Orthognatic Surgery

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What is orthodontics and who can promote orthodontic care?

Orthodontics is one of the recognized specialties by the Portuguese Dental Association (OMD), which purpose is to correct the positions of the teeth in the dental arches and to move the jaws into a more balanced position.

Professor Doutor Afonso Pinhão Ferreira
Prof. Dr. Afonso Pinhão Ferreira

The main purpose of orthodontics is to allow an aesthetic harmonization of the face and teeth and achieve adequate functionality of the oral structures.

Due to its specificity and according to the adopted norms in most countries, the practice of this specialty requires knowledge granted by a post-graduate training in the orthodontic area after concluding the Dental Medicine degree.

Legally, the title of specialist in orthodontics is obtained after public exam in the Portuguese Dental Association (OMD), which can only be required after successful training in a postgraduate course in this area of ​​knowledge in a university department or national/foreigner higher education unit, with a minimum length of 3 years part-time or 2 years full-time. Only dental practitioners who attain the specialist title through the Portuguese Dental Association are authorized to publicly use the title of orthodontist.

An orthodontist is a specialized dentist who promotes orthodontic treatments to correct malocclusions (incorrect forms of dental closure and articulation of the teeth).

In Portugal, the orthodontic specialty was officially recognized in 1999. For this reason, it is recommended that those who need orthodontic treatment should first be informed if the dentist they are going to consult is a specialist in orthodontics.

Professor Doutor Afonso Pinhão Ferreira
Prof. Dr. Afonso Pinhão Ferreira

At Ortopóvoa, the Clinical Director, Prof. Dr. Afonso Pinhão Ferreira is a Dentist and Specialist in Orthodontics since 1999.

For further information, you can call the Portuguese Dental Association (22 6197690/21 7941344), the Dentofacial and Orthopaedics Portuguese Society (SPODF – 22 6099086) or the Portuguese Association of Orthodontists (APO – direcao.apo@gmail.com).

When is orthodontic treatment necessary?

Orthodontic treatment is necessary when there are malposition’s of the teeth and jaws (malocclusions) as well as functional problems in the buccal and facial structures.

Therefore, a treatment performed by an orthodontist should promote the following aims:

  • To achieve a more harmonious face and an attractive smile, which usually results in the increase of the patient’s self-esteem with consequent ease of social insertion;
  • To facilitate oral hygiene, which will result in reducing future dental and gums problems and increasing dental longevity. The following image shows the differences in the health status of the gums before and after orthodontic treatment;
  • Reduce the probability of dental fractures, especially when teeth are positioned far ahead (protrusion);
  • Improve mouth and adjacent structures functions (chewing and swallowing, breathing, speech and facial expression);
  • Align teeth and where possible the jaws, restoring the proper function of the buccal structures, which will help dentists and other specialists to achieve better clinical outcomes in dental treatments, periodontal treatments, implant rehabilitation treatments and placement of fixed and / or removable prostheses;
  • Prevent certain problems in the temporomandibular joints (joints that connect the mandible to the skull).

What are the main causes of orthodontic anomalies?

Orthodontic anomalies, such as malocclusions, may arise from hereditary or environmental causes or a combination of both. In fact, the dimension of the teeth and jaws as well as the relation between them, are features that can be transmitted from parents to children. To exemplify a hereditary factor, imagine a child who “inherits” the father’s large teeth and the mother’s small jaws. In this case, the teeth will not fit in the jaws, and therefore, they become misaligned (crowding).

Environmental factors are usually a consequence of harmful habits such as breathing through the mouth, sucking fingers and tongue, gnawing nails or other objects (such as pens). These habits can lead to incorrect tooth movements and changes in shape and position of the jaws, thus negatively affecting the facial harmony.

Another circumstance that can cause orthodontic anomalies is the premature loss of temporary/deciduous teeth due to dental caries. This is due to the fact that temporary teeth maintain the necessary space for the eruption of permanent teeth.

If a temporary tooth is lost, the adjacent teeth move into the created space and “steal” some of that area. When it is time to erupt the permanent teeth there will not be enough space, which will result in crowding and/or other similar problems.

The malocclusions

There are three categories of malocclusions usually treated by orthodontists:

The orthodontic appliances

The appliances used during the orthodontic treatment may be removable, i.e., may be removed and placed by patients, or may be fixed, i.e., permanently attached to the teeth during the treatment period, and may only be removed by an orthodontist.

There is usually a slight discomfort in the first few days after the appliance is placed.


What kind of appliances are there?

Fixed appliance with brackets and attachments
They are the most commonly used orthodontic appliances. They consist of wire supports (brackets) with slots in which the metal arches are inserted in order to deliberate forces to move the teeth into better positions. The supports are essentially of two types: the brackets that are bonded to the surfaces of the teeth and the attachments welded to the bands, which are metal rings cemented around the teeth that support higher forces.
Transversal expansion appliance
Transversal expansion appliance

Transversal expansion appliances are used to transversally enlarge the upper jaw and teeth. They are used to alter the shape of the dental arch.

