Medical Care 2017

MEDICAL

Care 2017

INTERVIEW DR VERICA LAZIĆ, Director of The National Health Insurance Administration

By Saving the Patients Also Get More

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t the end of 2016, Dr Verica Lazić, director of the National Health Insurance Administration, welcomes with satisfaction the results of the institution that she has headed since last year.

As she says, she is proud of the achievements, especially the fact that for the first time in Serbia the practice of placing medicines on the list of medicines with the signing of special contracts has been established, thanks to which part of the costs of new medicines for the needs of insured people is borne by pharmaceutical companies.

- Thanks to that the NHIA will, through the three-year duration of the special contract, allocate significantly less additional funds for new medications than would be allocated for the same medicines to be placed on the list of medicines without any special contract – says Dr Lazić at the beginning of this interview for CorD Magazine.

For the first ten months of 2016, the NHIA sent 544 insured individuals for treatment abroad, free in-vitro fertilisation was performed at as many as 16 health facilities, availability of drugs is at a satisfactory level, while patients' rights have been extended when it comes to rehabilitation

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• How many innovative medicines have been added to the list of medicines in this way?

- The NHIA has submitted requests for innovative drugs for years, and the guidelines, which recognised models of special contracts, entered into force during 2014.

Under the auspices of fiscal consolidation measures, funds in the financial plan of the NHIA were reduced in 2015, and in such a situation it was not possible to add innovative new medicines, which represent extremely expensive therapy, to the list of medicines. In 2016, 996,5 million dinars has been allocated for these medicines.

Intensive work was undetaken on the elaboration of models of special contracts and defining the list of priority medicines by the competent expert commission, in order for special contracts to be introduced for the

first time in Serbia, all with the aim The NHIA Management Board adopted a new List of medicines1st of securing as many new medicines December 2016. It contains 23 innovative medicines that are as possible in the context of limited resources. Thanks to this, we were secured for the first time as a right from the resources of able to add to the List of medicines mandatory health insurance 23 new drugs at the expense of the compulsory health insurance, which cines in 2015, which represents about 20 per cent of means a larger number of drugs than would be secured the total budget available to this institution. This year for those funds without special contracts. that amount will be even higher, primarily due to higher growth in spending of medicines from the C list of medi• Do you succeed in securing continuous supplies of cines, which are particularly expensive. It is important to medicines for health facilities? know that the NHIA settles all obligations for medicines - This is our main goal as an institution. As medicines in promptly and pays special attention to regularly paying Serbia are secured through public procurement, it is of all of its obligations towards all health institutions. vital importance that there is constant communication • There has also been plenty of controversy about rebetween the competent services of the NHIA, the Ministry of Health, medicine wholesales, medicine permit placing health booklets with cards. How much progress holders, manufacturers of medicines and medical inhas been made with that? stitutions or pharmacies. In this regard, in the case of - The project of replacing health booklets with health timely notifying of possible problems in supplying the cards is still continuing. In April 2016, with the new annexing of the Agreement on Donations with the National medicine market, we undertake activities to secure Bank of Serbia, it became possible, in addition to newgreater amounts of appropriate therapeutic alternatives from other manufacturers or, in exceptional casborn children and vulnerable insured people, for free es, if necessary, unregistered medicines are also placed health cards to be received by victims of domestic violence and children with special needs. The legal deadline on the List of medicines. Considering the complete picture of the medicine market in Serbia and the number for replacements is 31st December 2016. So far more of medicines on the List of medicines, I can say that the than 4.5 million requests to replace health booklets with availability of medicines for insured people is at a sathealth cards have been submitted. isfactory level.

• What is the situation like when it comes to referring patients abroad for treatment?

• How much of the NHIA’s total budget is earmarked for - In 2016 the Ordinance on conditions and methods for medications? sending insured people abroad for medical treatment - The NHIA allocated about 43 billion dinars for mediwas amended. The Gamma Knife Centre at the Clinical

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there have also been additions to the list of foreign medical institutions with which we cooperate. For the first ten months of 2016, the NHIA sent 544 insured individuals for treatment abroad, and the amount paid on this basis during the mentioned period exceeds 307 million dinars.

Of this number of insured people, 449 were children.

• You have also expanded some of the rights of insured people when it comes to rehabilitation.

