Tuesday, October 20, 2009

All on Four, Teeth in a Day, & Teeth in a Hour–Uses and Abuses

Many patients have asked about heavily marketed implant options such as Teeth-in-an Hour, All-on-Four, or Teeth-in-a- Day. This a procedure where a person with a denture is able to have four implants placed and walk away wearing an implant retained denture replacement.
Here are my Expert Opinions: 1) Most marketing efforts on these concepts show a person chewing an apple right away. In the vast majority of cases they are using a temporary restoration with the permanent restoration being made in 3 to 4 months.2) Placing an implant supported restoration immediately is great, and I can do this in many cases, however, it adds considerably to cost, with no additional long term benefits.3) Although there is a high success rate once the permanent restoration is finished, for the very high price of All-on-Four (one large “chain” of dental implantcenters charges about $30,000 per arch), Ideally additional stability with more support than four implants is standard of care. 4) Avoiding bone grafts by placing implants at an angle is appropriate in some instances, in instances where implants are long enough and cross-splinted for mutual support.5) Immediate placement of restorations cannot successfully be placed in areas where tooth have just been extracted. Temporary restoration and bone healing must occur first.6) Special caution should be exercised before thinking that complex implant problems can be solved in “cookie-cutter” solutions such as All-on Four.” The number of implants required is HEAVILY dependent on other factors such as parafunction (clenching, grinding), shape of the jawbones, nature of opposing teeth (dentures vs. natural teeth, individual facial aesthetic, bone density, systemic disease, and many other factors. Both patient and practitioners should use caution not to over-simplify.6) The most important aspect of these restorations is the use of sophisticated software that uses CT bone scans to image the bone in 3D. This allows more accurate placement, less healing time, and more comfort for the patient. For you “techies” out there go to my website and look at how we do this for complex cases. All technology has uses, abuses, and limitations. I do use this technology, but I do believe some mass advertising of this is misleading.
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  1. Why go you think the mass advertising of this is misleading if you use the technology. If more people (properly trained) are offering it then more and more patients are being helped! Immediate placment of Dental implants in extraction sites and loading them with a hybrid works if done properly.

  2. I agree with you to an extent. I don't feel that this is an option for every patient as is what is portrayed in most mass advertisements. For the right patient and right situation it is an excellent option. Keep in mind as in your comment the surgeon MUST BE PROPERLY TRAINED.

    Thanks for reading

  3. I've had my uppers and lowers replaced with permanent implants. My uppers have broken away from the implant plate several times now. The doc I have in Phoenix repairs them in about a half hour and within days to a month, they've broken away again! Why won't they stay together like he says they will? I've given up hope now. I can't afford to have them fixed because I'm on a fixed income from disability. What can I do??? Please help! I've been without my uppers now for 9 months!