In this category one includes the removable expansion devices that need to stay in the mouth for 24 hours/day and also the fixed expansion devices.

Removable functional appliance (BIONATOR)
Removable functional appliance (BIONATOR)

They are removable or fixed devices that can be used to correct maxillary bone discrepancies.

They are used when the orthodontist intends to orientate, stimulate or inhibit the development.

They are placed in very young children and are mainly used in pre-puberty or puberty.

The removable functional devices are mostly used during the night and for a few hours of the day.

The advantages of removable devices are the ease with which they can be cleaned and removed during meals. However, in patients where there is little or no cooperation during treatment, the fact that these devices can be removed may be a disadvantage, and therefore the fixed devices are more indicated.

Extra-oral device (headgear)
Extra-oral device (headgear)

These are devices that develop forces capable of modifying the growth of the maxillary bones and can also be used to move the teeth into better positions.

In certain situations they can be used as a counterforce in order to prevent certain teeth from moving.

The headgear is the most common and consists of a facial bow and a elastic strap applied to the neck or head.

Auxiliary devices (distalizer appliance)
Auxiliary devices (distalizer appliance)

There are numerous devices that are used combining fixed appliances with different aims. Among these we can mention, the elastics, the elastic chains or certain special springs.

These devices, combined with the arches inserted in the slots of the brackets, cause forces that move the teeth in the three planes of space. They are used whenever it is necessary to move the teeth more accurately.

Retainer (Positioner)
Retainer (Positioner)

Once the orthodontic treatment (treatment’s active phase) is achieved, it is utterly necessary to maintain the outcome (treatment’s passive phase), since during a certain period of time there will be a tendency for the teeth to move to the previous positions (relapse).

The maintenance of the result, known as the retainer phase, is carried out with removable or permanent devices. The patient’s cooperation is crucial during this phase in order to avoid relapse, thereby ensuring the stability of the outcomes of the active treatment over time.

Orthodontic treatment in adults

The importance of orthodontist cooperation with other dental specialties

Patients with orthodontic problems who were not seen in a younger age may benefit from orthodontic treatment in adulthood.

In most cases, the treatment of adults requires the orthodontist cooperation with other specialties in dentistry or medicine (dentist, periodontist, oral surgeon, implantologist and prosthodontist, endodontist, plastic surgeon, maxillofacial surgeon, etc.).

These treatments can ensure the best functional and aesthetic result and indicate an advantage for the patient since he/she benefits from the treatment capabilities of the different specialties.

Orthodontic-surgical treatment

In certain cases of severe malocclusions, in addition to the orthodontic correction may be necessary surgical intervention.

The anomaly is so severe that if we move the teeth orthodontically to reach occlusion, they would leave the maxillary bones.

In fact, the maxillary bones themselves have disharmonious dimensions and positions. These anomalies are called dento-facial deformities (DDF).

To treat DDF, an interdisciplinary treatment called orthodontic-surgical is required.

In ORTOPÓVOA, these treatments are performed by the orthodontist, Prof. Dr. Afonso Pinhão Ferreira and the maxillofacial surgeon, Dr. Adriano Figueiredo, with the technical support of Ortopóvoa laboratory.

This complex and interdisciplinary treatment usually consists of three phases:

  • An orthodontic preparation before surgery, where the teeth of each dental arch are independently aligned and levelled, in view of occlusal congruence during corrective surgery of the dimensions and discrepant positions of the maxillary bones (orthognathic surgery);
  • Orthognathic surgery;
  • A finishing orthodontic refinement.

The surgical-orthodontic treament is one of the most rewarding treatments from the occlusal rehabilitation and improvement of dentofacial aesthetics point of view.

It is now a routine procedure where the technology and clinical experience allow, without any scar, an amazing facial, jaws and teeth change, extremely rewarding for the patient with regard to their capacity for relational influence and self-esteem.

Patient-oriented management

Ortopóvoa believes in a patient-oriented management. Thus, we pay close attention to the patient’s main complaint and perform personalized care. For this reason, and despite many requests, we never considered feasible to open branches, as we would not be able to maintain the same quality.

Follow us on an orthodontic treatment.

3D scanning of buccal structures
3D scanning of buccal structures
  • In the first appointment, you should go to the reception where you will be welcomed by Liliana, who will fill out your identification file and accompany you to the presence of the Administrative Director and Patient Coordinator Dr. Maria Alexandrina.
  • You will then be taken to collect the necessary data for studying your clinical case. The assistant Carina will make intra- and extra-oral photographs, 3D scanning of buccal structures, panoramic radiography and lateral cephalometric radiography.
  • Finally, and to complete the process of data collection, will be examined by the Clinical Director and Specialist in Orthodontics, Prof. Dr. Afonso Pinhão Ferreira.
  • Next, the clinical staff will study the case, considering the diagnosis, the treatment plan, the time needed for its effectiveness, the prognosis and the budget.
  • At the reception desk, you should schedule a new appointment to be informed of the results of the clinical study, the recommended orthodontic treatment and its budget.
Presentation of the case study
Presentation of the case study​

This appointment is very interesting because the patient is totally informed about the overall aspects related to his/her case.

