The Effects of Periodontitis

How does advanced gum disease impact everyday life?

Marc came to Dr. Genchev with advanced periodontitis. Every tooth in his mouth was loose. Eating was painful. Chewing normally was impossible. The inflammation that had quietly attacked his gums for years had eaten away at the bone supporting his teeth, leaving them with no stable foundation. He wanted two things above all: to chew normally again and to recover the smile he had when he was younger.

The panoramic X-ray told the full story. In the upper jaw, all the teeth were loose. The soft cancellous bone was porous and unreliable. Granulomas, pockets of infection, had formed at the roots of teeth 14, 22, and 24. In the lower jaw, the remaining teeth from positions 11–15 and 21–25 were also loose due to severe bone resorption. Two conventional implants that had previously been placed in positions 16 and 26 were stable but not connected to the remaining teeth, making them vulnerable to micro-movements.

Conventional Implant Dentists in France Said: “Non!”

Do I really need bone grafting and zygomatic implants to fix my upper jaw?

Dentists in France had assessed Marc’s upper jaw and delivered a daunting verdict: bone grafting procedures and zygomatic implants would be required to rehabilitate the maxilla. The estimated cost for this approach in France was €40,000. And that figure came with no guarantee. Bone grafting carries a well-documented failure risk, particularly in patients whose bone density has already been compromised by periodontal disease.

This is a common problem with conventional implantology. The All-on-4 and All-on-6 systems depend on the soft cancellous bone that is damaged by the periodontitis. When that bone is porous or absent, conventional implants cannot take hold. Bone grafts are then proposed as a workaround. But in patients with active gum disease, the inflammation increases the chance of bone graft failure. And, Marc wanted a solution that would be successful.

Basal Implants with Dr Genchev

How can basal implants work when there isn't enough bone for conventional implants?

Upper Jaw: 17 Basal Implants Against the Odds

Why did Marc need so many implants in his upper jaw?

For the upper jaw, the bone was porous and had in some areas low-density, it was the dense cortical bone structure, qualified as bone type D3 (Thin porous cortical bone | SNOMED CT 274191005) and D4 (Fine trabecular bone | SNOMED CT 51381005). Dr. Genchev placed 17 basal implants, 8 on the right side and 9 on the left. More implants were needed to distribute the load and provide stability to support a full fixed bridge. 

Dr. Genchev concentrated implants at the back of the upper jaw, using positions 11–17 on the right and 21–27 on the left. He selected wider implants with an aggressive, sharper thread design. They are designed to grip porous bone more effectively. Two tubero-pterygoid implants, Ihde Dental TPG Uno, one on each side, were placed behind the sinuses into the pterygoid process of sphenoid bone (Classification: SNOMED CT 72891007) to recreate molar function.

In the frontal area Dr Genchev combined BCS and TPG Uno and fixed the implants in the nasal cortex.

Lower Jaw: 8 Basal Implants

Can existing conventional implants be integrated into a basal implant restoration?

The lower jaw was in better condition. Dr. Genchev placed 8 basal implants in positions 31, 32, 33, 35, 41, 42, 43, and 45. Crucially, he kept the two existing conventional implants. He used them as additional support for the bridge.

The lower jaw was in better condition. The bone density varied, from the dense cortical bone structure, qualified as bone type D3 (Thin porous cortical bone | SNOMED CT 274191005) and D4 (Fine trabecular bone | SNOMED CT 51381005). Dr. Genchev placed 8 basal implants anchored to the hard cortical bone in positions 31, 32, 33, 35, 41, 42, 43, and 45. He combined TPG Uno and Ihde Dental BCS. Crucially, he kept the two existing conventional implants. He used them as additional support for the bridge.

Recreating Marc’s Smile

Is it possible to have the same smile as before?

The bridges fitted to both jaws were constructed with PFM metal-ceramic crowns. It combines durability and aesthetics. Each bridge has 14 crowns to restore full function to chew normally with the molars. The shade selected was A2, a natural off-white that closely mimics real tooth enamel.

The crowns were not simply functional replacements. They were specifically designed to reproduce the shape and appearance of Marc’s original teeth. He wanted the same smile as when he was a younger man. This is the dual achievement Dr. Genchev set out to accomplish: functional restoration of both jaws, and aesthetic restoration of the patient’s identity.

Cost Savings

How much can be saved by choosing basal implants in Bulgaria instead of conventional treatment in France?

Dr. Genchev’s price for a full-mouth restoration was completed is €9,990. In France, the same scope of treatment was quoted at €40,000. That is a saving of €30,000 for a treatment that was completed faster, with no bone grafting risk.