- That’s right. In 2016 the NHIA adopted the Ordinance on medical rehabilitation in health institutions specialising in rehabilitation. This ordinance has extended the duration of rehabilitation for children with diabetes, children with oncological diseases, as well as obese children, while it is also stipulated that psychiatric patients will have the right to rehabilitation, except in cases when the disease is in the acute phase. This right has also been extended for severe neurological diseases accompanied by paralysis.

• Insured people can once again undergo in-vitro fertilisation procedures at private health institutions at the expense of the NHIA. At how many institutions is that now possible?

- In order to shorten waiting times for the provision of in-vitro fertilisation services, the NHIA, on the basis of a public call, Shorter waiting times for cataract operations concluded contracts with private health institutions and secured - When it comes to cataract surgery, the National Health Insurance Administration, via the concluding of contracts with ten private health institutions, has secured an additional capacity of capacities until year’s end. So now, 3,080 services. Since the beginning of 2016, when insured people began being directed to these in addition to five state medical ininstitutions, of the 2,995 insured people who opted for surgery at private facilities, 2,323 have stitutions, insured people can also been operated on – says Dr Verica Lazić. opt for one of 11 private institutions.

Since the beginning of the year, the Centre of Serbia began working, which freed up financial NHIA has directed in the process of in-vitro fertilisation resources that have for years been spent on referring 2,426 insured people - 1,364 to state facilities and 1,062 patients abroad for gamma knife treatment and which to private health institutions. Patients now that right can now be used for other indications. The Ordinance has to make three attempts at in-vitro fertilisation at the an expanded list of indications for referral for treatment expense of the NHIA, instead of two, as was the case to abroad for indications that impact on the youngest segdate, and under the same conditions as the first and secment of the population, children and adolescents, while ond attempts. ■

Trust in experts • Magnetic resonance • Ultrasound diagnostics • Specialist examinations: internists (cardiologists, endocrinologists, rheumatologists, immunologists), neurologists, gynecologists

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+381 11 78 57 555; +381 62 288 470 office@panaceapoliklinika.com www.panaceapoliklinika.com

CORPORATE PROFESSOR ALEKSANDAR N. NEŠKOVIĆ, Chairman of the Clinic for Internal Medicine and Chief of the Interventional Cardiology at the Clinical Hospital Centre Zemun

Every Other Citizen of Serbia Dies of Cardiovascular Disease!

In Serbia nearly 60 people per day experience a heart attack and, on average, 16 of them do not survive! According to official indicators of the Dr Milan Jovanović Batut Institute for the Public Health of Serbia, in 2014 some 53,993 people in Serbia died of heart and blood vessel diseases. That is more than half of all deaths. Not counting other cardiovascular diseases, myocardial infarctions alone are suffered by 16,000 to 18,000 residents of Serbia annually, and the impression is that the number of heart attacks is increasing constantly – warns professor Aleksandar N. Nešković, chairman of the Clinic for Internal Medicine and Chief of the Interventional Cardiology at the Clinical Hospital Centre Zemun, speaking in this interview for CorD

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rofessor Nešković says that in most cases myocardial infarction, or heart attack, is the result of atherosclerosis and rupture of the unstable atherosclerotic plaque. This results in the formation of clots in the coronary artery, which leads to the partial or complete blockage of blood flow. Acute myocardial infarction represents the death of the heart muscle, which occurs as a result of reduced blood flow through the coronary arteries.

laboratories with or without stent implantation. Widespread use of this intervention in Serbia has has resulted in a 50 per cent reduction of deaths after heart attacks. To achieve the maximal potential benefit of this lifesaving intervention, it is mandatory to plan and ensure additional employment of a significant number of doctors, nurses and x-ray technicians in the catheterisation laboratories, because currently employed staff is insufficient. Also, financial issues related to running this programme, which are unresolved for more than two years, must be solved, and, finally, there a need for new angio equipment at the majority of cardiac catheterisation laboratories. It is also necessary to introduce innovative drugs to cardiovascular medicine, which have long been widely used in the countries of Europe and the region and which significantly reduce

• How high is the risk of patients who have experienced a heart attack suffering a repeat occurrence?

- Compared to the general population, patients who have already suffered myocardial infarction are certainly at a greater risk of developing re-infarction and even death. About 20 per cent of those who have survived a heart attack experience a repeat cardiovascular events, including In Serbia over the last decade the most advanced methods have new heart attacks and strokes, which become available to patients in the treatment and care of acute are associated with high risk of death. myocardial infarction, which are conducted at larger regional centres Today it is possible to significantly reduce these risks and improve quality of life through so-called secondary prevention measures, consisting of damage to the heart and mortality risk after myocardial infarction lifestyle changes and the use of modern medical treatment. and are very effective in secondary prevention. These medicines are currently available to our patients in limited amounts, due to the • Do patients in Serbia have access to modern treatments and fact that they are not on the National Health Insurance Association’s therapies, compared to the other countries of the region, or Eupositive list of medicines. rope, when it comes to acute care and secondary prevention of heart attacks?