We believe that a good decision is based on wide-ranging information. Therefore, we advise the patient to join us with his/her family and/or friends. The appointment takes place in two different parts always with the help of audio-visual media. In the first part, the patient is informed about the bureaucratic aspects, such as:

  • How Ortopóvoa works;
  • How the clinical cases are studied;
  • How the appliances are placed;
  • How long takes the expected treatment;
  • What is the budget and which are the payment possibilities.

In the second part, Prof. Dr. Afonso Pinhão Ferreira, clarifies the clinical features of the case by showing similar treated cases.

At the end of the consultation, a PDF document is sent to the patiens’s e-mail with all the diagnostic data as well as a written report where the treatment plan and the budget are listed. This document is accompanied by a term of responsibility which is stamped, identified, dated and signed.

Preparation for placing the orthodontic appliances
Preparation for placing the orthodontic appliances

After accepting the treatment proposal, the patient will be prepared for placing the orthodontic appliances.

Previously it may be necessary to:

  • Do some periodontal treatment;
  • Treat or extract some teeth;
  • Make impressions to execute certain types of orthodontic devices;
  • Or simply place stainless steel bands to facilitate the placement of fixed appliances (this may be performed during the second appointment).
Oral hygiene and care instructions
Oral hygiene and care instructions

In this appointment we start the active phase of the orthodontic treatment.

We place and activate the devices and provide instructions for its use, especially with regard to oral hygiene care.

In the first few days, Ortopóvoa offers an orthodontic kit consisting of: a toothbrush, toothpaste, a mouthwash, protective wax and an interdental brush.

The patient or his/her caregivers must sign an informed consent, explaining in detail the advantages and disadvantages of the treatment (both parties keep a copy of this document).

Then the 1st control and activation of the devices (about a month to a month and a half) must be scheduled.

Orthodontic monthly progress appointments
Orthodontic monthly progress appointments

In the following appointments (usually monthly), we will monitor the evolution of treatment with:

  • Activation of the appliances;
  • Placement of auxiliary devices (headgear, intermaxillary elastics, etc.);
  • Repair of appliances when necessary;
  • Control and motivation of oral hygiene;
  • Taking intra-oral photographs to record the clinical evolution of the case;
  • Annual radiographic control;
  • Information on treatment progress.

After achieving the aims of the orthodontic treatment and if the teeth are aligned and levelled, allowing functional occlusion, the devices are removed.

Thereafter, the dental arches are prepared for making retaining devices, i.e., orthodontic devices for night use during a period of time for preventing the teeth from misaligning and also to maintain treatment outcomes.

Usually happens one month after the removal of fixed appliances.

In this appointment:

  • We control and adjust the retaining devices;
  • We provide instructions on the use of the retainers and also their maintenance;
  • We remind oral hygiene procedures;
  • We collect x-rays and photographs to analyse and evaluate the treatment outcomes and also verify any treatment needs;
  • We prepare a final report.

If there is no unforeseen event, the patient should schedule an appointment one year after finishing his orthodontic treatment.

This appointment is included in the budget.


Before, during and after orthodontic treatment, there are numerous information and care to take into consideration, such as:

Thumb sucking caused an anterior open bite
Thumb sucking caused an anterior open bite

Children develop many habits that can cause dental and oral structural problems. Within these harmful habits we can point out mouth breathing (often related to large adenoids, asthmatic bronchitis, allergies, etc.), tension with teeth twitching, lingual pressure, biting and/or interposition of the lower lip, chewing fingernails or other objects (such as pencils, erasers, etc.), chewing only on one side, sucking fingers, etc.

In young children, the habit of sucking fingers usually stops between two and three years of age and the damage done is minor and can be solved without any special intervention. The children who, after that age, continue to exercise this habit can hide some kind of insecurity or stress caused by motives such as the absence of parents, moving home or even changing school.

In order to eradicate these problems, it’s important some support, affection and quality communication with the young ones. Even so, in more persistent cases, the orthodontist can support the parent’s effort by placing devices that help the child to overcome this habit. Yelling and punishing will surely be the worst possible approach. On the contrary, what will work best in these cases will be to encourage the children for the necessary effort and reward them when the goal is achieved.

During treatment we may need to extract some temporary teeth if they remain in the mouth beyond considered acceptable time. In some cases, the extraction or not of permanent teeth is a very thoughtful decision that the orthodontist must consider. Such situations occur when disproportion between the size of the jaws and the size of the teeth occurs (DMD – dento-maxillary disharmony) or when the skeletal development of the face is unbalanced (MMD – maxillomandibular disharmony). The orthodontist determines the timing for extraction and which teeth to extract, assuming the scientific and clinical responsibility for his decision.

