1. Orthognathic surgeryJaw surgeryPatient information guide1

2. Content3Introduction8Orthognathic procedures21 Treatment schedule30 Agave Clinic2 3. Introduction Orthognathic surgery is an unfamiliar term to most people. Therefore they are uncom- fortable, even fearful, in considering it as a treatment option. The information in this booklet is designed to take you step by step through the process involved with orthog- nathic surgery so you understand the entire orthodontic and surgical experience. It is our goal for you to feel completely informed and comfortable with your treatment.3 4. Combined orthodontic and orthoThe word orthodontics comes from the Greek word or-thos, meaning to straighten, and odons, meaning teeth.Orthodontics is a specialty of dentistry that is concernedwith the straightening of improperly aligned teeth.The word orthognathic also comes from the Greek wordorthos, meaning to straighten, and gnathos, meaningjaw. Orthognathic surgery thus means surgery tostraighten the jaw.Orthognathic surgery, also called jaw Because moving the jaws also moves theOrthognathic surgery focuses on im-surgery, corrects the jaws by means of an teeth, orthognathic surgery is usuallyproving the patients appearance asoperation. Such corrections are largely performed in conjunction with ortho-well as the functionality of the jawsachieved by dissecting the jaw in separatedontics so that the teeth are in proper and teeth. The aim is to achieve afragments which are then moved into position after surgery. In diagnosing yourproper occlusion (the manner in whichnew positions and fixed with plates and need for orthognathic surgery, the oral the upper and lower teeth fit together)screws. All incisions are made inside the and maxillofacial surgeon and the ortho-and a more aesthetically pleasing face.oral cavity, avoiding any visible scarring. dontist will work closely together. Theorthodontist is responsible for movingthe teeth so they will fit together proper-ly after the jaws have been repositioned.The maxillofacial surgeon is responsiblefor repositioning the jaw so the teeth andjaws are in proper alignment.4 Patient information guide 5. ognathic treatmentProper occlusion Enhanced facial aestheticsConclusionMany malocclusions are correctable Patients also enjoy an enhanced facialIn summary, orthodontics correct ab-by wearing orthodontic braces alone. profile, since oral disorders frequentlynormal tooth position and orthognathicIn some situations, however, the upper affect facial balance and aesthetics. surgery corrects abnormal jaw position.and lower jaws are of a different size or Some people may consider having cos-Combined orthodontic and orthognathicshape, or are in an incorrect relationship metic procedures to enhance their new treatment provides us with the oppor-to one another. In this situation it will appearance, such as surgery on the eyes,tunity to improve both functional andbe necessary to align the jaws and the nose, forehead, chin or neck. You may cosmetic problems at the same time.teeth. In this way the orthodontic result wish to discuss these options with youris not compromised and the optimum surgeon.result is achieved as far as long-termstability, appearance and function areconcerned. Sequence of treatmentSevere malocclusion (bad bite) maycause many functional problems. YouCombined orthodontic and orthognathicmay have already experienced some of treatment often takes considerable timethe following: to complete and therefore requires great motivation and cooperation from the inability to chew food properly patient. A close liaison between the pa- which compromises digestion tient, the orthodontist and the maxillo- speech problems facial surgeon is also important. Several facial muscle dysfunction character-stages are involved in treatment: ized by headaches, joint pain, etc. evaluation and planning periodontal trauma. pre-surgical orthodonticsFunctionality is increased when teeth surgical treatmentfit together firmly, making biting and post-surgical orthodonticschewing food easier. Surgery also allevi-ates the grinding and pressure associated follow-up visitswith most oral disorders, and preventsfurther damage to the affected teeth.Orthognathic surgery 5 6. About facial harmonyWhile tastes do differ, Dividing the face in thirdsin orthognathic theory, Facial balance typically is assessed by dividing the face in thirds. The upper third isa number of guidelinesfrom the anterior hairline to the point on the midline between the eye-brows (gla-bella). The middle third reaches until