• However, it often seems that innovative therapy is reserved only - In Serbia over the last decade ate larger regional centers the most for oncology patients and sufferers of rare diseases. advanced therapeutic options have become available to patients - That is not true. Considering that most deaths in Serbia are a result suffering from acute myocardial infarction. These options include of cardiovascular disease, if some of the key innovative medicines in re-opening of coronary artery occluded by thrombus using percuthis domain are made widely available to cardiac patients, they will taneous coronary intervention (PCI) in the cardiac catheterization suffer less and live longer, with better quality of life. ■

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CORPORATE DR ĐORĐE BAJEC, Bel Medic

Major Surgeries, Minor Incisions Bel Medic General Hospital is the only hospital in Serbia that has a complete centre for minimally invasive surgery. The goal of the centre is to eliminate the need for conventional surgery through the development, testing and implementation of less invasive procedures. Bel Medic provides surgery in all medical fields: VATS, laparoscopic surgery, arthroscopy and endoscopic spinal surgery

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e spoke with professor Đorđe Bajec about the advantages and opportunities of minimally invasive access in abdominal surgery. Dr Bajec is a general surgeon at Bel Medic and president of the Serbian National Association of Bariatric Surgeons.

• What is the difference between open abdominal surgery and laparoscopic surgery?

- Laparoscopic surgery, or keyhole surgery, is minimally invasive surgery that is associated with several advantages over traditional open surgery. In an open procedure, one large abdominal incision is made to expose the tissues and structures inside for examination and surgery. In a laparoscopic procedure on the other hand, only a small incision of up to 1.5 cm in length is made in the abdomen, usually around the belly button area. Scars from open surgeries are not only an aesthetic problem, but also a health problem, because they significantly distort the struc-

laparoscopically. This includes all urgent conditions such as gall bladder inflammation, ulcer perforation, appendicitis and so on.

• How is it possible to remove organs such as the spleen, or a gallstone through an incision of just a few millimetres?

- There are special instruments that can mulch tissue of the different organs or gallstones. Small tissue parts are then easily removed through a incision of less than 12mm.

• You are one of the leading experts in bariatric surgery in this part of Europe. What are the results of laparoscopic bariatric surgery?

- The World Health Organisation has recognised extreme obesity as a disease, because it seriously threatens health, primarily as a risk factor for the development of cardiovascular disease, type two diabetes and other diseases. In recent years extreme obesity has reached epidemic proportions, as confirmed by the fact that bariatric surgery is ranked in second place in the U.S. among all operations in the abdominal cavity. ExTechnology and the experience of surgical teams today have reached treme obesity is the result of complex interactions between genetics and the such a level that the majority of procedures in abdominal surgery can environment. It is usually very difficult be done laparoscopically for extremely obese patients to lose weight with conventional methods, ture of the anterior abdominal wall. Since the overall trauma to such as diet, physical activity and medication. Bariatric surgery the skin and muscles is reduced, less post-operative pain and has proved to be very effective in this case. Reducing stomach voldisability, a shorter hospital stay, and a quicker recovery period ume and consequently the food intake mass can be permanently are major advantages that laparoscopic surgery offers when reduced, and the risk of comorbidities is significantly decreased. compared to traditional operations.

• How much weight can be lost after bariatric surgery?

• What kinds of operation can be performed using laparoscopic - Patients who have a BMI (body mass index) more than 60 can surgery? reach an ideal weight within a year or two, while those with a lower - Twenty years ago indications for laparoscopic surgery were reBMI can do it even faster. Most people are aware of gastric bypass lated exclusively to gallbladder operations. Technology and the surgery and gastric banding as popular options for bariatric surexperience of surgical teams today have reached such a level gery. However, gastric sleeve resections have grown in popularity that the majority of procedures in abdominal surgery can be done over the last five years. ■

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CORPORATE Atlas General Hospital, Belgrade

Global Standards in Serbian Private Medical Practice Osmana Đikića 3, Belgrade Phone: +381 11 785 88 88 office@atlasklinika.rs atlasklinika.com

Atlas General Hospital is the first private hospital in Serbia focused on surgical services with the most complex and demanding surgical procedures

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tlas General Hospital is the first private hospital in Serbia focused on surgical services with the most complex and demanding surgical procedures.