Interdental brush
Interdental brush

The use of orthodontic appliances poses no risk to health, provided that they are applied by orthodontic specialists and that all recommended care is respected. One of the most important is undoubtedly the practice of a good oral hygiene.

Even so, the use of orthodontic appliances favours the retention of food and the development of bacterial plaque, which produces acids that will inflame the gums (swollen, red and bleeding) and demineralize the teeth (causing irreversible stains and caries). Therefore, it is important the inexistence of flaws in oral hygiene.

Our advice includes:

  • Avoid eating or drinking sugary foods, and when you eat or drink, brush your teeth afterwards;
  • Brush all the teeth (top and bottom, front and back, inside and out, without forgetting any, with small rotating movements) for two minutes counted by the clock, with a brush neither too hard nor too much soft (renewed every three months), after breakfast, after lunch and before going to bed;
  • We advise the use of an interdental brush, since it allows cleaning inaccessible places more than the usual brushing technique. In fact, the use of a small brush with back and forth movements inserted in the interdental spaces, between the brackets, the arches and the teeth, allows a careful cleaning of these places. Therefore, we recommend using the interdental brush before traditional brushing, at least once a day, preferably at night. Alternatively, you can use dental floss;
  • Brush the tongue whenever you brush your teeth (it decreases the number of bacteria);
  • Whenever you eat food in between tooth brushing, you must vigorously rinse three times with water (it reduces the number of food, bacteria and acids);
  • Flushing with fluoridated mouthwash twice a day (morning and night).
Class II intermaxillary elastics
Class II intermaxillary elastics

The outcome of orthodontic treatments is determined by permanent forces carried out by appliances throughout time. In some cases it may be necessary some additional force to move the teeth into correct positions. This is why the orthodontist asks the patient to use elastics. If used according to the specialist’s instructions, the faster you will get a healthy and beautiful smile.

Intermaxillary elastics, when used correctly, can cause some discomfort, making the teeth sore for a day or two. When the elastics are not used according to the instructions of the orthodontist, this discomfort lasts even longer and the teeth take much longer to reach the desired position.

To accomplish a better outcome when using elastics:

  • It is the patient’s responsibility to wear the elastics correctly and it is important to make sure that they are used regularly and according to the instructions;
  • The patient should always carry some elastics in case of any bursting. This way the patient can replace them when needed. If one doesn’t have spare elastics, the patient should contact ORTOPÓVOA to request more;
  • When the patient forgets to wear the elastics, which should not happen, he should use them normally as indicated, as soon as possible;
  • Elastics lose strength over time, and when this happens, the teeth and jaws are not receiving the wanted pressure. Therefore, it is important to change elastics even when they are not broken;
  • When brushing the teeth, the elastics should be removed and replaced soon afterwards and this should be done in front of a mirror.

The headgear and facebow are auxiliary devices that belongs to extra-oral appliances (devices that work forces inside the mouth with anchoring outside the mouth).

It is an orthopaedic device that develops forces in order to alter the growth of the face and maxillary bones. It is also used to move the teeth to better positions or to prevent them from moving when necessary.

This extra-oral device consists of a facebow and a headgear with a safety device. The inner arch of the facial bow is inserted into the attachments soldered to the bands (tubes), cemented around the first molars (small metal rings).

The facebow should be used on a daily basis according to the instructions (even on birthday and Christmas day), under the risk of being very difficult to overcome the barriers that the body creates to the displacement of bones. Every single day the device is not used, it implies a week of delay in treatment.

It should be placed and removed according to the instructions to avoid injury, even though the appliance has a safety device.

Whenever the patient goes to the control appointment, he or she should take the facebow, and if there is any problem (such as a loose band or if the appliance hurts), the patient should contact ORTOPÓVOA.

Face Mask
Face Mask

The face mask is an auxiliary device that belongs to extra-oral appliances (devices that work forces inside the mouth with anchoring outside the mouth).

It is an orthopaedic device that develops forces in order to alter the growth of the face and maxillary bones. The facial mask is used to move forward the upper jaw and the teeth into better positions.

The face mask should be worn every day according to the instructions (even on birthday and Christmas day), under the risk of overcoming the barriers that the body creates to bone displacement. Each day the patient doesn’t use the face mask, it implies a week of delay in the treatment.

Whenever the patient goes to the control appointment, he or she should take the face mask, and if there is any problem (such as a loose band or if the appliance hurts), the patient should contact ORTOPÓVOA.

Devices used during orthodontic treatment may be removable (removed and placed by the patient), or fixed (permanently attached to the teeth during the treatment period and can only be removed by the orthodontist).

There are several types of removable appliances, of which we highlight the most used:

  • Biomechanical devices (known as active plaques);
  • Functional devices (Bionator, Bimler, Frankell, Andresen’s Monobloc, etc.);
  • Retainer devices (Hawley plaque, Essix retainers, etc.).
Biomechanical device
Biomechanical device

Biomechanical devices consist of two components:

  • An acrylic portion that covers the palate in the case of the upper jaw;
  • Metal components (bows, hooks and springs) attached in the acrylic which serve to promote retention in the mouth and to develop forces to move the teeth.