a point immediately under the nose (subnasale).describe what are the The lower third ends on the midpoint of the chin (menton). When each of the thirdscharacteristics of an aes-is equal, the face is said to be vertically balanced and of ideal proportions.thetically pleasing face.1/31/31/36 Patient information guide 7. Facial ConvexityAdditionally, in profile view the face should have a slight degree of convexity as meas-ured from the glabella to the subnasale to the menton. Excess facial convexity, flatness,or concavity is felt to be less ideal. Of course it has to be noted that these guidelinesare only idealized concepts. They merely provide a guideline that is not true for everypatient. A wide range of faces defy such absolute canons.Ideal facial convexityLack of facial convexityExcess facial convexity Orthognathic surgery 7 8. Orthognathic procedures This section will describe all orthognathic procedures performed by Agaves team of specialists. In this chapter we discuss the orthognathic pro- cedures according to their anatomical location: the upper jaw, the lower jaw and the chin.Chapter contentLower jaw surgeryretractionadvancementUpper jaw surgeryretractionshorteningrotationwideningChin surgeryretractionadvancement8 9. Lower jaw surgeryLower jaw surgery isdone to correct abnor-Technical: Sagittal split osteotomymalities of the lowerjaw (mandible), whichmay be too small or too The operation is carried out almostentirely from inside the mouth tolarge. The jaw can be minimize visible scars on the skinadvanced or retracted of your face. It is performed undersurgically. Rotation is general anaesthesia.also possible.The most common operation toIt is then fixed with small screwsadvance or retract the jaw is called aand sometimes plates. It is oftensagittal split osteotomy (see the tech-necessary to make a small puncturenical box). This type of surgery allowsincision (a few mm long) low downfor the placement of bone screws oron the side of the cheek to allow theplates. Consequently the jaws dontscrews to be inserted. These titaniumhave to be wired together at the endscrews, which are left in placeof the procedure.permanently, do not set off metaldetectors in airports.The lower jaw is split in a verticalThe gum inside the mouth is sutured(sagittal) plane on each side withusing dissolvable stitches that may takea small saw behind the last tooth.3-4 weeks to dissolve Sometimes lightThe bone is split in a front to backelastics are placed between the teethdirection so the two pieces can slide to guide the jaw into the new bite.along each other and still overlap. Lower jaw surgery may be per-The part of the lower jaw with theformed as a single procedure or inteeth is moved forward or backwardcombination with other orthognathicas needed to obtain the desired biteprocedures.and appearance. Orthognathic surgery 9 10. Retraction of the lower jawWhen the lower jawgrows out too far in frontof the upper jaw, thisresults in mandible prog-nathism. The lower teethare more pronounced thanthe upper teetha condi-tion called underbite.Orthognathic surgery can be used toslide the lower jaw back.10 Patient information guide 11. Advancement of the lower jawThe underdevelopment ofthe lower jaw is called ret-rognatia. In this case, thelower teeth are positionedtoo far behind the upperfront teeth (overbite).This condition can be treated by surgi-cally advancing the lower jaw.Orthognathic surgery 11 12. Upper jaw surgeryUpper jaw surgery isnecessary to correct ab- Technical: Le Fort I osteotomynormalities of the superiorjaw bone (maxilla). A Le Fort I osteotomy is the most The upper jaw bone is then movedThe upper jaw may be or narrow, toocommonly used procedure tointo its final position (plannedlong, too short, too far forward or toomake bone incisions in the upperprior to your surgery) and held infar back to fit the lower jaw properly. In jaw. This procedure is performedplace with tiny titanium plates andmaxilla surgery, the upper jaw can be ro-under general anaesthesia.screws, which are left in placetated or repositioned forward, backward, permanently.or it can be raised or lowered. Also,The operation is carried outasymmetries between different sides of entirely inside the mouth. A U- The gums are stitched back intothe face can be corrected. Widening of shaped incision is made through place with dissolvable stitches.the upper jaw is possible by a surgicalthe gums above the upper teethThese stitches may take three tosplit in the midline followed by distrac-to gain access to the jawbone.four weeks to dissolve.tion (see technical box on page 17). The gum is then raised off theUpper jaw surgery is performed mainlybone. After the bones heal together, theby utilizing a bone dissecting procedure jaw regains its normal strength.called Le Fort I osteotomy (see techni-The upper jaw incisions arecal box).made with highly specialised tools, which allow for a control- led parting of the bone. Additional bone is removed if the upper jaw is to be shortened. Bone can be added if necessary to lower the jaw and make it longer (bone graft).12 Patient information guide 13. Advancement of the upper jawThe underdevelopment ofthe upper jaw is calledhorizontal maxillarydeficiency. The lower teethare in front of the upperteeth a condition calledunderbite.These patients may have a sunken in orvery flat face. Facial contour and dentalocclusion can be harmonized with theadvancement of the upper jaw by cuttingit horizontally and moving it forward.Orthognathic surgery 13 14. Shortening of the upper jawVertical maxillary excessis when the upper jaw(maxilla) has grown toofar down.When smiling, too much gingiva is visible(gummy smile) and often there are dif-ficulties in putting the lips together. Notonly is this situation cosmetically undesir-able, it can also result in sore, red, bleedinggums from chronic exposure to air.This problem can be orthognathically cor-rected by excising a segment of upper jaw,therefore elevating the level of the teeth.14 Patient information guide 15. Rotation of the upper jawWhen only the back por-tion of the upper jaw isoverdeveloped vertically,this will result in the in-ability for the front teethto meet a conditioncalled open bite (aper-tognathia).As the back portion of the upper jawgrows vertically downward, the lower jawwill open in a clockwise direction. Thisexplains why open bite patients have along facial appearance. There is little orno ability to bite using the front teeth.This makes eating a challenge, and causesproblems with swallowing, speech, andoften resulting in red swollen gums dueto chronic air exposure. This conditioncan be corrected by removing a wedge ofbone in the upper jaw.Orthognathic surgery 15 16. Widening of the upper jawWhen the upper jaw istoo narrow, this results inwhat is called a transversemaxillary deficiency. Thisnarrowness can cause theupper teeth to bite insidethe lower teeth (crossbite),crowding of the teeth,or black corridors uponsmiling.The patient may have a smile thatshows mostly the two prominent frontteeth, with the others in shadow (buc-cal corridors). Also crossbites can havea pronounced effect on the overall facialappearance.With a distraction procedure the upperjaw can be widened until it fits around thelower jaw. Surgery is used to separate thetwo halves of the upper jaw and a distrac-tion device is placed into the jaw. Thepatient has to turn the expansion screw ofthe device every day for about two weeks.New bone fills in between the graduallywidened two halves. Orthodontic treat-ment will close the gap created by thedistraction (for more information see thetechnical box on the next page).16 Patient information guide 17. Technical and practical: Distraction of the upper jawThe surgical procedure to make the has a center screw that must bebone incisions in the upper jaw is turned with a key. The divider isthe same as previously explained activated by placing the key intoin the Le Fort I osteotomy of thethe key-hole in the center screw andupper jaw. However, to create twothen gently pushing toward the backhalves one more incision is made of the mouth.vertically on the midline of yourupper jaw. Each day, we open the palate 0,5 mm. So, after 10 days, we canA distraction device is placed withexpect an opening of 5 mm between Before distraction.a little plate on each side of the the two front teeth.palatal bone of the upper jaw. Atthe end of the operation, a smallThe screw usually has to be turnedblocking screw is inserted.for 1 to 3 weeks depending on the amount of widening needed. Consolidation phase Once the widening of the palate is achieved, the fixing screw is placed again. The distractor should be kept firm and immobile in the mouth for After the activation phase. 