical case by an implant placement with immediate loading, according to the main MCI protocol which is presented in my website jeromeweinman.com.
  • We also assume, unless you specifically state otherwise in writing, that you understand the specific variation that tailors the main MCI protocol to your particular case.
  • By default, also and unless you specifically and clearly state otherwise in writing, we consider that I have presented to you, that you have understood and challenged all alternative treatments and other possible variants.

As non-exhaustive examples:

  • A bridge fixed on your natural teeth (in the event that some teeth can be preserved a little longer);
  • And/or a total or partial removable prosthesis solution;
  • And/or any other implant variants other than immediate loading implants according to the main protocol presented on my website www.jeromeweinman.com

Should you require any further information, you must let us know clearly and in writing so that we can arrange for an additional briefing as soon as possible.

By default and in the absence of a challenge from you, we will assume that all points of your treatment plan are understood and accepted.

THE REHABILITATION OF YOUR DENTAL ARCH IN THE LOWER JAW:
THE MCI MANDIBULAR PROTOCOL

If your clinical case allows for an implant extraction with immediate loading, the two fundamental operative points to consider are

  • On the one hand, the teeth must be extracted at the time of implant placement to minimize the physiological and unavoidable post-extraction alveolar bone resorption.

Indeed, the key point of our protocol is to place the implants in native bone at the time of tooth extraction in order to preserve sufficient height and width of the bone wall (alveolar bone) necessary for implant placement.

It is important to understand that the alveolar bone immediately begins its physiological resorption at the time of tooth extraction.

  • On the other hand, the bone grafts of apposition are made in the same operating time, from banked bone, either allogenic (human) or (and/or) xenogenic (animal) enriched in autologous tissue growth factors by the addition of FRP membrane.

All our information on this subject of bone grafts are here :

https://www.jeromeweinman.com/greffes-osseuses/greffes-osseuses-preimplantaire-comblement-sinus-implant-dentaire-paris/

All our information on this subject of Regenerative dentistry with PRF and PRP : the contribution of autologous tissue growth factors, regeneration and tissue healing, in supra physiological concentration, manufactured from an autologous blood concentrate (platelet autograft) of the patient as PRF and/or PRP, are here :

https://www.jeromeweinman.com/medecine-regenerative-rejuvenative/utilisation-clinique-prf/

The first difficulty is the degree of initial vertical and horizontal resorption of the lingual wall (behind the lower teeth) in the anterior region where the implants are to be placed.

The guiding principle of our surgical techniques is that the alveolar bone wall must be sufficient in all 3 dimensions of its volume to place implants.

To respect this principle, it is necessary to use operating techniques:

  • Which avoid losing the necessary alveolar bone height to make a prosthesis with the right vertical dimension of occlusion (DVO);
  • Which block bone resorption to the maximum by inducing bone regeneration (regenerative dentistry);
  • Which anticipate bone loss or correct the one already present by reconstructing the bone volume in an optimal way (bone grafts).

All our information on this subject of cosmetic dentistry is here:

https://www.jeromeweinman.com/esthetique-dentaire-sourire/rajeunissement-sourire-anti-age/

Therefore, the teeth should preferably be extracted at the time of the implant procedure to prevent disastrous bone resorption.

If, on the other hand, the dental extractions were done a long time ago, then the jawbone has already been greatly resorbed.

Or, if the periodontal disease (loosening of the teeth) is old and almost terminal, then the alveolar bone along the roots has already been destroyed over a very large height.

In these cases, the aesthetic result with the satisfying impression that the ceramic dental crowns screwed onto the implants are literally “sticking out” of the gums will be very difficult to achieve.

A false gum (preferably pink cosmetic ceramic) applied around the ceramic teeth of the implant-supported bridge will sometimes be an aesthetic requirement.

The height of the teeth and the vertical occlusal dimension (VOD) is determined by the degree of vertical resorption of the lingual wall in the anterior region where the implants are to be placed.

  • The correct vertical dimension of the lower face (DVO): it is determined by the height of the teeth.

See the chapter on the aesthetics of the lower face: https: //www.jeromeweinman.com/esthetique-dentaire-sourire/rajeunissement-sourire-anti-age/

  • In order to maintain or regain this vertical dimension of the lower face (DVO) without a “long teeth” effect, we will sometimes be obliged to fabricate a ceramic false gum around the ceramic crown between it and the intraosseous dental implant.

In this way, we can raise the implant-supported bridge, without having an effect of abnormally elongated teeth, which is very unsightly.

This ceramic (or resin) false gum is totally invisible to the people who will look at you.

– All our information and techniques on this subject of cosmetic dentistry and restructuring of the aesthetic and anti-aging lower face are here:

https://www.jeromeweinman.com/esthetique-dentaire-sourire/exemple-rajeunissement-visage/

The second difficulty is a loss of the normal anatomy of the upper dental arch due to very decayed teeth and therefore a destructured inter-maxillary occlusion.

However, to make this type of very sophisticated MCI prosthesis, it is imperative to have an ideal occlusion between the two arches (upper and lower).

This will require:

  • Or perform reconstruction work on the antagonist arch with a series of treatments on your natural teeth and defined in another treatment plan;
  • Either seriously optimize the prosthetic solution you currently have with another temporary prosthesis;

These various interventions to resolve these difficulties will be performed in parallel with the placement of implants on this mandibular arch.

  • Or perform an MCI procedure on both arches in the same operative time frame.

The third difficulty is the passage of the inferior alveolar nerve (NAI) which runs in the horizontal branch bone of the mandible under the molars and premolars:

The inferior alveolar nerve (NAI) is closer to the bone surface (in the posterior and inferior area) the more your mandibular bone is resorbed from past extractions.

What are the difficulties:

  • If the dental nerve is within 8 to 6 millimeters of the top of the usable bone ridge, then implant placement is almost impossible in this state.

Additional grafts to increase this height can be considered.

  • The risk is an injury to the lower dental nerve at the time of implant placement that could generate paresthesia of the lip and chin on the side of the procedure.

What are the solutions:

  • However, it is generally possible to place between 6 and 8 implants in the mandible, with 2 short implants or mini implants, in the two posterior areas (right and left).

But only if the dental nerve is within a few millimeters (between 10 and 8 millimeters) of the usable bone surface of the alveolar ridge.

  • Below this minimum height, a strategic decision must be made: either to perform a vertical bone augmentation graft, to perform a nerve rerouting (NAI), or to opt for an implantation only on the anterior part of the mandible.

Systematization of allogeneic and/or xenogeneic appositional bone grafts associated with PRF to compensate for bone resorptions.

Bone grafts are performed on the entire circumference of the implanted arch.

They will be systematically performed at the time of implant placement to compensate for the inevitable post-extraction physiological bone resorption and possible bone gaps.

All our information on this subject of bone grafts and MCI is here :

https://www.jeromeweinman.com/greffes-osseuses/greffes-osseuses-preimplantaire-comblement-sinus-implant-dentaire-paris/

And our information on this FRP topic is here :

https://www.jeromeweinman.com/medecine-regenerative-rejuvenative/utilisation-clinique-prf/

These proactive techniques make our protocol a pioneer in the field of mandibular MCI implant placement.

If the vertical and horizontal bone resorption of the anterior AND posterior bone walls is not too great, or is compensated for by bone grafts, then the bone volume is sufficient for implant placement.

In this case, the placement of implants in the posterior sectors is just as feasible as in the anterior sector.

In this configuration, it will be possible to make a molar-to-molar screw-retained implant-supported bridge with 6 to 8 implants.

This is the All on 6 or All on 8 technique: All the information on the subject of implant placement in MCI is here:

https://www.jeromeweinman.com/implants-et-greffes/mise-charge-immediate-mci/

This is certainly the ideal option because it is the simplest!


We call this

bridge screwed onto the implants

The “Resilient Implant-supported Full Arch Bridge with Immediate Loading”:
RIFA Bridge with IL: Resilient Implant-support Full Arch Bridge with Immediate Loading.