The removable functional appliances are used to correct dimensions and positions of the maxillary bones. They are placed in young children and used in pre-puberty or puberty.

Removable functional devices are used all day long.

Frankell functional appliance
Frankell functional appliance

These devices take advantage of the functionality of the mouth to develop forces with more suited vectors to face growth. For example, when the patient swallows the saliva (which he does 60 times per hour), he is forced to close his teeth and, if he is using the functional appliance, this closure will be oriented to a more favourable position for the growth and positioning of the mandible.

After removing the fixed appliance to prevent the teeth from returning to their positions before treatment, it is important to keep them in the correct final position, especially in the first few years after orthodontic treatment.

The role of this type of device is to prevent relapse, that is, to prevent the teeth from returning to undesirable positions.

Retention appliance (Hawley retainer)
Retention appliance (Hawley retainer)

For this purpose, there are retainers, mainly for night use.

There are also retainer splints for the same effect consisting of a wire bonded or fixed in the lingual surfaces of the anterior teeth, keeping them “united”, thus avoiding their displacement.

The most commonly used removable retaining device is called Hawley Retainer. It consists of an acrylic plaque, retaining hooks and a vestibular arch.

These three components cooperate to maintain the final position of the teeth.

Common questions

The sooner the better

Prevention is essential in any medical or dental specialty. For this reason, we recommend that the first visit to the orthodontist to be before the age of seven. It is the ideal time for the orthodontist to observe the patient, identify the problems, assess the severity and decide the best time to start orthodontic treatment.

Preventive orthodontics, targeted to very young patients, aims to treat some situations, such as premature loss of temporary teeth, prolonged finger sucking and incorrect tongue positions. In cases where finger sucking and tongue projection occurs, it is possible to interrupt these harmful habits without the use of orthodontic appliances provided that both parents and children are properly instructed and oriented.

The treatments carried out between seven and nine years old correspond to the so-called interceptive orthodontics. Its purpose is to promote treatments in order to avoid functional and skeletal problems.

If these problems are not promptly treated, they will allow an incorrect growth and development of the oral and facial structures.

The following image shows the result of an interceptive treatment where an anterior crossbite was rectified. Corrective orthodontics treats completely established malocclusions in children or adults.

Anterior crossbite orthodontic treatment
Anterior crossbite orthodontic treatment

The ideal time to start a corrective treatment is determined by the orthodontist and it depends on the severity and the growth of the teeth and maxillary bones.

  • Better prognosis for avoiding extraction of permanent teeth;
  • Supervision and easier orientation of maxillary bone problems, since the orthodontist can control the skeletal development before the onset of puberty (dentofacial orthopaedics);
  • Better reaction of biological tissues to treatment;
  • Easier adaptation of young patients to appliances;
  • Younger children are not apprehensive and generally do not have psychological problems such as adolescents;
  • When treatment starts earlier it ends before the child enters puberty. For this reason, they have more self-esteem than other adolescents, since they have improved their facial aesthetics;
  • Adult patients, whose bone development is completed, are most often subjected to permanent tooth extractions or, if they have severe skeletal problems, require orthognathic surgery (to correct maxillary bone dimensions and positions).


Home » Treatments » Implants


Implantology and Fixed Prosthesis

In recent decades there has been a great development regarding oral rehabilitation. Improvements relate to the possibility of complete replacement of a missing tooth with an artificial tooth supported by an implant, which prevents the toothless patient from using removable dentures or the dentist having to prepare (wear) teeth that will receive crowns and fixed prostheses.

Dr. António Pinhão Ferreira
Dr. António Pinhão Ferreira
Implantology and Prosthodontics

The implants are nothing but screws (usually of biocompatible metal) with different calibres and heights, with different threads to allow (most often under local anaesthesia and with their own rotary instruments) their placement in the maxillary bones, more precisely at the corresponding locations of the missing teeth.

It is a special and much studied screw.

Dr. António Pinhão Ferreira
Dr. António Pinhão Ferreira
Implantology and Prosthodontics
Implant-supported tooth

Implant-supported tooth

If a patient who needs to place an implant-supported artificial tooth paid only for the manufacture and material corresponding to the screw, half a dozen cents would be enough. However, what the patient usually pays are patents due to scientific researchers who over the past few years have promoted research so that the placement of these implants would be functional and aesthetically successful, causing no damage to the patient.

Usually, implants are made of biocompatible materials so that the organism does not identify them as strange bodies. The metal used is usually titanium. Such biocompatible material should not cause inflammatory adverse reactions and should allow intrinsic binding to the biological bone known as osseointegration. This phenomenon, which allows the implant to be anchored in the bone, takes an average of four months to complete.