3 to 5 months. This allows time for new bone to form and ensures that the widening will not relapse. In this phase, the orthodontist may begin treatment to close the gapActivation phase between the front teeth.A new consultation is scheduled aweek later. The blocking screw willLater on, the plates on both sides ofbe removed and the activation of the palate will be removed surgicallythe device can start. The distractor under local anaesthesia. After orthodontic treatment. Orthognathic surgery 17 18. Chin surgerySome faces have a poorprojection of the chin, anTechnical: Sliding genioplastyoverprojected chin, or aproblem with the width or Chin surgery is carried out underheight of the chin. Chin a general anaesthetic and takessurgery can be used to about one hour.improve the appearance An incision is made inside theof a persons chin.mouth, so no scar will be visible on the outside. A particular process, known as a slid-The chin is cut from back to front ing genioplasty, involves separating aon both sides, using a powered horseshoe-shaped piece of the chin bone saw with a special blade to from the lower jaw and sliding it eitherseparate the edge of the chin. The backwards or forwards, and finally fixing bone segment is then slid forward it in place using titanium screws.or backward, or any direction desired. If needed, a segment of The profile of a patient can be sig-bone can be removed. nificantly altered with a chin procedure. This, in turn, has a significant effect onThe piece is then secured with overall facial symmetry.permanent titanium miniplates Men and women look best with certainand screws, which will never be types of chins. A small chin can make a removed. large nose look even bigger, or conversely, a large chin may even make a large nose look tiny for the face. This chin/nose relationship must be harmonious.If dental occlusion is satisfactory, the appearance of the chin can be dealt A central consideration in deciding if with by chin surgery alone. chin remodeling alone is appropriate is whether dental occlusion (the way yourIf it is not, a combination of upper or teeth meet) is correct or not.lower jaw surgery may be needed.18 Patient information guide 19. Advancement of the chinIf only the lowest third ofthe face is sunken in, yetthe occlusion is normal, achin advancement may bethe solution. Especially inmen, it can help to makethe face look stronger.Orthognathic surgery 19 20. Retraction of the chin In patients with an over- projected chin and a normal occlusion, the chin as a separate entity can be retracted.20 Patient information guide 21. Treatment schedule The following is a general sequence of events that occurs once your treatment begins. Please remember that each treatment plan and case may vary from this general sequence of events. Treatment schedule 1Evaluation and treatment planning1 week 2Pre-surgical orthodontics12-18 months 3Surgery2 weeks 4Post-surgical orthodontics 3-9 months 5Follow up visits 6 months21 22. 1Evaluation and planningDuring your first visit, a set of diagnostic records will be made to determine thenature of your problem and what can be done to correct it. After processing andanalyzing these records, we will meet you to discuss your treatment options. Thefollowing explains the individual records that may be taken and their purpose. PhotographsCephalometric radiograph Panoramic radiograph Frontal and profile facial photographs are This side view radiograph of the face al-The panoramic radiograph is a compos- an essential part of the overall planninglows us to compare your tooth and jawite view of the teeth as well as both jaws. of the case. These images serve as visualrelationships to normal or ideal measure-In one film, it shows us if you have the aids for bony and soft tissue analysis soments. Computerized analysis permits the normal number of teeth, wisdom teeth, that the facial aspects of treatment can prediction of planned bone movements or impacted teeth. be thoroughly evaluated. Photographs ofand resulting soft tissue response through the teeth will also be taken to provide an the merger of the facial pictures with the accurate record of the mouth at the time cephalometric radiograph. treatment begins.22 Patient information guide 23. Optional: Conebeam CT A new software has been developed by Medicim in Belgium, called Maxilim. Using the Maxilim software we can make virtual incisions to move the jaws and chin as planned, then show the potential result to the patient. Small corrections can be made on the computer during the consul- tation. If the patient likes the result, we send the data to Belgium. After a week, we receive a set of acrylic templates that will enable the surgeons to follow the computer plans precisely during theDental modelsactual procedure.Dental models will be used to study theproblems that exist at the beginning ofThe use of Maxilim software permits us to predictthe treatment and are used for reference the facial changes which you might expect withduring pre-treatment planning. treatment. To be able to do this, a conebeam CT scan will need to be taken. A conebeam CT has the advantage of extremely low radiation dosage plus the fact that the patient is in a sitting position, which gives a more natural appearance of the soft tissues. Please note that the use of Maxilim is not standard and will increase the cost of your treatment.Orthognathic surgery 23 24. 