It is said to be ” resilient” because its skeletal structure (frame or central beam) is designed and manufactured with the help of the computer (3D laser printer for metal) in a sufficiently ductile alloy (titanium or chrome cobalt) to absorb shocks and sufficiently rigid without breaking so that once screwed onto the implants, it guarantees their immobility with a tolerance of less than 200 microns , in order to avoid micromovements that are fatal to osseointegration (healing of the bone on the implants).

All our information on this subject of implants is here :

https://www.jeromeweinman.com/implants-et-greffes/implants-dentaires-definition/

In addition, its plastic cosmetics are also very resilient thanks to the aesthetic qualities of the PMAA family of acrylic glass materials, which are also produced with CAD/CAM.

PMMA provides resilience to the whole, absorbing energy from chewing shocks to protect the healing implants.

  • This resilient bridge screwed onto the implants solves the dilemma of an immediate loading that is both very rigid and “soft”.
  • This resilient bridge protects the implants from micromovements of more than 200 microns and from shocks that cause disosteointegration and healing failure.
  • At the same time, this resilient bridge ensures a very nice aesthetic thanks to the aesthetic qualities of the acrylic glass material.
  • The resilient bridge will be screwed in 4 to 7 days postoperatively: this is the time for the prosthetic laboratory to make a custom-made semi-final bridge.
  • This resilient bridge will be left in place for a minimum of 6 to 12 months for healing and maturation of the hard tissue (maxillary alveolar bone) and also soft tissue (gingiva and oral mucosa).
  • This resilient bridge is different from a traditional “temporary” or “transitional” resin bridge. Its skeletal structure is manufactured in exactly the same way as a permanent ceramic bridge. This is not the case with the skeletal structures of traditional “temporary bridges” made of resin or even reinforced with a metal arch (welded intraoperatively) that are imprecise and not passive.
  • This resilient bridge is different from a “provisional” or “transitional” bridge made prior to implant placement following surgical planning on an implant simulation software such as “All on 4” or “All on 6“. Indeed, the impression made extemporaneously during the procedure allows us to make an exact replica of the dental arch and the smile ideally imagined once the procedure is done. Our protocol has much more scope for adaptation and flexibility intra- and postoperatively than a protocol with a fixed preoperative planning and/or implant navigation technique that cannot be modified during the procedure.

For your information, here are the techniques for preoperative planning and/or implant navigation.

You can view Dr. Jerome Weinman’s films of planned implant surgeries assisted by digital surgical navigation with the ROBODENT system on UTube here:

https://www.jeromeweinman.com/videos/#29

By deciding to do this rehabilitation of your mouth and your smile, you have started a new slice of life.

This intervention is important from all points of view.

We are all aware that it will determine a “before” and an “after”.

The burden is multiple, both physical, emotional and financial.

Thanks to our MCI protocol, we are able to both compact the treatments to give you back your smile in an extremely short period of time and to make them last.

We give you time to choose to optimize your smile with techniques even more sophisticated aesthetically and functionally:

  • First option: Keep this implant-supported resilient bridge with its beautiful acrylic glass material cosmetic for many years to come. It can be eventually renovated, if needed.

In general, this bridge is kept as it is for economic reasons.

  • Second option: Opt for a replacement of this implant-supported resilient bridge by its copy in ceramic cosmetics, even more aesthetic, even more biocompatible and even more durable over time.

Maturation of the soft and hard tissues around the first resilient bridge is completed in about ten months.

This is why the second ceramic implant-supported bridge allows for the correction of possible bone resorption due to the maturation of the soft and hard tissues for an even more refined AESTHETICS and MASTICATION.

After this period of 6 to 12 months, the implants are osseointegrated.

Therefore, they can absorb the energy of hard shocks, generated by biting and chewing on ceramic which is a non-resilient and non-ductile material.

The implants are osseointegrated, so it is no longer necessary to load the implants with a “resilient” screw-retained bridge.

At this stage of the loading protocol, it is possible to replace the resilient screw-retained bridge with another ceramic screw-retained bridge that is much more sophisticated and demanding in terms of bite and esthetics.

Cosmetic ceramic material cannot be loaded onto implants in the first instance because it is far too hard and traumatic for newly placed implants.

It risks disosteointegration of the implants.

This second implant-supported and screw-retained ceramic bridge is fabricated with the same type of CAD/CAM metal framework. But, it has a stratified ceramic cosmetic that is even more aesthetic and more cutting and grinding for a better chewing.


We call this bridge screw-retained on the implants: The “Ceramic Implant-supported Full Arch Bridge in Immediate Loading”:
CIFA Bridge in IL: Ceramic implant-supported Full Arch Bridge in Immediate Loading

Laminated ceramics allow a perfect mimicry of the aesthetics of the smile, because its visual qualities are even closer to those of the teeth than acrylic glass material.

In addition, the hardness of the ceramic allows for a much more efficient bite and chewing, especially for fibrous foods such as meat.

All the information on this subject of implant-supported bridges in MCI is here:

https://www.jeromeweinman.com/implants-et-greffes/remplacer-toutes-ses-dents/

MCI Surgical Team Fees:

Our MCI operative package includes all the fees of the specific MCI team that will perform the necessary procedures for the MCI implant surgery.

The MCI package includes the collegiate fees corresponding to the different procedures performed:

  • All consultations and preparations necessary for the placement of a screw-retained prosthesis in immediate loading as defined above;
  • The execution of the surgical procedure itself: the surgical intervention including dental extractions with extemporaneous implant placement and bone grafts enriched with aPRF and iPRF ;
  • Fees for specialized ICM operating assistants;
  • Costs related to bone grafts: bone biomaterials, bone bank
  • Expenses related to international brand dental implants;
  • The team of nurses specializing in phlebotomies required for the manufacture of aPRF and iPRF ;
  • The cost of manufacturing the screwed bridge in MCI by the specialized laboratory;
  • And of course, the installation a few days later in the office of this first intention screw-retained resilient bridge, with the latest generation of CAD/CAM metal frameworks and its beautiful PMMA acrylic glass cosmetic.

The amount of the MCI package is a fixed price of 24,800 EUR/CHF (twenty-four thousand eight hundred euros or Swiss Francs)

Anesthesiologist’s fees:

The MCI fee package does not include fees for performing intravenous (IV) sedation or general anesthesia.

  • Fees of the anesthesiologist at the Geneva clinic:

Fees forgeneral anaesthesia in a surgical clinic in Geneva: the MCI anaesthesia package is between 1,500 euros/CHF and 2,500 euros/CHF depending on the volume of the implant procedure.

  • The fees of the anaesthetist in the Paris or Geneva office:

Fees for semi-unconscious intravenous sedation performed by an in-office anesthesiologist: the MCI anesthetic package is 550 euros/CHF for a single session.

And

An MCI package is between 1500 euros and 3000 euros/CHF for a half day of surgery under medicated hypnosis in the office.

NB: An estimate and consent is systematically provided by the anesthesiologist.


The fees of the surgical clinic in Geneva
:

The MCI package does not include operating room fees if general anesthesia is required.

In some cases, for reasons of general state of health or age (classification of patients ASA1 or ASA2) or complexity of the procedure, it is necessary to perform the first surgery in the operating room, in a surgical clinic, under general anesthesia, either as an outpatient or with an overnight stay in the hospital for comfort and safety.

This option is not systematic: In certain simple cases, the surgical intervention of installation of the implants can be carried out at the dental office under vigorous IV sedation thanks to the presence of a resuscitating anesthetist.

However, it is necessary to verify that the planned intervention is not too complex, that the patient’s health condition allows it and/or that his desire for comfort is not too demanding.

If the operation is performed under general anesthesia in a surgical clinic in an operating room in Geneva:

The MCI package for hospitalization at the GENEVA Surgical Clinic for an operation in the operating room under general anesthesia is between 1,500 and 3,900 EUR.

It includes:

  • Outpatient operating room fees. The outpatient day means you go in in the morning and come out at the end of the day.
  • However, if you wish to spend a night in a medical room for reasons of convenience or safety, the clinic will charge you a “night package” which generally does not exceed 600 euros/CHF.

NB: An estimate is systematically provided by the clinic.


Fees for the second version of the implant-supported ceramic screw-retained bridge
The MCI fee does not include the fee for a second version of the implant-supported CAD/CAM bridge with a more sophisticated ceramic cosmetic.