This means that after placing an implant it is beneficial to wait about four months before placing the artificial tooth (crown).

When a tooth is lost, it is possible to replace it with a crown supported by an implant. Usually the implant (made of biocompatible metal) is placed in the jawbone under local anaesthesia. If all goes well, the implant attaches to the bone through a biological process called osseointegration over a period of approximately 4 months.

Implant-supported tooth

Space management to place an implant-supported tooth

Prior to placing an implant, a study of the general and local conditions is required.

It is important that the patient has good health, since the placement of implants undergoes a biological response to the surgical act and also to the material of the implant. This means that there are diseases and medications that, partially or totally, contraindicate the placement of implants, which is why it is the patient’s duty to inform the dentist about the medications and about the diseases that affect them.

Locally it is necessary to check the space conditions in the dental arch, i.e. if we need space or if there is more space to place the implant-supported tooth. For this, a clinical examination is performed, 3D scan of the oral structures and a panoramic radiograph. If the clinician finds that the space is inadequate, orthodontic appliances may need to be placed in order to move the adjacent teeth to better positions.

With adequate space and required rehabilitation, it is important to check that we have enough bone to fit and support the implant, particularly as regards thickness. Thus, we use Computerized Axial Tomography (CAT), which, besides giving us very reliable images about local bone conditions, allows in some cases, to ask for a three-dimensional protocol to guide the implantologist to safely place the implant.

In some cases, there is not enough bone to allow placing one or several implants. When this happens it may be necessary to provide the location with more bone. This can be achieved by placing artificial inert powder bone (bio-bone) or by applying a withdrawn bone graft in another part of the body (jaw, skull, etc.).

1 If space is inadequate, orthodontic braces may need to be placed to move adjacent teeth to better positions. In this case, the posterior molar tooth leaned forward occupying the place where the missing tooth was previously, which forced the appliance to upright the molar and return it to its anterior position.

2 Once the space has been reached, the implant is placed and the bone ligation (osseointegration) process takes about four months.

3 Achieving successful osseointegration, the crown is placed, thus succeeding the fixed rehabilitation of the missing tooth.

Implant placement where bone is missing

Once the radiographic and clinical situation is verified, the implantologist, after local anaesthesia, will open the surgical site to heal (scrape the bone) causing some bleeding and widen the wound separating the cortices of the bone.

It will then place inert bone powder (bio bone) into the surgical wound, mixing with blood containing cells that will help solve the inflammatory process and reshape a new bone to receive the implant.

This bone remodelling process known as osseointegration will take about four months. Only then the crown can be placed.

In the following images, we exemplify the process of placing an implant in a case where there is bone loss.

1 Laying of artificial bone powder (bio bone) covered with a membrane and then sutured.

2 After placing the bio-bone (so the patient doesn´t leave the clinic without the front tooth), we insert a removable prosthetic device with an artificial tooth. If all goes well, the blood soaks the artificial bone, and in about four months a new bone will be formed to allow the placement of an implant.

3 After four months, following the osseointegration of the implant placed in the new bone, we can place the crown.

Placing an implant where there’s extreme bone loss

In other more severe cases with extreme bone loss, it is preferable to place a bone graft where we want to place implants.

The following images illustrate the process of placing an implant in such cases.

1 In these cases, a bone graft is placed. These bone portions can be collected at the same time at various locations in the human body (jaw bones, iliac bones, skull cap bones, etc.). The bone portion is fixed with small screws, which will be removed after bone graft integration.

2 Now, four months later, we already have bone thick enough to place the implant. If everything goes accordingly, the implant will integrate the bone (osseointegration) and the crown may be fitted.

Placing implants when there’s loss of posterior teeth in the upper jaw

Another common situation has to do with the loss of posterior teeth in the upper jaw. When a patient loses these teeth too early, bone resorption can make the distance between the bony border and the nasal sinus very small, to the point that there is no bone height to place implants.

1 To achieve height in the bone, a procedure called maxillary sinus lift known as “Sinus Lift” is performed.

With local anaesthesia and under appropriate medication, the implantologist detaches the gingiva and the bony edge becomes exposed. In the lateral zone, one opens a bone window to allow the insertion of an instrument to lift the lining membrane of the sinus cavity.

2 We now fill the created space with inert artificial bone (bio-bone).

This bone will mix with the blood, which contains the repairing cells and substances essential for integration and remodelling of the new bone.

This process will take about six months, after which implants can be placed; they will take four months to be osseointegrated.

The surgical process is illustrated in the following images:

It is important to say that the placement of an implant is a technical-surgical act that requires adapting the surrounding biological tissues in the resolution of the inflammation.

Usually, being a specialized and experienced clinician, if high quality materials and own medication are used, in 95% of the cases the implant is fixed to the surrounding bone, therefore resolving the inflammatory repair process in about four months (osseointegration).

The loss of an implant is not a catastrophic event and should be understood as a local biological problem.