2 Pre-surgical orthodontics Pre-surgical orthodontic treatment often involves fixed brace treatment lasting 12-18 months and is essential for the stability of the result.The purpose of orthodontic therapy is to Tooth irregularities are treated usinglevel and align the teeth so that once the corrective appliances known as braces.surgeon moves the jaw bones, the teeth Braces are made from wires and springswill fit together. attached to tiny metal plates or a plastic mould. Braces use gentle pressure toOrthodontists are specialised dentists slowly shift teeth into their new posi-that are typically required to complete tions. Modern orthodontic treatmentan additional three to four years of post- uses very mild pressure to reduce thedental school education before becoming discomfort. Also, modern braces are lessa certified practitioner of orthodontics. noticeable than old-fashioned braces. The braces remain in position during the operation to aid the surgeon in position- ing the jaws correctly.24 Patient information guide 25. 3The surgeryPre-Operative InstructionsThe operationComplications You should not eat or drink anything You will be admitted to the hospi-The possible complications include: 8-10 hours before surgery.tal the morning of your scheduled Bleeding. Arrange the necessary time off from surgery. The length of your surgery depends on the procedure being per- Infection. work or school. Most patients will need one to four weeks of convales- formed, but normally ranges from 2 Nerve injury (permanent numbness cence.to 5 hours.of the lip, tongue, cheek, etc.). To avoid pulling clothes over your Orthognathic surgery is performed Relapse or return to original jaw po- head postoperatively, bring someunder general anaesthesia. sitioning. button-down or zippered shirts. Intravenous fluids are administered at Damage to teeth. We strongly advise you to stop smok-the time of surgery. The I.V. is used during surgery to maintain adequate Scarring. ing three weeks before surgery, as smoking counteracts wound healing.fluid levels and is used after surgery Temporomandibular (TMJ, or jaw to administer pain medication, an- joint) problems. tibiotics, etc. It is generally removed the day after surgery. Nasal airway obstructions. Non-union (inadequate closure) ofthe bone. Sinusitis (swelling of the nasal si-nuses). All of these are rare.Orthognathic surgery 25 26. Post-operative instructions: Cooling: During the first postop- Oral hygiene: We will provide you Aftercare: Normally, you will be dis- erative hours a mask with a constantwith a post-surgical antiseptic mouth- charged from hospital by your surgeon temperature of 15 degrees Celsius willwash, with which you should rinseone or two days after surgery. If alone, cool the surface of your face and keepas directed until you can brush your one of our nurses will accompany you bruising and swelling to a minimum. teeth normally. However, you shouldto your hotel. You will have daily revi- This will add to your comfort and as- try to switch to fully cleaning your sions in Agave Clinic during your stay sist you in a more rapid recovery fromteeth with a toothbrush, toothpastein Marbella. surgery. Nevertheless you should be and dental floss as soon as possible. Our team is permanently at the pa- prepared to be seriously bruised and Mouth opening: Immediately after the tients disposal. Contact with our swollen for about one week. operation you should actively exercise specialist during office hours can be Pain: Postoperative pain normally isyour jaw (using your chewing muscula-made by telephoning our direct line. surprisingly mild. We will provide youture, not by manipulating your jaw withAfter hours this contact is available with painkillers for the first few days.your hands). Practice gently opening through the 24-hour emergency serv- your mouth and moving your jaw fromices of the USP hospital. Food: It is a good idea to only eat soft side to side. This ensures a speedy re- foods for the first few weeks. After Before you leave Marbella you will be covery of normal jaw function. about a month, patients can switch toseen again at Agave Clinic. If neces- foods with regular consistencies.sary, sutures will be removed 5 to 7days, before leaving Marbella. Working: About two to three weeksafter surgery you can start workingagain. The swelling will disappearcompletely in about six months. Sports: Refrain from contact sportsfor 6 weeks.The cooling mask againstpain and swelling.26 Patient information guide 27. 