This screw-retained bridge completes the MCI protocol in the second intention, starting at least six months after surgery.

It has a state-of-the-art CAD/CAM metal framework and a more sophisticated and advanced ceramic cosmetic.

It will come according to your desires and your project of Smile Design (aesthetics of smile and facial expression) complete the first version of the MCI, when the alveolar bone and gingiva attached peripheral to the implants have healed around the first version of the bridge, at about 6 to 12 months postoperatively.

The fees for a screw-retained bridge version with a state-of-the-art CAD/CAM metal framework and a layered ceramic cosmetic, ideally made according to your wishes, range from 10,900 euros/CHF (ten thousand nine hundred euros/CHF) to 14,900 euros/CHF depending on the clinical case.


Fees for the practice of specific bone grafts
:

The MCI package does not include fees for those separate and/or prerequisite MCI procedures such as specific pre-, per- or postoperative bone grafts required or sinus lifts:

For sinus lift:

This is a flat rate of 3,800 Euros/CHF for each sinus lift.

NB: In case of abandonment of the MCI protocol by you, these fees are not refundable.

Specific bone grafts:

They can have different packages to be determined on a case by case basis.


Fees for the practice of dental care and/or removal of pre-existing dentures
:

The MCI package does not include fees for any dental care and/or removal of pre-existing dentures that may be required and/or the pre-requisite for implant surgery.

This preparation and/or the installation of the temporaries, can be compacted, under IV sedation, at the office, with our anesthetists for reasons:

– reduction of the time-consuming techniques required;

– of safety, taking into account the fragility of your age and/or the need to compact quite painful care or the presence of stomatophobia.

In some cases, these sessions can be included in the package if they are very light. If not, they are subject to a specific treatment plan.

On the other hand, the anesthesiologist’s fees for IV sedation are always additional.

REHABILITATION OF YOUR DENTAL ARCH IN THE UPPER JAW:
THE MCI MAXILLARY PROTOCOL

If your clinical case allows for an implant extraction with immediate loading, the two fundamental operative points to consider are

  • On the one hand, the teeth must be extracted at the time of implant placement to minimize the physiological and unavoidable post-extraction alveolar bone resorption.

Indeed, the key point of our protocol is to place the implants in native bone at the time of tooth extraction in order to preserve sufficient height and width of the bone wall (alveolar bone) necessary for implant placement.

It is important to understand that the alveolar bone immediately begins its physiological resorption at the time of tooth extraction.

  • On the other hand, the bone grafts of apposition are made in the same operating time, from banked bone, either allogenic (human) or (and/or) xenogenic (animal) enriched in autologous tissue growth factors by the addition of FRP membrane.

All our information on this subject of bone grafts are here :

https://www.jeromeweinman.com/greffes-osseuses/greffes-osseuses-preimplantaire-comblement-sinus-implant-dentaire-paris/

All our information on this subject of Regenerative dentistry and PRF and PRP : the provision of autologous tissue growth factors, regeneration and tissue healing, in supra physiological concentration, manufactured from an autologous blood concentrate (platelet autograft) of the patient as PRF and / or PRP, are here :

https://www.jeromeweinman.com/medecine-regenerative-rejuvenative/utilisation-clinique-prf/

In principle, the procedure is exactly the same as for the lower jaw (mandible). Therefore, the costs are exactly the same, except in the case of additional surgery, such as one or two sinus lifts.

However, the anatomy of the maxilla poses specific problems that may add complexity to the placement of implants in this area and to the surgical scheme presented so far.

The first difficulty is the degree of initial vertical and horizontal resorption of the palatal bone wall in the anterior region where the implants are to be placed.

The guiding principle of our surgical techniques is that the alveolar bone wall must be sufficient in all 3 dimensions of its volume to place implants.

To respect this principle, it is necessary to use operating techniques:

  • Which avoid losing the necessary alveolar bone height to make a prosthesis with the right vertical dimension of occlusion (DVO);
  • Which block bone resorption to the maximum by inducing bone regeneration (regenerative dentistry);
  • Which anticipate bone loss or correct the one already present by reconstructing the bone volume in an optimal way (bone grafts).

All our information on this subject of cosmetic dentistry is here:

https://www.jeromeweinman.com/esthetique-dentaire-sourire/rajeunissement-sourire-anti-age/

Therefore, the teeth will have to be extracted at the time of the implant procedure to avoid disastrous bone resorption.

If, on the other hand, the dental extractions were done a long time ago, then the jawbone has already been greatly resorbed.

Or, if the periodontal disease (loosening of the teeth) is old and almost terminal, then the alveolar bone along the roots has already been destroyed over a very large height.

In these cases, the aesthetic result with the satisfying impression that the ceramic dental crowns screwed onto the implants are literally “sticking out” of the gums will be very difficult to achieve.

A false gum (preferably pink cosmetic ceramic) applied around the ceramic teeth of the implant-supported bridge will sometimes be an aesthetic requirement.

The height of the teeth and the vertical occlusal dimension (VOD) is determined by the degree of vertical resorption of the lingual wall in the anterior region where the implants are to be placed.

  • The correct height of the teeth determines the correct vertical dimension of the lower face (DVO).

See the chapter on the aesthetics of the lower face:

https://www.jeromeweinman.com/esthetique-dentaire-sourire/rajeunissement-sourire-anti-age/

  • In order to preserve or regain this vertical dimension of the lower face (DVO), we will in some cases be obliged to fabricate a ceramic false gum around the ceramic crown between it and the intraosseous dental implant.

In this way, we can raise the implant-supported bridge without having an effect of abnormally elongated teeth which is very unsightly.

This ceramic (or resin) false gum is totally invisible to the people who will look at you.

All our information and techniques on this subject of cosmetic dentistry and restructuring of the aesthetic and anti-aging lower face are here:

https://www.jeromeweinman.com/esthetique-dentaire-sourire/exemple-rajeunissement-visage/

The second difficulty is a loss of the normal anatomy of the upper dental arch due to very decayed teeth and therefore a destructured inter-maxillary occlusion.

However, to make this type of very sophisticated MCI prosthesis, it is imperative to have an ideal occlusion between the two arches (upper and lower).

This will require:

  • Or perform reconstruction work on the antagonist arch with a series of treatments on your natural teeth and defined in another treatment plan;
  • Either seriously optimize the prosthetic solution you currently have with another temporary prosthesis;

These various interventions to resolve these difficulties will be performed in parallel with the placement of implants on this mandibular arch.

  • Or perform an MCI procedure on both arches in the same operative time frame.


The third difficulty is the presence of very pneumatized (voluminous) maxillary sinuses and an alveolar ridge (bone around the teeth) that is too resorbed below these sinuses, at the level of the molars and premolars
.

The maxillary sinuses are the anatomical air cavities in the upper jaw, located in the cheekbone between the upper molars and premolars and the lower eyes.

The maxillary sinuses are located above the posterior sectors at the level of the molars and premolars.

What are the difficulties:

  • The sinuses can be pneumatized (the volume of the cavity is too large) to the detriment of the jawbone in which the implants are housed.
  • The posterior alveolar ridge below the sinus on the molar and premolar teeth is highly resorbed both vertically and horizontally.

What are the solutions:

  • It will be possible to place between 8 and 10 implants in the maxilla with 2 short implants or mini implants, in the two posterior areas (right and left).

But only if the floor of the sinus is within a few millimeters (between 10 and 8 millimeters) of the usable bone surface of the alveolar ridge.

Below this minimum height, a strategic decision must be made: either to perform a vertical bone augmentation graft of the sinus lift type (sub-sinus graft), or to opt for an implantation only on the anterior part of the maxilla.

See below.

These proactive techniques make the MCI protocol a pioneer in the field of MCI implant placement in the maxilla

  • First clinical configuration in MCI where the vertical and horizontal bone resorption of the anterior AND posterior bone walls is not too important. Therefore, the bone volume is sufficient for implant placement without grafting.

In this case, the placement of implants in the posterior sectors is just as feasible as in the anterior sector. This is certainly the ideal option because it is the simplest!

In this configuration, it will be possible to place up to 8 to 10 implants on the entire dental arch, including the molar areas: This is the All on 8 or All on 10 technique.