Usually it is removed, and after careful study within four months, the implant is replaced.

Like our own teeth, implants don’t last forever.

After several years an inflammation known as peri-implantitis can develop in the surrounding bone of the implant, which may lead to implant mobility and loss.

Ortopóvoa prides itself on having the knowledge and the vast experience to promote complex orofacial rehabilitation involving tooth-supported and implant-supported teeth.

In addition, we have our own laboratory and technicians for fabricating ceramic crowns and veneers and guarantees full coverage and assistance of our treatments.


Home » Treatments » Periodontology

What is Periodontology?

Periodontology is the area of ​​dentistry dedicated to the study and treatment of periodontium.

It is made up of periodontal tissues that surround and support the teeth, namely the gingiva, the alveolar bone, the cementum and periodontal ligament.

The Periodontologist is a dentist who is a specialist in treating conditions that affect the periodontium.

Dr. João Coimbra
Dr. João Coimbra
Periodontology and Oral Surgery

Periodontal disease

The main etiological agent of periodontal disease in humans is the bacterial plaque.

However, habits such as smoking, or systemic conditions such as uncontrolled diabetes may also contribute to its development, influencing the severity and the speed of its expression and the responsiveness to its treatment.

The most common form of periodontal disease is gingivitis, which is characterized by a reversible inflammatory process of the gingiva. Gingivitis is caused by the accumulation of plaque and tartar around the teeth. In this situation, the gingiva is reddish (erythematous, rather than the traditional light pink appearance), with its increased volume (edematous gingival margin) and bleeding after touching (during brushing or after using the interproximal brush).

Untreated gingivitis allows its evolution to periodontitis, with involvement of the alveolar bone and irreversible progressive loss of dental support due to decreased clinical adherence. Clinically, periodontitis is characterized by bone resorption with possible development of gingival recessions, periodontal pockets, tooth mobility and persistent gingival haemorrhage after touching (pus and bad breath may even be present in some cases).

Treatment of early periodontal disease may be limited to mechanical removal of tartar and plaque, motivation and care instruction in your oral hygiene at home. In more advanced cases, with bone loss already associated, therapy may involve the need to surgically access deeper sites for them to be instrumented. Regenerative procedures may also be promoted to try to recover lost dental support.

Failure to treat the most severe cases will result in dental loss. Once the disease is treated in its active phase, the patient will move to a stable, supportive phase in which the disease can be controlled by keeping the characteristic inflammatory signs away.

Illustrative cases

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Gingival aesthetics

Periodontal Plastic Surgery

Periodontology also includes a set of procedures that aim to provide harmony in the smile and find the most appropriate gingival aesthetics for each patient.

These techniques establish the periodontal plastic surgery, which aims at correcting unfitting gingival contours, restoring the normal soft tissue architecture around the tooth and ensuring optimal conditions for periodontal tissue hygiene.

Based on the use of these procedures, it is possible to accurate situations of excessive gingival exposure during the smile (called gum smile, with apparently short teeth present) or to treat gingival defects that imply exposure of dental roots (gingival recessions).

In Ortopóvoa we have the most advanced techniques of periodontal microsurgery, which allow us to satisfy the most demanding aesthetic necessities through minimally invasive interventions, by using sensitive microsurgical instruments and work field enlargement devices.

These approaches enable dramatic reduction of pain and discomfort and enhance highly predictable postoperative outcomes without scarring or sequelae.


Home » Treatments » Invisalign


The Invisalign is an orthodontic system appliance consisting of a set of clear, removable aligners, personalised for each patient to move their teeth to the intended new positions.

In order to gradually move the teeth into the desired position, each aligner is different from the anterior aligner, allowing for a small additional movement.

It is the application of the concept of elastodontics. This is a relatively recent method that has evolved a lot and the aligners are made by computer after a computer planning of three-dimensional orthodontic treatment (ClinCheck).


In search of aesthetics and dental harmonization

Aesthetics is one of the benefits of this type of appliance. Being almost transparent, it goes unnoticed. In addition, it is removable, which allows the patient to remove it for eating and to allow easier tooth brushing compared to the fixed appliance.

Alinhador Invisalign
Invisalign Aligner

How does orthodontics works with Invisalign?

In order for the teeth to move gradually to the desired position, each aligner is different from the anterior one, allowing for a small additional movement.

Dental correction is then performed using a series of transparent aligners (called aligners) that fit perfectly into the teeth, making a slight pressure previously calculated and planned through advanced technology.

Aligners are now made of a material called SmartTrack that is much more comfortable as it has plastic and elastic properties. These aligners fit exactly to the gum line, allowing a perfect fit and are easy to place on and to remove.

What does ClinCheck consist of?

The positioning of the teeth (initial and final position) is previously computer-studied through 3D scans in a concerted process between INVISALIGN and ORTOPÓVOA, called ClinCheck.

The orthodontist defines the treatment goals, the dental movements to be performed and their priority. INVISALIGN sends a proposal in computer format, which can be viewed either by the orthodontist or by the patient himself.