4 Post-surgical orthodonticsUsually a period of post-surgical orthodontics arerequired after the surgery to fine-tune the bite. This finish-ing period usually lasts between 6 to 9 months. RetentionThree weeks after surgery, the orthodon- Usually a fixed retainer will be bonded totist continues with the treatment plan.the inside of the lower front teeth beforeThe tooth arcs were already in line, but removing the braces. The upper retainernow the relationship between them hasis usually removable. One week afterbeen normalized by the surgeon. The or-removing your braces, you will receivethodontist will now work to finetune the this retainer and instructions on care Fixed retainer for the lower teeth.bite so all the lower teeth make contact and use.with the corresponding upper teeth. Retention is a crucial part of your or- thodontic treatment. Retainers are to be worn at all times during the first few months to one year following treatment. Once you have reached a point where your teeth and bones have stabilized, you will be able to limit the use of your retainer to sleeping only. Keep in mind, however, that the more the retainers are worn, the less chance there is of teeth moving out of place.Removable retainer for the upperteeth. Orthognathic surgery 27 28. 5Follow upOne, three and six weeks after surgery wewould like to check your bite and evalu-ate your healing progressOnce your treatment is complete, a setof final records will be taken at AgaveClinic. These records consist of the samerecords taken at the time of your initialvisit. This appointment is generally 1-2weeks after your braces are removed.Six months later one more visit to theorthodontist is necessary to check yourbite and to adjust your retainer (for thelast time!).28 Patient information guide 29. Frequently asked questionsDo I need to follow a spe- Will my jaw break more eas- Is orthognathic surgerycial diet after the surgery? ily after such an operation?painful?You should only eat soft foods for the No. Once the bone is completely healed, The postoperative pain is remarkablyfirst weeks. After about a month, pa-your jaw is as strong as before.mild and can be managed with standardtients can switch to normal foods. painkillers. The swelling, however, causes discomfort for 1 to 2 weeks.In principle, patients can eat anythingthey want to, just not always in the way When can I start workingthat theyre used to. Food can be finely again?shredded with a food processor, blender, Is orthognathic surgeryor mixer.Most people start working after two todangerous? three weeks. This type of surgery, in the hands of anWhen can I start practi- experienced team, is very safe and has ationing sports?Do the plates activatevery predictable outcome. In very rare cases a second surgery in the first week metal detectors?after the initial intervention is necessary,Bone healing will take 6 weeks. After because the position of the jaws is notthat the bone will be as strong as beforeNo, they are too small for that. as planned. Apart from complete sensorythe operation and you can practice any nerve damage, resulting in permanentsports you like again. numbness in half of the lower lip and How long will the swellingchin (which is extremely rare), no major last? complications exist.Will the plates and screwsbe removed?About 90% of the swelling will subside in 3 months. But it takes up to 6 monthsNo. Plates and screws are usually not re-for the swelling to disappear completely.moved, only in the rare case of infection.Orthognathic surgery 29 30. Agave Clinic Agave Clinic is an international pioneering centre dedicated to complete oral and facial reconstruction. Our goal is to achieve natural looking beauty by creating facial harmony.30 31. To create facial harmony you need tobe able to manage not only the facialskin, but also the facial bone and teeth.In our centre we perform: dentistry and implants, orthodontics, maxillofacial surgery, and facial plastic surgery.Because we have this complete team ofexperts for dentistry and facial surgery un-der one roof you can be sure that all possibleoptions will be taken into consideration andyou will get the most