All the information on the subject of MCI implants is here on our site:

https://www.jeromeweinman.com/implants-and-transplants/immediate-load-mci/

A resilient PMMA bridge in immediate loading will be screwed onto the implants a few days after the implant surgery (4 to 7 days).


We call this bridge screw-retained on implants: “Resilient implant-supported full arch bridge with immediate loading”:
RIFA Bridge with IL: Resilient implant-supported Full Arch Bridge with Immediate Loading.

The special feature of this implant-supported screw-retained RIFA bridge:

The CAD/CAM metal framework and its aesthetic acrylic glass cosmetic features two molar teeth at the posterior right and left ends are supported by implants.

The bridge has 10 to 12 teeth all supported by 8 to 10 posterior implants and WITHOUT cantilever extensions.

That is, this bridge includes the right and left first molars with two implant supports at the posterior ends of the bridge.

Fees for the MCI in this case :

To perform the extractions as well as the placement of the implants and the upper MCI appliance, the protocol is exactly the same on the top and bottom.

Therefore, the package is the same: EUR 24,800 (twenty-four thousand eight hundred euros/CHF) for all procedures and the resilient prosthesis in immediate loading.

This amount does not include the fees of the operating room or the anesthesiologist.

(See details below).

  • Variation of this first clinical configuration: the vertical and horizontal bone resorption of the anterior and posterior bone walls is not important enough to prevent the placement of implants, BUT it is important enough to imply bone grafts of the “sinus lift” type in order to place implants of sufficient size.

This clinical case is classic when there are important bone resorptions following extractions in the posterior molar and premolar sectors.

In this case, the bone volume required is sufficient to “hook” implants into the bone (primary fixation) BUT insufficient to place implants of the right size for the solid fixation of a full arch bridge in MCI.

The solution is to perform one or two sinus fillings (right and/or left sinus lift) at the same time as the posterior implant procedure.

The placed implants can be loaded immediately provided that they have sufficient primary fixation of 35 newtons of torque. If not, they will be put in foster care while waiting for the healing

Fees for the MCI in this variant of the first scenario:

To perform the extractions as well as the placement of the implants and the upper MCI appliance, the protocol is exactly the same on the top and bottom.

Therefore, the package is the same: EUR 24,800 (twenty-four thousand eight hundred euros/CHF) for all procedures and the resilient prosthesis in immediate loading.

It is necessary to add the fees for one or two sinus lifts (depending on the case) which are not included in the above operative package because they are separate procedures from the placement of implants with MCI :

This is a flat rate of 3,800 euros/CHF for each side.

This amount does not include the fees of the operating room or the anesthesiologist if any

(See details below).

  • Second clinical configuration in MCI: Intervention for the placement of an implant-supported bridge in MCI in cases where the two maxillary sinuses are too pneumatized and the sub-sinus molar and premolar alveolar bone is too resorbed for the placement of implants in this posterior area. BUT the resorption of the anterior bone wall is not too important. Therefore, the placement of implants in this anterior area is possible.

If the anterior area (incisors, canines, first and second premolars) is not too vertically resorbed, then 6 to 8 implants can be placed, usually up to the first or second premolars:

This is the All on 6 or All on 8 technique.

See the page on our website about our minimal invasive MCI protocol: the “All on 8” and “All on 6”:

https://www.jeromeweinman.com/implants-et-greffes/mise-charge-immediate-mci/

In this configuration, an immediate bridge will be screwed onto the implants a few days after the implant surgery (4 to 7 days).


We call this bridge screw-retained on implants: “Resilient implant-supported full arch bridge with immediate loading”:
RIFA Bridge with IL: Resilient implant-supported Full Arch Bridge with Immediate Loading.

The special feature of this implant-supported screw-retained RIFA bridge:

The CAD/CAM metal framework and its aesthetic acrylic glass cosmetic features two premolars or two molars at the posterior right and left ends are not supported by implants.

The bridge has 10 to 12 teeth supported by 6 to 8 posterior implants and WITH two extensions the premolars and/or cantilevered molars. That is, not supported by an implant.

That is, this bridge includes a double posterior extension to the right and left first molars at the most.

It has six teeth on the right and left.

Unlike the previous versions, these will be made in extension at the ends of the bridge WITHOUT implant support and therefore with a cantilever.

This overhang, if it does not exceed 12 mm, is not a problem.

On the other hand, the ability to chew is more reduced.

This protocol eliminates the need for bone grafts to fill the sinuses (sinus lift): it is the same MCI procedure as the molar-to-molar bridge, but without first performing a bone graft to fill the sinuses on the right and left.

In this configuration of the previous clinical case there are two possible choices for the patient

  • First variant: Either the patient decides that this option is suitable for him/her and waives any additional surgery on the posterior areas.

He decides to remain in an All on 6 or 8 situation with the first molars in extension at best.

  • Second variant: Or, on the contrary, he decides to do sinus lift type grafts that make possible the option of an All on 8 or 10 posterior supported bridge.

The placement of posterior implants is made possible. And so he can return to the first situation with an All in 8 or 10 bridge and the molar sectors supported posteriorly by implants.

There are several factors that indicate making an extended and strong posterior support:

MAJOR INDICATION: The most important indication is that the anterior bridge is totally insufficient to allow a good mastication and a smile because it stops at the canines or at most at the first premolars.

SECONDARY INDICATIONS: The other indications are to be considered when the bridge has a support up to the premolars with possibly an extension that does not exceed the first molars.

The patient considers in agreement with the practitioner:

  • his young age;
  • and/or its strong size;
  • and/or his demand for chewing comfort;
  • and/or fragility of the temporomandibular joints

In order to overcome this difficulty, bone grafts in the sinus (called sinus lift) are performed before or after the MCI procedure in order to implant in the posterior sectors.

First variant of sinus lift indication:

If the case allows it, it is preferable to perform bone grafts by sinus lift BEFORE the placement of the implants, keeping the residual anterior teeth for the healing time.

Once the sinus lift has healed, after 4 months, the remaining anterior teeth are extracted and all implants are placed at the same time to make an All in 10.

Second variant of sinus lift indication:

If the anterior teeth no longer fit because they are

  • Too decayed by decay;
  • Or broken crowns;
  • Or in cases of end-stage periodontal disease,

It is therefore preferable to extract all residual teeth and implant the anterior sector as a matter of urgency and place a first bridge in MCI in order to resocialize the patient within a week.

At the latest after the MCI bridge is placed, the sinus lift will be performed.

Four months of bone healing later, two to three posterior implants will be placed to reconstruct the ends of the dental arch.

In this case, it is customary for the latter implants to be loaded at the time of final bridge placement with a ceramic cosmetic, at the same time as all other implants.

All the information on this subject of sinus lift is here :

https://www.jeromeweinman.com/greffes-osseuses/sinus-lift-comblement/

If the vertical and horizontal bone resorption of the anterior AND posterior bone walls is not too great, or is compensated for by bone grafts, then the bone volume is sufficient for implant placement.

In this case, the placement of implants in the posterior sectors is just as feasible as in the anterior sector.

In this configuration, it will be possible to make a molar-to-molar screw-retained implant-supported bridge with 6 to 8 implants.

This is the All on 6 or All on 8 technique: All the information on the subject of implant placement in MCI is here:

https://www.jeromeweinman.com/implants-et-greffes/mise-charge-immediate-mci/

This is certainly the ideal option because it is the simplest!


We call this

bridge screwed onto the implants

The “Resilient Implant-supported Full Arch Bridge with Immediate Loading”:
RIFA Bridge with IL: Resilient Implant-support Full Arch Bridge with Immediate Loading.

It is said to be ” resilient” because its skeletal structure (frame or central beam) is designed and manufactured with the help of the computer (3D laser printer for metal) in a sufficiently ductile alloy (titanium or chrome cobalt) to absorb shocks and sufficiently rigid without breaking so that once screwed onto the implants, it guarantees their immobility with a tolerance of less than 200 microns , in order to avoid micromovements that are fatal to osseointegration (healing of the bone on the implants).