Scan das estruturas bucais (ClinCheck)
Mouth Structure Scan (ClinCheck)

In each INVISALIGN treatment, several intermediate aligners are designed to gradually move the teeth from the initial to the desired position. Each aligner is usually replaced every 2 weeks until the planned final result is achieved.

I want an orthodontic treatment with the Invisalign method. How to proceed?

If you want an orthodontic treatment with the INVISALIGN method, ORTOPÓVOA´s orthodontic specialist, Professor Dr. Afonso Pinhão Ferreira, has the certified qualification (INVISALIGN Master Course) for the use of this technology.

In this case, you should have a first consultation in ORTOPÓVOA and inform that you want such treatment.

1 – Professor Afonso Pinhão Ferreira will evaluate if the treatment is appropriate for you, and if so, intra and extraoral photographs, panoramic radiography, lateral radiograph of the face and 3D scanning of your mouth will be taken.

Then, the Professor will plan the orthodontic treatment that will be sent to the international affiliate INVISALIGN along with the standardized diagnostic data.

All this data will be used to create a 3D computer treatment plan (Custom ClinCheck), which will be sent to ORTOPÓVOA for rectification.

2 – Once the treatment plan has been prepared, rectified and agreed with the patient, INVISALIGN sends the set of aligners and auxiliary devices to ORTOPÓVOA to begin the orthodontic treatment.

Caso tratado com INVISALIGN
Case treated with INVISALIGN

Dental Veneers

Home » Treatments » Dental Veneers

Dental Veneers

Dental veneers are very wafer-thin laminates or shells of tooth-coloured material bonded to the front surface of teeth to improve their cosmetic appearance.

Depending on the aesthetic needs and the type of teeth involved, in order to place veneers, we may or may not have to wear out your teeth a little.

Veneers can be placed to provide a natural look and improve dento-labial aesthetics in a variety of situations such as fractured teeth, chipped teeth, stained teeth, worn teeth, uneven teeth, misaligned teeth, transparent teeth, diastema (teeth with space between them).

Responsible Doctors

Dr. António Pinhão Ferreira
Dr. António Pinhão Ferreira
Implantology and Prosthodontics
Dr. Adriano Sousa
Dr. Adriano Sousa
Prosthodonty and Oclusion

Types of Dental Veneers

Dental Veneers

Common questions

  • Improves dental aesthetics and smile;
  • Restores the buccal anatomy;
  • Improves gum health;
  • Improves phonetic and chewing functions;
  • Repairs fractures or stains.
  • The tooth wear procedure for the veneer to be bonded is irreversible;
  • If the dentin is much stained, the tooth may appear darker when the enamel is worn, compromising the final restoration in terms of colour.

Cleaning of dental veneers is equal to the rest of natural teeth. Therefore, you should always brush your teeth three times a day with fluoride toothpaste and at least at night, floss or brush and cheek with plaque elixir. All these daily actions helps to remove food waste, prevents plaque formation and consequent cariogenic and inflammatory gingival acidification.

Ceramic veneers last over 10 years on average.

If they deteriorate within this time, it may be necessary to repair or even replace the applied blade. It all depends on the technique used by the dentist and the personal care, hygiene and food.


Home » Treatments » Endodontics

What is endodontics?

Endodontics, popularly known as “devitalization,” treats dental pulp diseases (a set of living nerve tissue, blood vessels, and sensitivity receptors).

The pulp which is inside the tooth, in the pulp chamber and in the pulp canals, helps to irrigate (bring nutrients to the tooth) and cooperates for tooth sensitivity.

Dr.ª Vera Coelho
Dr. Vera Coelho
Endodontics and Restorative Dentistry

Endodontic treatment

When the pulp is struck by deep caries, repeated restorative treatments, dental trauma, fractures and severe wear, it becomes inflamed. Inflammation causes the pulp to swell and release gases, compressing the dental sensory receptors, causing acute pain, from occasional slight painful sensation caused by temperatures to spontaneous, violent and unbearable pain.

Untreated, the pulp eventually loses its vitality, becoming a dead tissue to which the body reacts, sending repair cells (white blood cells) to the site, constituting a collection of pus (abscess) that the body drains through of a fistula (small ball in the gingiva). The tooth is still alive because it is irrigated through the periodontium, but its interior has dead tissue. These signs and symptoms point to the need for endodontic treatment.

An endodontic treatment consists in the preparation and disinfection of the cavities and root canals to remove all dental pulp. The treatment ends with a sealing / obturation of the root canals by applying a biocompatible material to prevent bacteria from entering (a kind of “rubbery” material that the body does not recognize as a strange body).

Endodontic treatment may be done in a single session or in several sessions, depending on the condition of the periapical tissues.

After the endodontic treatment, the rehabilitation of the clinical crown will be necessary. This treatment allows saving natural teeth, preserving them from the aesthetic and functional point of view.

Illustrative cases

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