Implantology and Oral Surgery (Dental Surgery)

In our Dental Clinic we make an accurate plan of implantological therapy for every patient, with the help of the latest generation PLANMECA SERENUS digital scanner that allows us to check the bone tissue, and hence provides an insight in the eventual bone deficiency, essential for the placement of implants.

Our Dental Clinic offers the possibility of expansion of the lost bone with various surgical interventions such as raising the maxillary sinus floor (large and small sinus lift), bone regeneration and bone augmentation.

There are various kinds of implants that differ according to their surface structure, form and shape of the neck.

In our Dental Clinic we use only high quality certified dental implants FDI declared and CE marked products.

Usually, it is necessary to wait a few months after the placement of an implant before starting with a new load. However, for immediate load implant, a temporary crown is applied right after the procedure. The patient’s bone structure conditions the selection of implants and the load period of the implant.


Regardless of whether one, several or all teeth are missing, dental implants will make you feel like you have your very own teeth.

Dental implants are artificial tooth roots, inserted into the bone under the gum through a simple and short surgical procedure.

The intervention is painless because it is performed under local anesthesia, and once out of the anesthesia, the pain can be compared to that of a simple extraction of a tooth.

Most of the implants are made in titanium, all the materials are biocompatible and produced according to international quality standards. Generally, the success of the procedure is not depending on the age of the patient, but by the quantity and quality of the bone mass of the jaw. In case of lack of bone, there is always the possibility to use the bone regeneration technique.

When the bone is of a sufficient volume and quality, when the implants have good quality, when the implantologist is highly educated, and when the patient is a non-smoker with good oral hygiene – there’s a 99,9% success rate. The success percentage decreases when the bone is weak, when low class implants are being used, when the implantologist is poorly educated and when the patient is a strong smoker with poor oral hygiene.

Treatment stages:

  1. The first part of the intervention is the diagnosis. This stage requires a visit during which, through direct observation and X-ray support, our team finds the most suitable solution to each person.
  2. The second stage is the surgery. The implant is placed into the jawbone with a small intervention (with local anesthesia) causing no particular complications, in fact, can be compared to a simple tooth extraction.
  3. For a period ranging from three to five months, the duration varies from case to case, the point where the implant has been inserted must reform going to grow around the implant. This process is well known as osseointegration (the bone cells attach themselves directly to the titanium surface of the implant). Usually at this stage, during the period of recovery, the patient wears a temporary prosthesis.
  4. With the titanium screw fully integrated a titanium abutment is being inserted. Once the dental implant and the abutment are in place, our dentist fits the crown, the bridge or the prosthesis.

In the end the patient receives a certificate that shows in details about the model, the diameter and batch number of the implant. This information is of great importance not only for warranty purposes, but also for the protection of the patient, and in case of future need, the patient can provide all the details to any dentist in the world.

Implantation has a number of advantages comparing with usual methods of restoration of missing teeth:

– Missing teeth can be restored to any location on the dentition

– This method allows not to grind the adjacent teeth

– Prevention of atrophy of the jaw tissues as the implant prevents the resorption of bone tissue

– Implants last longer than the crowns or dental bridges

– Fully restored chewing function

– Implants are resistant to stress and are durable

– Dental implants have reasonable prices

In our clinic the implants are being inserted by specialists in oral surgery. They continually educate themselves, participate in the various industry conventions. Our implantologist has more than 20 years of experience and more than 2500 implants installed in his career.

One of the challenges of modern implantology is the implant aesthetics. Our top educated surgeons successfully apply implantology protocols in the aesthetic sphere. Thanks to the rich experience and knowledge that our surgeons transfer as lecturers on congresses, and especially thanks to the close collaboration with prosthetic specialists and technicians, splendid aesthetics of dental implants in our Clinic is not a coincidence but a rule.

All on four – All on six

New Teeth in 24 hours: ALL ON FOUR

ALL ON FOUR is a fairly new method that allows for edentulous (toothless) patients or for patients with dentures to get new teeth in just 24 hours. A whole set of teeth is placed on only four implants.

Thanks to the particular method of insertion of the implants bone augmentation or sinus floor lift procedures usually performed when the implants are inserted using the traditional methods, are not necessary.

The ALL ON FOUR is the ideal solution for patients who, because of the lack of jaw bone, cannot receive traditional dental implantology treatments.

With this method, the implants are placed in strategic positions in the front part of the jaw where the natural quantity of the bone is usually enough to support an implant. The implants are inserted under a specific angle in order to include as much bone as possible.

Advantages of choosing the All on Four method:

  • Less recovery time
  • Bone augmentation or sinus floor lift procedures are not necessary
  • Patients can safely consume all foods
  • A long term solution
  • Oral hygiene is easily maintained
  • Natural appearance

Advantages of choosing the All on Four method over dentures:

  • Not need of removal for daily cleaning
  • No adhesives
  • Does not irritate the gums
  • Improved sensations of flavour and hot and cold
  • Avoids further deterioration of the bone

The All-on-6 treatment concept was developed to provide edentulous patients with an efficient and effective restoration using only six implants to support an immediately loaded full-arch prosthesis. It is very similar to the All-on-4 concept, but this solution is more stable than the All on 4 concept.