All our information on this subject of implants is here :

https://www.jeromeweinman.com/implants-et-greffes/implants-dentaires-definition/

In addition, its plastic cosmetics are also very resilient thanks to the aesthetic qualities of the PMAA family of acrylic glass materials, which are also produced with CAD/CAM.

PMMA provides resilience to the whole, absorbing energy from chewing shocks to protect the healing implants.

  • This resilient bridge screwed onto the implants solves the dilemma of an immediate loading that is both very rigid and “soft”.
  • This resilient bridge protects the implants from micromovements of more than 200 microns and from shocks that cause disosteointegration and healing failure.
  • At the same time, this resilient bridge ensures a very nice aesthetic thanks to the aesthetic qualities of the acrylic glass material.
  • The resilient bridge will be screwed in 4 to 7 days postoperatively: this is the time for the prosthetic laboratory to make a custom-made semi-final bridge.
  • This resilient bridge will be left in place for a minimum of 6 to 12 months for healing and maturation of the hard tissue (maxillary alveolar bone) and also soft tissue (gingiva and oral mucosa).
  • This resilient bridge is different from a traditional “temporary” or “transitional” resin bridge. Its skeletal structure is manufactured in exactly the same way as a permanent ceramic bridge. This is not the case with the skeletal structures of traditional “temporary bridges” made of resin or even reinforced with a metal arch (welded intraoperatively) that are imprecise and not passive.
  • This resilient bridge is different from a “provisional” or “transitional” bridge made prior to implant placement following surgical planning on an implant simulation software such as “All on 4” or “All on 6“. Indeed, the impression made extemporaneously during the procedure allows us to make an exact replica of the dental arch and the smile ideally imagined once the procedure is done. Our protocol has much more scope for adaptation and flexibility intra- and postoperatively than a protocol with a fixed preoperative planning and/or implant navigation technique that cannot be modified during the procedure.

For your information, here are the techniques for preoperative planning and/or implant navigation.

You can view Dr. Jerome Weinman’s films of planned implant surgeries assisted by digital surgical navigation with the ROBODENT system on UTube here:

https://www.jeromeweinman.com/videos/#29

By deciding to do this rehabilitation of your mouth and your smile, you have started a new slice of life.

This intervention is important from all points of view.

We are all aware that it will determine a “before” and an “after”.

The burden is multiple, both physical, emotional and financial.

Thanks to our MCI protocol, we are able to both compact the treatments to give you back your smile in an extremely short period of time, and to make sure that they last.

We give you time to choose to optimize your smile with techniques that are even more sophisticated in terms of aesthetics and function:

  • First option: Keep this implant-supported resilient bridge with its beautiful acrylic glass material cosmetic for many years to come. It can be eventually renovated, if needed.

In general, this bridge is kept as it is for economic reasons.

  • Second option: Opt for a replacement of this implant-supported resilient bridge by its copy in ceramic cosmetics, even more aesthetic, even more biocompatible and even more durable over time.

Maturation of the soft and hard tissues around the first resilient bridge is completed in about ten months.

This is why the second ceramic implant-supported bridge allows for the correction of possible bone resorption due to the maturation of the soft and hard tissues for an even more refined AESTHETICS and MASTICATION.

After this period of 6 to 12 months, the implants are osseointegrated.

Therefore, they can absorb the energy of hard shocks, generated by biting and chewing on ceramic which is a non-resilient and non-ductile material.

The implants are osseointegrated, so it is no longer necessary to load the implants with a “resilient” screw-retained bridge.

At this stage of the loading protocol, it is possible to replace the resilient screw-retained bridge with another ceramic screw-retained bridge that is much more sophisticated and demanding in terms of bite and esthetics.

Cosmetic ceramic material cannot be loaded onto implants in the first instance because it is far too hard and traumatic for newly placed implants.

It risks disosteointegration of the implants.

This second implant-supported and screw-retained ceramic bridge is fabricated with the same type of CAD/CAM metal framework. But, it has a stratified ceramic cosmetic that is even more aesthetic and more cutting and grinding for a better chewing.


We call this bridge screw-retained on the implants: The “Ceramic Implant-supported Full Arch Bridge in Immediate Loading”:
CIFA Bridge in IL: Ceramic implant-supported Full Arch Bridge in Immediate Loading

Laminated ceramics allow a perfect mimicry of the aesthetics of the smile, because its visual qualities are even closer to those of the teeth than acrylic glass material.

In addition, the hardness of the ceramic allows for a much more efficient bite and chewing, especially for fibrous foods such as meat.

All the information on this subject of implant-supported bridges in MCI is here:

https://www.jeromeweinman.com/implants-et-greffes/remplacer-toutes-ses-dents/

MCI Surgical Team Fees:

Our MCI operative package includes all the fees of the specific MCI team that will perform the necessary procedures for the MCI implant surgery.

The MCI package includes the collegiate fees corresponding to the different procedures performed:

  • All consultations and preparations necessary for the placement of a screw-retained prosthesis in immediate loading as defined above;
  • The execution of the surgical procedure itself: the surgical intervention including dental extractions with extemporaneous implant placement and bone grafts enriched with aPRF and iPRF ;
  • Fees for specialized ICM operating assistants;
  • Costs related to bone grafts: bone biomaterials, bone bank
  • Expenses related to international brand dental implants;
  • The team of nurses specializing in phlebotomies required for the manufacture of aPRF and iPRF ;
  • The cost of manufacturing the screwed bridge in MCI by the specialized laboratory;
  • And of course, the installation a few days later in the office of this first intention screw-retained resilient bridge, with the latest generation of CAD/CAM metal frameworks and its beautiful PMMA acrylic glass cosmetic.

The amount of the MCI package is a fixed price of 24,800 EUR/CHF (twenty-four thousand eight hundred euros or Swiss Francs)

Anesthesiologist’s fees:

The MCI fee package does not include fees for performing intravenous (IV) sedation or general anesthesia.

  • Fees of the anesthesiologist at the Geneva clinic:

Fees forgeneral anaesthesia in a surgical clinic in Geneva: the MCI anaesthesia package is between 1,500 euros/CHF and 2,500 euros/CHF depending on the volume of the implant procedure.

  • Fees of the anaesthetist in Paris or Geneva:

Fees for semi-unconscious intravenous sedation performed by an in-office anesthesiologist: the MCI anesthetic package is 550 euros/CHF for a single session.

And

An MCI package is between 1500 euros and 3000 euros/CHF for a half day of surgery under medicated hypnosis in the office.

NB: An estimate and consent is systematically provided by the anesthesiologist.


The fees of the surgical clinic in Geneva
:

The MCI package does not include operating room fees if general anesthesia is required.

In some cases, for reasons of general state of health or age (classification of patients ASA1 or ASA2) or complexity of the procedure, it is necessary to perform the first surgery in the operating room, in a surgical clinic, under general anesthesia, either as an outpatient or with an overnight stay in the hospital for comfort and safety.

This option is not systematic: In certain simple cases, the surgical intervention of installation of the implants can be carried out at the dental office under vigorous IV sedation thanks to the presence of a resuscitating anesthetist.

However, it is necessary to verify that the planned intervention is not too complex, that the patient’s health condition allows it and/or that his desire for comfort is not too demanding.

If the operation is performed under general anesthesia in a surgical clinic in an operating room in Geneva:

The MCI package for hospitalization at the GENEVA Surgical Clinic for an operation in the operating room under general anesthesia is between 1,500 and 3,900 EUR.

It includes:

  • Outpatient operating room fees. The outpatient day means you go in in the morning and come out at the end of the day.
  • However, if you wish to spend a night in a medical room for reasons of convenience or safety, the clinic will charge you a “night package” which generally does not exceed 600 euros/CHF.

NB: An estimate is systematically provided by the clinic.


Fees for the second version of the implant-supported ceramic screw-retained bridge
The MCI fee does not include the fee for a second version of the implant-supported CAD/CAM bridge with a more sophisticated ceramic cosmetic.

This screw-retained bridge completes the MCI protocol in the second intention, starting at least six months after surgery.

It has a state-of-the-art CAD/CAM metal framework and a more sophisticated and advanced ceramic cosmetic.