It has placed itself among the top private healthcare providers in Serbia by investing in state-of-the-art equipment to perform the most complex surgical procedures.

“Our success lies in our knowledge, experience, commitment, effort and constancy.”

Atlas hospital is headed by the founders, Dr Igor Georgijev and Dr Lazar Pajevic. The Hospital has highly trained medical experts who keep up with current global trends, experts who attend training courses and search for professional development in order to provide patients with the most advanced treatments.

DR LAZAR PAJEVIĆ, specialist in aesthetic, plastic and reconstructive surgery (left) and DR IGOR GEORGIJEV, specialist in aesthetic, plastic and reconstructive surgery

“Our patients are from all over the world who are in need of surgical treatment”.

The hospital consists of two modern, luxurious buildings covering an area of 1,600 m2. It has a Diagnostic Endoscopy Centre, a Spinal Surgery Centre, an Arthroscopic and Sports Surgery Centre combined with Bioregenerative medicine.

Atlas General Hospital provides professional and secure patient transport across Serbia and worldwide, accompanied by highly qualified doctors and medical staff trained in emergency medicine, traumatology, cardiology, paediatrics and neonatology.

Atlas General Hospital has successful cooperation with the largest insurance companies from Serbia and abroad, and also is the first private hospital in Serbia that has ever signed a contract with the national fund - The Health Fund of Republika Srpska. ■ “We provide 24/7/365 services.”

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CORPORATE DR TANJA RADENKOV MICIĆ, Eterna

Another Year Older, But Younger Why shouldn’t the New Year bring with it a new and fresher face? It’s still not too late for that to happen

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r Tanja Radenkov Micić from the specialised beauty enhancement centre Eterna is a champion of so-called instant youthfulness and has some advice for how to achieve it.

• What do you first recommend to obtain young, fresh skin?

- On the basis of my rich experience I would recommend Ellansé bioresorptive collagen stimulator. This dermal filler not only repairs the appearance of wrinkles, it also stimulates the production of collagen in the skin, which gives a natural and lasting effect. Ellansé is different from all other fillers on our market, because it offers a completely personalised treatment with a reliably lasting effect from one year (Ellansé-S), up to as much as four years (Ellansé-E).

• How does Ellansé work?

- Collagen is very important for our skin, as it helps maintain its firmness, elasticity and tension. With time, the skin loses collagen which leads to its relaxing with deep fissures and wrinkles as a result. Ellansé works in a completely different way from traditional dermal fillers, which just correct shallower and deeper wrinkles. Thanks to its unique properties, Ellansé not only repairs the appearance of wrinkles and deeper fissures on the face, but rather by stimulating the production of collagen in the skin removes the main cause of ageing, leading to a long-lasting, natural skin appearance. The treatment takes about 30 minutes, after which you can freely return to your everyday activities.

• How long does the result of the treatment last?

- The results in terms of a natural and beautiful appearance are immediately visible, and the uniform effect lasts from one to four years, depending on which form of Ellansé you choose. Ellansé’s advantage lies in the fact that with just a single treatment you will see visible and lasting results, which makes it a very economical and comfortable treatment. After the treatment, a visit to the sauna or intense physical activity is not recommended for the first 24 hours. It is also advised that you avoid sunbathing or the solarium for the first week after treatment.

• Why do you think Ellansé is the perfect choice both for women and men?

- For several reasons. The immediate visible effect, the revitalisation of the appearance and firmness of the skin through the stimulation of collagen, the natural, fresh look, the long-lasting effect that comes after just one visit to the doctor. And I should repeat that we are talking of a very economical treatment.

• Apart from Ellansé dermal fillers, what else do you recommend to reduce the effect of wrinkles and freshen the facial skin?

- CellularMatrix combines autologous conditioned plasma enriched with thrombocytes with growth factors and hyaluronic acid. The wellknown PRP treatment is a safe and effective way of stimulating endogen regeneration and healing capacities. The growth factor from thrombocytes in the deeper layers of the skin activates the process of regeneration. Hyaluronic acid has been used in dermatology and aesthetic medicine for over 25 years. It is a natural constituent of our organism and is marked out by its large capacity for binding water, which gives The results in terms of a natural and beautiful appearance are our skin back its hydration, volume and immediately visible, and the uniform effect lasts from one to four support. CellularMatrix combines hyaluyears, depending on which form of Ellansé you choose ronic acid with the stimulating effect of autologous growth factors. This revolu-

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tionary method carries a reduced risk of undesired reactions, since it is a product of autologous origin. The procedure involves a combination of derivatives of the patient’s own blood with unmeshed hyaluronic acid.

