Implant Solutions
in Petaling Jaya

After a tooth is lost, the bone that held it shrinks, quickly in the first year and slowly afterwards. Gum disease and infection also destroy bone. When the CBCT scan shows there is not enough bone to hold an implant securely, we rebuild it first.

The graft material we use is EthOss, a fully synthetic beta tricalcium phosphate and calcium sulphate material. It contains nothing of animal or human origin, which matters to some patients for religious or personal reasons and is worth knowing before you ask. Dr. Koh is a Key Opinion Leader for EthOss in Malaysia and lectures on its use, which we state here rather than leave for you to find out. Grafting adds one healing phase to the timeline, so a case that needs a separate graft typically runs nine to twelve months from start to finish, or longer when a separate sinus lift is needed.

• Socket preservation: bone graft material is placed into the socket at the time of extraction so the ridge keeps its shape for a future implant. Healing takes about four to six months depending on the graft material.
• Ridge augmentation: a graft, sometimes with a membrane, widens or raises a ridge that has already shrunk. It may be done before the implant (healing four to nine months) or together with placement in smaller defects.
• Sinus lift: in the upper back jaw the sinus sits close to the roots. A sinus lift raises the sinus lining and places graft material beneath it. A small lift can be done through the implant site during placement. A larger lift is usually a separate procedure that heals for about six to nine months before the implant.

Two implants can support a bridge of three or four teeth without touching the neighbouring natural teeth. For a whole arch, four to six implants can carry a fixed bridge (often called All-on-4 or All-on-6), or two to four implants can hold a removable overdenture that clips on and off for cleaning.

Fixed full-arch bridges are usually fitted with a provisional bridge within days of surgery, when the implants are firm enough at surgery, and replaced with the final bridge after healing. Overdentures are the more economical option and are more stable than a conventional denture, at the cost of being removable. Which is appropriate depends on bone, budget, how easily you can clean, and what you want from the result.

Some conditions do not rule implants out but change the planning. Smoking slows healing and raises the risk of early implant failure and later bone loss around the implant, so we discuss stopping or pausing before and after surgery. Diabetes that is well controlled is compatible with implant treatment, while poorly controlled blood sugar affects healing, so we may ask for a recent HbA1c result and coordinate with your doctor. Osteoporosis medication (bisphosphonates and similar drugs), previous radiotherapy to the jaws, immune conditions and blood thinners need a medical review before surgery. Teeth grinding puts extra load on implants and usually calls for a night guard once the crown is fitted.

The only way to know whether an implant is right for you is a clinical examination and a 3D CBCT scan, which we take in the clinic.

We place four implant systems: Straumann from Switzerland, Anthogyr from France, and Osstem and MegaGen from South Korea. Anthogyr is part of the Straumann Group. All four are established systems with published clinical records and a supply of components in Malaysia, so an implant can be maintained or restored years later rather than becoming unserviceable when a part is discontinued.

They sit in two groups, and that is a large part of why a single implant with a crown spans a range rather than carrying one figure. Which group suits your case is a clinical decision made from the CBCT scan and the site, not a menu choice, and we will tell you which we are proposing and why before you agree to anything.

Dr. Koh is a Key Opinion Leader for Anthogyr and lectures at meetings sponsored by Straumann and Anthogyr. That is a commercial relationship and we state it here rather than leave you to find out. It does not change how a case is planned, and the system chosen for yours is named in your written treatment plan together with the reason for it. If you want to see the manufacturer's documentation, ask at the consultation and we will show you.

Implants are reviewed at the fitting of the crown, at six months, and then at your routine check-ups, where we check the gum, the bite, and the bone level on an X-ray at intervals. Complications are uncommon but real: a loose abutment screw, a chipped crown, gum inflammation around the implant (peri-implant mucositis), or bone loss around it (peri-implantitis). A loose screw or a chipped crown is usually straightforward to fix, and mucositis is reversible with cleaning. Peri-implantitis is harder to treat and may need surgery, which is why the review visits matter.

What happens if a complication arises, and how follow-up is arranged, is explained in your written treatment plan. Ask our team before treatment begins.

With this routine, implants can serve for many years. The crown is the part most likely to need replacement over time from normal wear.

• Brush twice a day with a soft brush, including the gum line around the implant crown.
• Clean between the implant and its neighbours every day with interdental brushes or floss. A water flosser helps around bridges.
• Do not smoke. Smoking is linked to higher implant failure and bone loss around implants. Together with daily cleaning, it is the risk you have most control over.
• Wear a night guard if you grind or clench. An implant has no ligament to cushion the load.
• Keep six-monthly check-ups and professional cleaning, with an X-ray of the implant every one to two years.
• See us promptly if the crown feels loose, the gum bleeds or swells, or you notice a bad taste around the implant.