It will come according to your desires and your project of Smile Design (aesthetics of smile and facial expression) complete the first version of the MCI, when the alveolar bone and gingiva attached peripheral to the implants have healed around the first version of the bridge, at about 6 to 12 months postoperatively.

The fees for a screw-retained bridge version with a state-of-the-art CAD/CAM metal framework and a layered ceramic cosmetic, ideally made according to your wishes, range from 10,900 euros/CHF (ten thousand nine hundred euros/CHF) to 14,900 euros/CHF depending on the clinical case.


Fees for the practice of specific bone grafts
:

The MCI package does not include fees for those separate and/or prerequisite MCI procedures such as specific pre-, per- or postoperative bone grafts required or sinus lifts:

For sinus lift:

This is a flat rate of 3,800 Euros/CHF for each sinus lift.

NB: In case of abandonment of the MCI protocol by you, these fees are not refundable.

Specific bone grafts:

They can have different packages to be determined on a case by case basis.


Fees for the practice of dental care and/or removal of pre-existing dentures
:

The MCI package does not include fees for any dental care and/or removal of pre-existing dentures that may be necessary and/or the pre-requisite for implant surgery.

This preparation and/or the installation of the temporaries, can be compacted, under IV sedation, at the office, with our anesthetists for reasons:

– reduction of the time-consuming techniques required;

– of safety, taking into account the fragility of your age and/or the need to compact quite painful care or the presence of stomatophobia.

In some cases, these sessions can be included in the package if they are very light. If not, they are subject to a specific treatment plan.

On the other hand, the anesthesiologist’s fees for IV sedation are always additional.

The problem of posterior bone resorption and the indication of additional bone grafts such as sinus lift

We recommend an MCI All on 6 or All on 8 bridge in the anterior region, similar to the screw-retained implant-supported bridge described in the second scenario above.

This solution allows the patient to be resocialized immediately, in less than a week:

In fact, the patient often loses his or her teeth and/or the anterior prosthesis supported by loose and/or infected teeth.

It is therefore urgent to replace the anterior teeth for aesthetic reasons and to avoid social isolation in addition to chewing and eating problems.

The MCI bridge is set and we leave it at that!

Except for the possibility of replacing it with a bridge with a ceramic cosmetic.

Fees for ICM WITHOUT sinus lift:

To perform the extractions as well as the placement of the implants and the upper MCI appliance the protocol is exactly the same as before.

The fee is : EUR 24,800 (twenty-four thousand eight hundred euros/CHF) for all procedures and the resilient implant-supported prosthesis in immediate loading.

This amount does not include the operating room and the anesthetist.

This variant waives the fees for the preliminary sinus lift as well as those of the anaesthetist and any operating room fees for these procedures.

In this case, the patient decides to have a more extensive MCI bridge in the posterior.

We recommend an MCI All on 6 or All on 8 bridge in the anterior region, of the same type as the screw-retained implant-supported bridge described in the second case above.

This solution allows the patient to be resocialized immediately, in less than a week:

In fact, the patient often loses his or her teeth and/or the anterior prosthesis supported by loose and/or infected teeth.

It is therefore urgent to replace the anterior teeth for aesthetic reasons and to avoid social isolation in addition to chewing and eating problems.

The strategy is as follows: after this first screw-retained MCI bridge on implants is placed and during the osseointegration period of the implants between 4 and 6 months, then we can perform sub-sinus bone grafts (sinus lift).

The goal is to wait quietly for the healing of the sinus lift. Then add posterior implants. And then, 4 months later, place a more extensive implant-supported bridge posteriorly as in the first case of All on 10

In this case, when the implants are loaded, the implant-supported bridge with a ceramic cosmetic described above can be used directly.

If you need to perform a sinus lift: you must give your informed consent, i.e. authorization to perform this procedure, the relevance of which you have assessed.

The sinus lift concerns the replacement of the left and right posterior lateral sectors: i.e. the 2 premolars and 2 molars on the right and the 2 premolars and 2 molars on the left.

The fees for a possible sinus lift are not included in the MCI operative package because it is a separate and/or prerequisite procedure to the MCI implant placement.

It is a fixed price of 3,800 euros/CHF for the procedure and all the corollary consultations for each side (not reimbursable in case of abandonment of the protocol by you during the procedure).

  • We can perform sinus lift procedures in the dental office, which is equipped to meet safety and asepsis requirements.
  • It will be necessary to repeat the sinus lift procedure for both sides if the resorption is bilateral.
  • It is possible but delicate to do both sides at the same time, especially for an elderly person. This should be discussed with the anesthesiologist. But in the end, it is the course of the clinical case during the operation that validates the choice.

Fees for MCI WITH SINUS LIFT:

To perform the extractions as well as the placement of the implants and the upper MCI appliance, the protocol is exactly the same on the top and bottom.

Therefore, the package is the same: EUR 24,800 (twenty-four thousand eight hundred euros/CHF) for all procedures and the resilient prosthesis in immediate loading.

This amount does not include the operating room and the anesthetist. See details below.

However, the fees for a possible sinus lift are not included in the above operative package either, since these are separate procedures that are required for the placement of implants with MCI.

This is a flat rate of 3,800 euros/CHF for each side.

These fees are non-refundable once the procedure has been performed if you abandon the protocol during the procedure.

This case is the most complex because it is a priori impossible to place implants in MCI!

Bone grafts must be performed before the implants are placed. In particular, sinus lifts, and sometimes not only, to remove implant impossibilities.

Depending on the results of the grafts, we return to the situations of the first two cases.

In this case, a list of necessary interventions will be given to you with a corresponding estimate.

In this clinical situation, the question of the indication of zygomatic implants arises.

See here the explanations of this protocol:

https://www.jeromeweinman.com/les-implants-zygomatiques/

For your information, you have two films that I have made that allow you to understand these interventions in this case:

https://www.jeromeweinman.com/implants-et-greffes/mise-charge-immediate-mci/#video

Surgical solutions performed to overcome the specific difficulties of the upper jaw anatomy at the time of implant placement

These proactive techniques make our protocol a forerunner in the field of MCI implant placement.

  1. 1. Allogeneic and/or xenogeneic appositional bone grafts associated with PRF, on the whole circumference of the implanted arch, will be systematically made, at the time of the installation of the implants, to compensate for the inevitable physiological post-extraction bone resorption and the possible bone gaps.

All our information on this subject of bone grafts and MCI is here :

https://www.jeromeweinman.com/greffes-osseuses/greffes-osseuses-preimplantaire-comblement-sinus-implant-dentaire-paris/

And our information on this FRP topic is here FRP :

https://www.jeromeweinman.com/medecine-regenerative-rejuvenative/utilisation-clinique-prf/

  1. A resilient bridge for immediate loading will be screwed onto the implants a few days after the implant surgery (4 to 7 days).

We call this bridge screw-retained on the implants: The ” resilient bridge for immediate loading of implants”:

RIFA Bridge with IL: Resilient implant-supported Full Arch Bridge with Immediate Loading.

It is said to be ” resilient” because its skeletal structure (frame or central beam) is designed and manufactured with the help of the computer (3D laser printer for metal) in a sufficiently ductile alloy (titanium or chrome cobalt) to absorb shocks and sufficiently rigid without breaking so that once screwed onto the implants, it guarantees their immobility with a tolerance of less than 200 microns , in order to avoid micromovements that are fatal to osseointegration (healing of the bone on the implants).

All our information on this subject of implants is here :

https://www.jeromeweinman.com/implants-et-greffes/implants-dentaires-definition/

In addition, its plastic cosmetics are also resilient thanks to the aesthetic qualities of the PMAA family of acrylic glass materials, which are also produced with CAD/CAM.

It ensures resilience to the whole, by absorbing the energy of the shocks of the mastication.