Eterna is dedicated to its patients The specialised centre for enhancement of beauty Eterna is a centre that indulges its patients and improves the modern way of life. Eterna works to develop the vision of being known as a centre that is a modern, high quality and trustworthy partner in treatment and the improvement of health. Eterna is dedicated to its patients and provides timely, high quality and modern services every day, respecting ethical and leading best practices. The exceptionally professional Eterna team has acquired its knowledge both in Serbia and abroad.

• How is the procedure carried out?

- One procedure lasts a short time, between 30 minutes and at most an hour. And it is important to remember that the patient can return to everyday activities immediately after the treatment. The procedure involves taking a blood sample, separating the blood’s components by centrifuge, mixing hyaluronic acid and PRP and application of CellularMatrix on the desired area.

• How many treatments of CellularMatrix are required?

- The application protocols depend on the depth and prominence of the wrinkles, hypertrophic scars, keloids… According to the examination the doctor decides on the required number of treatments for each patient individually, to achieve the best result. The treatment is safe, but precautionary measures must be born in mind. To be more precise, taking blood and applying CellularMatrix must be carried out in a sterile environment to avoid the possibility of infections.

• When are the first results visible?

- This is one of patients’ favourite questions. An immediate effect in terms of hydration and increased volume is visible immediately after the first treatment. The gradual freeing of growth factors brings visible results over a period of two weeks after treatment.

• What would you say are the advantages of CellularMatrix treatment?

- There are many advantages of this treatment. I could mention the completely natural look with no effects of over-filling or frozen facial features, the stimulation of regeneration of the skin, its rehydration, the long-lasing freeing of growth factors thanks to the interaction of thrombocytes and hyaluronic acid, the insignificant undesired effects as the autologous product is 100 percent biocompatible. Thanks to such treatments and products I can tell all our patients: “Welcome to www.eterna.co.rs the future!” ■

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CORPORATE NAĐA STUPAR MD, Clinical biochemistry specialist, Aqualab

NIPT – Next Generation

Pregnancy represents one of the most beautiful experiences for women, which carries with it a great sense of responsibility.

Support is needed from loved ones, but also professional people who should provide all necessary information related to this complex condition, which in Serbia is referred to with reason as the “second state”. Women who have been informed and sure of themselves have had positive experiences

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lthough pregnant women are expected to make numerous visits to the doctor for mandatory inspections and controls, they should approach that positively and try to dispel normal fears about their health, and especially the health and development of the child. Undoubted asssistance in this is provided for both pregnant women and doctors by the latest generation Panorama non-invasive prenatal screening tests, produced by American company Natera. Aqualab Plus laboratories are exclusive representatives of these tests for Serbia, Montenegro and Bosnia-Herzegovina.

• What is NIPT? What sorts of tests exist?

- Non-invasive prenatal screening test which detects congenital anomalies caused by disorder in the number or structure of a baby’s chromosomes.

A large number of tests exist on our market and use the method of counting, but only Panorama uses patented SNP technology of the latest generation.

• Who is advised to take the test? Are there any limitations?

- All pregnant women, regardless of their age, who want to eliminate doubts about possible genetic disorders of their baby, especially pregnant women over the age of 35; pregnant women referred for amniocentesis following an ultrasound test and/or common test from maternal serum (Double, Triple, Quadruple); pregnant women who already have a child born with a genetic disorder. Apart from in these cases, this test should also be carried out when there is evidence of previous miscarriages or with carriers of genetic disorders, especially when there is increased risk from invasive diagnostic methods (amnio and cordocentesis).

The test is not carried out in the case of twins and multiple pregnancy.

• What needs to be done to obtain a test result?

- The test is simple and easy to perform and implies providing data and taking sampling of venous blood of the mother. The process doesn’t take long to perform. Consumption of food or Aqualab Plus laboratories are exclusive representatives of medicine, or time of day, do not influence the test results.

these tests for Serbia, Montenegro and Bosnia-Herzegovina • What is Panorama and what are the advantages?

