Teeth In One Day
The procedure was implemented in Lisbon, Portugal in 1998 by Dr. Paulo Malo’. It is often referred to as the “All-on-4” procedure because all teeth in each jaw are anchored by as few as 4 implants. Since 1998, the procedure has been refined and huge advancements have been made due to the introduction of 3D imaging and newer implant technologies. Today the procedure is very commonly done in many dental implant offices and is routinely done at Clear Choice Dental Implant Centers as well as here at our office. I have been personally trained in this technique by Dr. Malo’ at his training facility in Rutherford, New Jersey.
As with most surgical procedures, a thorough workup and case planning is essential for success. Patient medical history and current medication lists must be analyzed. Patients with diabetes, heart disease, immune deficiencies and smokers are at higher risk for complications. After the preliminary work-up, a 3D CAT scan is done to identify nerves and blood vessels and the location of the sinus cavities and other anatomical landmarks. We use the i-CAT scanning machine in our office, and in conjunction with Anatomage implant software, we can plan the surgery on a virtual basis before we start. Often, a surgical guide is fabricated using the DICOM (Digital Imaging and Communications in Medicine) data from the scan. Please see these websites for more information: www.imagingsciences.com, www.anatomage.com.
After the treatment plan is complete, impressions are taken and new dentures are made in advance of the surgery. This requires 3-4 appointments about 1 week apart. Once the dentures are made, the patient is scheduled for surgery. If only 1 jaw is being restored, the surgery typically takes 4-5 hours, and may be 6-7 hours if both jaws are restored. We usually prescribe 4 medicines prior to the procedure:
- An antibiotic to protect the patient from germs in the mouth getting into the bloodstream.
- A sedative to relax the patient. (Usually a board certified dental anesthesiologist will start an IV and administer the sedation. Sometimes, oral sedatives are used. Most patients don’t remember being at the office that day)
- An analgesic for pain control. (Usually hydrocodone)
- An antiseptic mouthwash to help prevent secondary infection after the procedure (Usually chlorhexadine)
Once the patient is in the operatory, they are prepped for surgery. A blood pressure/pulse monitor and a blood oxygen monitor are attached, and remain during the entire surgical procedure. When the sedation takes effect, the patient is given local anesthetic to numb the region. Remaining teeth are then extracted and the jaw bone is contoured to receive the implants. Usually 4-5 implants are placed in each jaw and the dentures are converted to temporary bridges which are supported by the implants. These bridges cannot be removed by the patient. During surgery, the torque or torsion resistance, of each implant is carefully measured as it is placed. In rare cases, if the torque or strength of the implant is not sufficient to support a fixed bridge, then the implants are NOT loaded and the dentures are worn by the patient until the implants have sufficiently healed within the bone. The dentures are then converted to fixed bridges at a later time. In most cases, however, the dentures can be immediately converted to fixed bridges at the time of the surgery.
It is important that the patient have a caregiver who can be responsible for them for several hours after the procedure. The sedative lasts for several hours and the procedure requires that the patient have bed rest for 24-48 hours afterward. Post operative instructions are given to the caregiver and the patient is transferred by wheelchair to the caregiver’s car. For about 90 days, the patient is instructed to eat only soft foods. There are usually several follow-up appointments over the next 90 days. After about 90 days, the implants and gums are fully healed, and impressions are taken for the final bridges. These new bridges are made using CAD- CAM technology. A solid block of Titanium is precision milled to form a bar which is anchored to each implant. From there the teeth are added and processed onto the bar. This is the closest thing to natural teeth that dentistry has to offer. They look, feel and function very much like real teeth. Most people request whiter teeth so that their smile is really noticed.
Many people ask me how long these teeth can be expected to last. The answer, of course, depends on the patient. Big men with strong jaws or people with grinding habits will wear the teeth faster than a little old lady from Pasadena! The good news is that, generally speaking, the implants do not wear out, and it is relatively easy to “retread” the bridges with new teeth whenever the teeth wear out.
I hope that this brief overview of the “Teeth in One Day” procedure has been helpful to you. Please feel free to call my office for a free consultation, or if you have any specific questions. Our goal is to give our patients a smile that they can be proud of and the ability to eat the foods that they desire.