  • This resilient bridge screwed onto the implants provides both a very rigid and “soft” immediate loading.
  • This resilient bridge protects the implants from micromovements of more than 200 microns and from shocks that cause disosteointegration and healing failure.
  • At the same time, this resilient bridge ensures a very nice aesthetic thanks to the aesthetic qualities of the acrylic glass material.
  • The resilient bridge will be screwed in 4 to 7 days postoperatively (this is the time it takes for the prosthetic laboratory to create a custom-made bridge).
  • This resilient bridge will be left in place for 6 to 12 months for healing and maturation of the hard tissue (maxillary alveolar bone) and soft tissue (gingiva and oral mucosa).
  • This resilient bridge is different from a traditional “temporary” or “transitional” resin bridge. Its skeletal structure is manufactured in exactly the same way as a permanent ceramic bridge. This is not the case with the resin or even metallic skeletal structures of traditional temporaries.
  • This resilient bridge is different from a “provisional” or “transitional” bridge made before the placement of the implants following surgical planning on an implant simulation software. The extemporaneous impression taken during the procedure allows the fabrication of an exact replica of the dental arch and the ideal smile with much more latitude and operative flexibility than with a planning or implant navigation technique.

For your information, here are the techniques for preoperative planning and/or implant navigation.

You can watch Dr. Jerome Weinman’s films of planned implant surgeries assisted by digital surgical navigation with the ROBODENT system on our UTube channel here:

https://www.jeromeweinman.com/videos/#29

At the end of this healing period of the "implant-supported resilient bridge" you will have the choice between two options according to your aesthetic requirements


First option:
Keep this implant-supported resilient bridge with its beautiful acrylic glass material cosmetics for many more years. It can be eventually renovated, if needed.

In general, this bridge is kept as it is for economic reasons.


Second option:
Opt for a replacement of this implant-supported resilient bridge by its copy in ceramic cosmetics, even more aesthetic, even more biocompatible and even more durable over time.

Maturation of the soft and hard tissues around the first resilient bridge takes place after about ten months.

This is why the second ceramic implant-supported bridge allows for the correction of possible bone resorption due to the maturation of the soft and hard tissues for an even more refined AESTHETICS and MASTICATION.

After this period of 6 to 12 months, the implants are osseointegrated.

Therefore, they can absorb the energy of the hard shocks generated by biting and chewing on the ceramic which is a non-resilient and non-ductile material.

The implants are already osseointegrated. Therefore, it is no longer necessary to load the implants with a so-called “resilient” screw-retained bridge.

At this stage of the loading protocol, it is possible to replace the resilient screw-retained bridge with another ceramic screw-retained bridge that is much more sophisticated and demanding in terms of bite and esthetics.

Cosmetic ceramic material cannot be loaded onto implants in the first instance because it is far too hard and traumatic for newly placed implants.

It risks disosteointegration of the implants.

This second implant-supported and screw-retained ceramic bridge is made with the same type of metal framework. But, it has an even more aesthetically pleasing laminated ceramic cosmetic:

CIFA Bridge in IL: Ceramic implant-supported Full Arch Bridge in Immediate Loading.

Laminated ceramics allow a perfect mimicry of the aesthetics of the smile, because its visual qualities are even closer to those of the teeth than acrylic glass material.

In addition, the hardness of the ceramic allows for a much more efficient bite and chewing, especially for meat.

All the information on this subject of implant-supported bridges in MCI is here:

https://www.jeromeweinman.com/implants-et-greffes/remplacer-toutes-ses-dents/

Fees: with my entire MCI team, we operate on a flat fee basis:


MCI surgical team fees
:

Our MCI operative package includes all the fees of the MCI team that will perform the necessary procedures for the MCI implant surgery.

The MCI package includes the collegiate fees corresponding to the different procedures performed:

  • All consultations and preparations necessary for the placement of a screw-retained prosthesis in immediate loading as defined above;
  • The execution of the surgical procedure itself: the surgical intervention including dental extractions with extemporaneous implant placement and bone grafts enriched with aPRF and iPRF ;
  • Fees for specialized ICM operating assistants;
  • Costs related to bone grafts: bone biomaterials, bone bank
  • Expenses related to international brand dental implants;
  • The team of nurses specializing in phlebotomies required for the manufacture of aPRF and iPRF ;
  • The cost of manufacturing the screwed bridge in MCI by the specialized laboratory;
  • And of course, the installation a few days later in the office of this first intention screw-retained resilient bridge, with the latest generation of CAD/CAM metal frameworks and its beautiful PMMA acrylic glass cosmetic.

The amount of the MCI package is a fixed price of 24,800 EUR/CHF (twenty-four thousand eight hundred euros or Swiss Francs)

Anesthesiologist’s fees:

The MCI fee package does not include the fee for performing intravenous (IV) sedation.

Fees of the anesthesiologist at the Geneva clinic:

Fees forgeneral anaesthesia in a surgical clinic in Geneva: the MCI anaesthesia package is between 1,500 euros/CHF and 2,500 euros/CHF depending on the volume of the implant procedure.

Fees of the anaesthetist in Paris or Geneva:

Fees for semi-unconscious intravenous sedation performed by an in-office anesthesiologist: the MCI anesthetic package is 550 euros/CHF for a single session.

And

An MCI package is between 1500 and 3000 euros/CHF for a half day of surgery under medicated hypnosis in the office.

NB: An estimate and consent is systematically provided by the anesthesiologist.


The fees of the surgical clinic in Geneva
:

The MCI package does not include operating room fees if general anesthesia is required.

In some cases, for reasons of general state of health or age (classification of patients ASA1 or ASA2) or complexity of the procedure, it is necessary to perform the first surgery in the operating room, in a surgical clinic, under general anesthesia, either as an outpatient or with an overnight stay in the hospital for comfort and safety.

This option is not systematic: In certain simple cases, the surgical intervention of the implants can be carried out in the dental office under vigorous IV sedation thanks to the presence of a resuscitating anesthetist.

However, it is necessary to verify that the planned intervention is not too complex, that the patient’s health condition allows it and/or that his desire for comfort is not too demanding.

If the operation is performed under general anesthesia in a surgical clinic in an operating room in Geneva.

The MCI package for hospitalization at the GENEVA Surgical Clinic for an operation in the operating room under general anesthesia is between 1,500 and 3,900 EUR.

It includes:

  • Outpatient operating room fees. The outpatient day means you go in in the morning and come out at the end of the day.
  • However, if you wish to spend a night in a medical room for reasons of convenience or safety, the clinic will charge you a “night package” which generally does not exceed 600 euros/CHF.

NB: An estimate is systematically provided by the clinic.


Fees for the second version of the implant-supported ceramic screw-retained bridge
The MCI fee does not include the fee for a second version of the implant-supported CAD/CAM bridge with a more sophisticated ceramic cosmetic.

This screw-retained bridge completes the MCI protocol in the second intention, starting at least six months after surgery.

It has a state-of-the-art CAD/CAM metal framework and a more sophisticated and advanced ceramic cosmetic.

It will come according to your desires and your project of Smile Design (aesthetics of smile and facial expression) complete the first version of the MCI, when the alveolar bone and gingiva attached peripheral to the implants have healed around the first version of the bridge, at about 6 to 12 months postoperatively.

The fees for a screw-retained bridge version with a state-of-the-art CAD/CAM metal framework and a layered ceramic cosmetic, ideally made according to your wishes, range from 10,900 Euros/CHF (ten thousand nine hundred Euros or Swiss Francs) to 14,900 Euros/CHF depending on the clinical case


Fees for the practice of specific bone grafts
:

The MCI package does not include fees for those separate and/or prerequisite MCI procedures such as specific pre-, per- or postoperative bone grafts required or sinus lifts.

For sinus lift:

This is a flat rate of 3,800 Euros/CHF for each sinus lift.

NB: In case of abandonment of the MCI protocol by you, these fees are not refundable.

Specific bone grafts:

They can have different packages to be determined on a case by case basis.


Fees for the practice of dental care and/or removal of pre-existing dentures
:

The MCI package does not include fees for any dental care and/or removal of pre-existing dentures that may be necessary and/or the pre-requisite for implant surgery.

This preparation and/or the installation of the temporaries, can be compacted, under IV sedation, at the office, with our anesthetists for reasons:

– reduction of the time-consuming techniques required;

– of safety, taking into account the fragility of your age and/or the need to compact quite painful care or the presence of stomatophobia.

In some cases, these sessions can be included in the package if they are very light. If not, they are subject to a specific treatment plan.

On the other hand, the anesthesiologist’s fees for IV sedation are always additional.