- Panorama represents the next generation of NIPT’s. That is the only non-invasive prenatal test that distinguishes available fetal DNA from available maternal DNA. It has the lowest percentage of false negative (0.7%) and false positive results (0.35%). It detects conditions that other tests cannot detect: triploidy, mosaicism in the mother, molar pregnancy, vanishing twin syndrome. Another important advantage is the most competitive price on the market, with the possibility of payment in six monthly installments.

• In which week of pregnancy can the test be done and what is revealed by this test?

- Already after 9+ weeks of gestation. Panorama in three panels reveals trisomy of the 21st (Down), 18th (Edwards) and 13th (Patau) chromosomes, Monosomy X (Turner Syndrome), triploidy of all chromosomes / Vanishing twin, 22q11.2 microdeletion syndrome (DiGeorge), Angelman, Cri-du-chat, 1p36 and Prader-Willi syndrome.

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• Is it possible to determine the sex of the baby?

- Yes, gender determination is 100% accurate. It is an integral part of the test and the result is only shown if expressly desired.

• When are test results received? How reliable is the test?

- Results are obtained within 3-5 days of the sample being received at Natera (USA). Due to the transportation, we issue the result within a deadline of 7-10 days. The accuracy of the results exceeds 99%.

• What if the test is positive? Where can the Panorama test be done?

- In the case of a positive finding, amniocentesis and analysis of amniotic fluid is free of charge, as is consultation with a genetic advisor.

It is necessary visit Aqualab Plus laboratories or one of the collaborative clinics. All information can be obtained at the information desks of any of our laboratories, as well as by calling the contact numbers that you find on the Aqualab Plus laboratories website:

www.aqualab.rs ■

CORPORATE Adent

Trends In Modern Dentistry Many of us have bad memories of dental treatment some years ago. Dental treatment did focused on the patient, but on removing the patient’s immediate problems, mostly pain

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day but certainly within 48 hours. Our patients receive an mplant dentistry was developed with the idea of rehabiliimmediate prosthesis that is fixed with retention screws tating the chewing function, so that patients without teeth that can only be removed by the dentist in the clinic, which could eat well without removable dentures, since these provides a great opportunity for cleaning on a follow-up were usually uncomfortable and fitted badly. Implants bevisit. In some cases, due to a lack of bone, patients require came the most natural replacement for missing teeth, when grafting procedures to be able to receive dental implants. one or just a few teeth were missing. Restorations with imWith techniques like All-on-4® that we began using 11 years plants don’t require grinding or damaging neighbouring teeth, so they cause the least biological trauma. However, the time ago, our patients avoid aggressive and traumatic procerequired for patients to receive final restoration meant that dures of bone grafting, and are still able to receive a fixed many of them reverted to a different type of treatment. And restoration on 4 implants. as additional procedures were often needed, the time needed The use of digital techniques also shortens the treatment to finish treatment was prolonged, sometimes even more time and increases the quality of rehabilitation with dental than a year. implants. Thanks to the Cone Beam CT, or to use a popular exIn the last 10-15 years, as a changing society brought about pression the 3D x-ray, and in combination with planning softcertain trends and heightened demands, implant dentistry ware, we are able to predictably plan implant positions, so that became focused on patients’ needs.

Research, development, and advanceThanks to the Cone Beam CT, or to use a popular expression the 3D ments in technology and clinical techx-ray, and in combination with planning software, we are able to niques enabled us to offer treatments predictably plan implant positions, so that restoration on implants that allowed patients to function and aesthetics to be rehabilitated immehas a more natural appearance diately. For example, when a patient comes into our clinic with a fractured tooth that has to be restoration on implants has a more natural appearance. The removed, she leaves the clinic with a temporary crown fixed use of digital intraoral scanners like Cerec allows us to create on an implant, and this provides a satisfactory functional and a crown on a single implant within 45 minutes, without having aesthetic result. The NobelActive® implant provides excepto take uncomfortable impressions. For bigger restorations, CAD/CAM machines give us the ability to produce very pretional results in such a situation, and the Adent dental clinic cise restorations that are attached to implants with screws, was part of the prelaunch group for that implant. making them reliable, safe, and aesthetically superior rehabiliWe often face patients that are about to lose all of their tations for our patients. teeth. Besides functional and aesthetic considerations, The Adent dental clinic has 25 years of experience with patients are faced with the psychological concern of losing Cerec, 22 years of experience with Dental Implants (Nobel teeth and wearing dentures. However, these patients can Biocare) and 11 years of experience with All-on-4®. ■ be treated with immediate restorations, usually the same

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