The All-on-6 treatment concept offers clinicians and their patients various clear benefits:

– Stability even in minimum bone volume

– Excelent clinical results

– Prosthetic flexibility

– Increased efficiency

– Higher stability than the All-on-4 concept

Jawbone reconstruction

Implantologists are offered a vast choice of different producers and products for bone replacement. Dental Tourism Macedonia uses only certified products of high quality and proven performance. Artificial bone is in form of particles, paste, pellets of different sizes, structures and characteristics. It is efficient for filling (augmentation) defects of various shapes and sizes. However, if there is a lack of the patient’s own bone cells that would fuse with the augmentation, the bone needs to be taken from a different source and used (in the shape of a block, ring, cell of supporting membranes) to reconstruct the missing bone structure.

If there is sufficient bone volume for the implant to stand at an axis, the missing bone can be reconstructed simultaneously with the placement of implants. For large defects, it is necessary to build the bone first, with blocks of the patient’s own bone, taken from the back part of the lower jawbone.

Bone expansion – split crest

If the anatomy allows it, it is possible to avoid the reconstruction of bones in blocks before placing the implants (blocks need 4-7 months of integration before they can get implanted). With a less pronounced atrophy, the bone is expanded using special instruments. With a heavily pronounced atrophy, the jawbone is cut transversely with ultrasonic piezosurgery, it then gets expanded so that implants can be placed within the existing flaps.

Sinus augmentation (lift)

Sinuses, the areas filled with air, whose size is individual, are located in the upper jawbone. When molars of the upper jawbone are missing for a long time, sinuses tend to lower due to bone loss, reducing the space, that is, not leaving enough space as the remaining height of the jawbone is not sufficient to place the implant. Problems are even more pronounced if molars have been taken out due to an advanced periodontal disease, since in that case the bone is further destroyed by chronic infection.

Luckily, surgical techniques of raising the sinus floor give excellent results. Depending on the height of the existing bone, a small (closed) or large (open) sinus floor lift is performed.

Unfortunately, when we lose a tooth, the bone that once supported it loses its volume.
Dental implants cannot be inserted if there is not enough bone volume to support them. In order to proceed with dental implantology in the upper jaw, a sinus floor augmentation procedure or a sinus lift needs to be performed.

The sinus floor augmentation procedure (sinus lift) is a painless, routine treatment performed under local anesthesia. Before the treatment the patient does not need to undergo any special kind of preparation. The success rate of this operation in our clinic is 98% and the implants inserted in the newly formed bone have the same duration as those inserted in an already existing, healthy bone.

The materials used to create the new bone can be synthetic, such as BioOss, boneceramic, grafton (just to name a few). There is also a possibility to use the patients’ own bone (bone allograft) taken from the lower jaw, ground and placed in the sinus.

In most cases it is not necessary to use the patents’ own bone, and in cases where there are at least 2 mm of bone, implants can be inserted during treatment which greatly shortens the time in which the patients get their new and definitive teeth.

If this seems complicated, we can assure you that it is not: the treatment begins with the opening of the gums at the border of the nasal sinus. The treatment consists of raising the sinus membrane in order to insert the granules of the artificial bone. After the granules are inserted, the opening is sutured.

The first image shows the state of the bone before the sinus lift treatment. In the areas where the implants will subsequently be added there are only 2-4 mm of bone.

From the next image we can see how after the sinus lift procedure the new bone is now 10 mm high.

Six months after the procedure two implants are inserted (10 and 8 mm) and three months later a dental bridge is placed on them.

Periimplant soft tissue surgery

Periodontal soft tissue is especially important not only for aesthetic purposes, but also for good long term forecast of the functional aspect of dental implants.

If there is not enough strong gingival tissue, we can encounter several problems with implants: when chewing, a small crack is likely to appear between gums and implants, hence, food can get inside the crack. A gingival tissue that is not fixed tends to be sensitive and patients avoid brushing, which can lead to inflammations.

That is why our surgeons don’t wait for problems to occur due to a lack of strong gingival tissue, but instead reconstruct it, with cosmetic surgery techniques, before implants assume their function.

Apicoectomy (removal of root infections)

Smaller surgical oral interventions used to remove the tip of the tooth root are called apicoectomy. Such intervention is performed only if tooth treatment (endodontic therapy), or repeated cleaning and filling of the root canal (revision), have not achieved their objective, that is, the retreat of the inflammation around the tip of the tooth root. If necessary the root canal is filled (sealed) reversely, that is, from the sides of the root tip. For this procedure our surgeons use micro-piezo tools, with a special bended extension, which eases the intervention procedure even in case of roots that are difficult to access. A control examination with intra-oral X-ray teeth scan should be performed after 6 months.


A cystectomy is the complete surgical removal of a small cyst with subsequent wound closure. The cyst is completely removed after a mucosa incision. This operation can also be combined with a root tip resection. The mucosa above the bone defect is then tightly sealed. New cysts may arise from any cyst residues.