comprehensive treat-ment plan options to solve your problems. Itis the wide variety of treatments offered incombination with this close collaboration be-tween professionals that makes Agave Clinicreally unique.Agave Clinic is truly international becauseof its multilingual staff and the proximity toan international airport. Our staff are fullyconversant in English, German, Spanish,Dutch and Portuguese. For all other lan-guages we can provide an interpreter.Agave Clinic is only a 25 minute taxi drive toMalaga International Airport. Each month wealso have consultations in London, Blaricumand Papendrecht (the Netherlands).In Agave Clinics state-of-the-art facility,you are sure to receive first-rate service ina modern atmosphere. Here our experi-enced team of professionals utilise the latesttechnologies for a detailed examination andradiological assessment. Orthognathic surgery 31 32. Surgeries requiring general anaesthesia take place in the adjacent USP Hospital. Agave Clinic not only cooperates closely with the USP Hospital, but also serves as its maxillofacial and dentistry department. This hospital houses a team of more than 150 medical specialists, with six operating theatres, an intensive care unit as well as an Emergency Services department. Agave Clinic can be contacted 7 days a week, 24 hours a day, through the USP Emergency Services. The founding of Agave ClinicAgave Clinic was founded by Dr. Bart vande Ven (the Netherlands) and Dr DanielSimon (Brazil). They got to know andappreciate each others expertise duringtwo missions in Vietnam and Kenya for theCleft Surgery Organization (CSO). CSOis another initiative of Dr Bart van de Ven.Its mission is to provide free cleft surgeryfor affected children from poor families(www.cleftsurgery.org).Dr Bart van de Ven and Dr Daniel Simonnot only shared their passion for the CleftSurgery Organization, but also sharedthe dream of starting an all-round clinicfor facial surgery and dentistry in Europe,where patients could access quick andsuperior treatment options.32 Patient information guide 33. Patient coordination Our patient coordinator, Lilia Koss, looks after pa- tients that have to stay in Marbella a bit longer after their surgery. She assists with accommodations, recommends airlines and organizes your taxis and appointments.Flying to Malaga Hotels in MarbellaOur patient coordinators will suggest air- We will help you find your preferredpanion; patients who travel alone may belines from your country to Spain. From accommodations nearby and assist with recommended an extended hospital stayAgave Clinic to Malaga international reservations. Room service, internetor nursing care in the hotel (additionalairport is only a 25 minutes taxi drive. and other amenities are available uponfees involved).More than 60 airlines fly to Malaga. request. Prices may vary according to theWell pick you up from the airport and season. Consultations and check-bring you back for free. ups abroadAbout 40% of the population of Marbel- Aftercare in Marbella Each month we have a day of consulta-la is of non-Spanish origin so youll find tions and check-ups in the UK (London)English-speaking people everywhere.Our personal care and attention contin- and in the Netherlands (Blaricum and Pa- ues long after your procedure. During the pendrecht). You can make an appointment first week post-op, you will have daily re- by contacting Agave Clinic in Marbella. If visions in Agave Clinic. Once you returnyoure interested in dental implants and home, we hope to arrange for 3-month, have a panoramic x-ray it would be very 6-month and 1-year evaluations with the useful to bring it with you. surgeons. It is highly recommended to our surgical patients to come with a com- Orthognathic surgery 33 34. Contact information Address:Av. Severo Ochoa, 24. Marbella, Spain (next to USP hospital) Website:www.agaveclinic.com Email:info@agaveclinic.com Tel Agave clinic: +34-952.864.191 Tel USP Hospital: +34-952.774.200 Each month, we also have a day of consultations and check-ups in the United Kingdom (London) and in the Netherlands (Blaricum and Papendrecht). You can make an appointment by contacting Agave Clinic in Marbella.34 Patient information guide 35. If you have any questions,please dont hesitate to contact us. 36. Address: Av. Severo Ochoa, 24. Marbella, Spain Website: www.agaveclinic.com Email: info@agaveclinic.comTel Agave clinic: +34-952.864.191Tel USP Hospital: +34-952.774.200General conditionsYou can find the general conditions of Agave clinicon www.agaveclinic.com/EN/conditions.php.