YOUR CLINICAL CASE IN BRIEF

It includes the following elements:

A full arch in MCI with two sinus lifts on the left and right maxilla.

A complete arch in MCI in the mandible or lower jaw.

1 – MCI fees cover surgery including: extractions with immediate implantation and PRF-enriched bone grafts. A few days later, under light IV sedation, the first intention screw-retained resilient bridge was placed in the office, with the latest generation of CAD/CAM metal frameworks and its beautiful PMMA acrylic glass cosmetic material.

The amount is EUR 24,800 (twenty-four thousand eight hundred euros/CHF)

2 – Fees for both sinus lifts intraoperatively

The amount is 3,800 euros/CHF for each sinus lift = 7,600 euros/CHF

Subtotal surgery = 32,400 euros/CHF

3 – Anesthesiologist’s fees for a half day of surgery under medicated hypnosis (narco hypnosis) or general anesthesia in the operating room.

The amount is a flat rate of 2,500 euros/CHF

4 – The fees of the surgical clinic in an operating room in Geneva: The MCI hospitalization package of the surgical clinic of GENEVA for an operation in the operating room under general anesthesia is between 1,500 and 3,900 EUR/CHF.

THE PLACEMENT OF YOUR MCI IMPLANTS WENT WELL:
HERE ARE OUR POSTOPERATIVE INSTRUCTIONS

Here are the strict postoperative instructions and our advice for the maintenance of your prostheses.

IF we have reached this point in your treatment plan, it means that we have successfully placed your implants and bridge. So we worked well.

It’s your turn to take care of our work.

The first thing:

You can eat anything you want as long as this strictly soft food can be swallowed without chewing and without pressure on the teeth and especially without pressure on the gums!!!

To know what you can eat, it’s very simple, do this test: anything you can’t crush between your thumb and index finger, you must not eat!

Instructions for 6 months after surgery

The second thing:

This feed should not contain residue or granules or fibers that can wrap around the sutures and not emerge and become trapped around the sutures or sink between the lips of wounds that are not yet sealed.

Instructions for 1 month post-op

The threads will spontaneously resorb after one month 🚩🚩

So avoid all thick soups, creams, yoghurts, mincemeat, purees, salads and all forms of pips.

Eat solid or liquid food, but eat small foods that can be swallowed whole like

– rice

– shells

– boiled eggs

– boneless fish

– minced meat.

Hydrate well 🚰🚰

Take vitamins in particular

Vit D 10.000 IU/d

And vit C 2 grams/d.

Take lots of food substitutes that you can find at the pharmacy: omega 3 trace elements and proteins.

Make sure to use Hextril and Alodont mouthwashes alternately 5 to 6 times a day.

You can wipe very delicately and with the most extreme softness and prudence the wounds which would be embarrassed of food debris with a well soaked compress of mouthwash or a disc of cotton type make-up well soaked with mouthwash.

The wounds must be absolutely clean.

You should check your bathroom with a magnifying mirror and very good lighting.

Same protocol as above. 🦷🏁

But you can also apply a little essential oil of Clove:

Puressentiel – Clove Tree Essential Oil – Organic – 100% pure and natural – EOBBD – 5 ml

= 2 drops in a glass of water to make a mouthwash.

You must do a VERY GENTLE brushing with a very soft post surgical toothbrush sold in pharmacies after each meal.

WITH MOVEMENTS ONLY IN THE DIRECTION OF THE TEETH AND ONLY FROM THE GUM TO THE TEETH.

Once the prosthesis is in place and the wires are almost gone, you should start brushing your teeth more effectively. 🦷🏁

At this point, a postoperative check-up at the office is necessary. 🚩🚩

You must have an electric brush of a model sophisticated enough to contain a power variator and also a Water Pik also a model equipped with a power variator.

Some models do both at the same time 🚿🚿🎅🎅

Buy a plaque remover at the pharmacy and put 2 drops on your tongue and rub it over your teeth.

Then rinse once or twice.

What remains stained on your teeth are colonies of bacteria called bacterial plaque. This is the enemy that has destroyed your teeth! Don’t let these nasty beasts ruin our efforts! 🦇

Some toothpastes like ELGYDIUM ENFANT are both a toothpaste and a bacterial plaque remover.

🦷🦷🎅🎅🎅

Remove anything that is colored. That is to say, the bacteria but with surgical precision and extreme delicacy.

It is out of the question to put the toothbrush in your mouth and scrub like a sick person with your mouth closed while watching TV or listening to the radio or doing your emails!

This should be done at least 3 times a day: in the morning and evening and if possible at noon.

This is the sinequanone condition for the sustainability of our work.

Once you have done these operations it is not over:

You have to take the Waterpik and fill it halfway with water and then halfway with a mouthwash.

Change your mouthwash regularly by alternating :

Betadine

Eludril

Alodont.

You put the variator on a power that will be very low at the beginning of the healing and more important when the gums will be healed a few weeks later and you water to rinse the brushing that has just been done.

While being sure to pass the water jet lightly between the teeth at the gums.

The idea is to create a flushing effect that takes away the bacteria that you have removed with the toothbrush.

The jet does not remove the bacteria or you use such a strong power that it is iatrogenic and will remove everything.

It is a rinse of the brushing.

The old ones are loaded with bacteria.

You must have several new toothbrushes that you sanitize in turn in a mouthwash or in diluted bleach or diluted hydrogen peroxide to avoid re-contaminating yourself.

It’s simple it is strictly forbidden to smoke 🎺

In case you are tempted by a cigarette or a firecracker, it is impossible to succumb because it would be an immediate breach of the contract of care that unites us.

My anesthesiologists are able to provide a hypnosis and intravenous sedation treatment that has exceptional results for smoking patients who really want to quit.

We are at your disposal for more information

HOW TO CONTINUE YOUR DECISION-MAKING PROCESS AND START YOUR TREATMENT?

This costed treatment plan is an estimate of the dental project we have discussed.

He explains the different options that we have chosen following our conversations.

It requires your consent and acceptance of the conditions.

I refer you to the beginning of this document for the general conditions.

If necessary, let me know your questions in writing or during an appointment on Doctolib so that I can answer you precisely.

When your decision is made and all clarifications are given, you will be asked to give your final informed consent.

CASE 1 - We have already met in the dental office for a clinical consultation

If your acceptance is immediate and without restraint, then you just have to answer this mail by specifying that you have

“You have read, accepted and understood all the treatments and clauses and that you accept them.

A validation appointment on Doctolib will be scheduled and/or a signature appointment in person at the office.

Treatment appointments will follow at your convenience.

CASE 2 - We have not yet met in the dental office for a clinical consultation

Then you just have to reply to this email and specify that you have

You may also be informed that you have “read, accepted and understood all the treatments and clauses” or, on the contrary, that “you have questions and need further clarification”.

CASE 3 - We have not yet met in the dental office for a clinical consultation

AND you reply to this email stating that you did not “understand the treatments and clauses” and that “you have questions and need further clarification”.

And/or, you wish to make adjustments or study other treatment variants or any other reasons.

In this case, you must:

  • Please specify here your questions, by return of mail in writing.
  • Quickly set up an appointment at the office for a face-to-face consultation in order to validate, complete or modify the treatment plan according to our level of diagnosis and refinement of the treatment plan.

After clarification and validation of all the obscure points, we will return to the situation N°1 above.

TIME LIMIT Legal retraction

It is important to note that you have a legal cooling-off period of 15 days from the moment you let us know that you accept the costed treatment plan included in this email.

If you accept this proposed treatment plan and if it is carried out, an invoice will be issued with the CCAM codes if they exist for the procedures listed in the nomenclature.

Your decision to be treated at Dr. Weinman’s office should not be conditional upon reimbursement by your insurance.

We disclaim all liability of any kind if your insurance does not cover all or part of our fees.

We remind you that these almost systematically exceed the basic rates of the social security, most of them are “out of nomenclature”, or “not reimbursable” or very little reimbursed.


If you accept this contract of care you must copy the following sentence
I have read, accepted and understood all the treatments and clauses.

You must initial each page before the page number.

You must sign and date here:

With our ever devoted feelings.

Doctor Jérôme Weinman DDS and his team.