In 1944, Don Gardner wrote the famous song with lyrics that included “All I want for Christmas is my two front teeth”. Little did he know that over 72 years later, we can make this wish become a reality in one day. It is interesting to see how many of our patients are trying to restore their smiles and function before the holidays. With the current implant design features which include roughened surfaces, tapered implant bodies, and aggressive thread patterns, we have been able to place implant fixtures into extraction sockets and then attach temporary abutments and crowns with great predictability and success. Fully edentulous arches can be restored on just four implant fixtures. These procedures are incredibly gratifying for both the patients and the practitioners. Although we have been placing implants in our practice for over 30 years, the excitement continues as the technology evolves! Happy Holidays!
PERIODONTAL ASSOCIATES
photo credit: Zazzle
Advantages of the system:
Stable yet removable solution that offers the comfort of a fixed prosthesis
Easy to clean
Optimal chewing and function
Desirable phonetics and esthetics
A cost effective solution
Another great All-on-4 dental implant case with computer guided surgery in partnership with Ira and Brandon Dickerman of Dickerman Dental Prosthetics! The patient was scanned in a Carestream CS 9300 CBCT scanner while wearing a surgical/diagnostic guide with radiopaque teeth. With that information, the virtual implants and other components are located within the prosthesis and bone during an online treatment planning conference session with the doctor and lab technician. The locking pins are also located which will stabilize the guide on the arch during surgery.
This case was set up for the use of Nobel Biocare NobelReplace Conical Connection implants which provide maximum stability due to the tapered body design, and crestal bone preservation due to the horizontal “platform shift” of the restorative table. Of course, the proprietary NobelBiocare surgical kit must be used for the implants in this particular case. However, any dental implant that is designed for guided surgery may be used, per the choice of the surgeon, as long as that manufacturer’s guided surgery kit is utilized.
The surgery typically involves minimal discomfort for the patient and can be completed in significantly less time than conventional implant surgery.
These cases are cost-effective, durable, and esthetic, which vastly improves the quality of our patients’ lives.
My partner, Giovanni Castellucci, and I have been placing dental implants in our periodontal practice for over 27 years. In the early days, the Branemark “hybrid” prosthesis was the standard of care for restoration of fully edentulous patients with five or six implant fixtures. We followed the traditional two-stage protocol and our patients enjoyed tremendously successful outcomes which have improved their quality of life. However, as time progressed, the hybrid prosthesis became less popular as more conventional PFM fixed restorations were fabricated on custom abutments.
In recent years, we have seen a resurgence of the use of the hybrid prosthesis with the “All-On-4” Immediate Dental Implant (Teeth in a Day) protocol. Now, we successfully restore fully edentulous arches on four implant fixtures on the same day that the hopeless teeth are removed, oftentimes without the need for bone grafts. Our patients are thrilled with the results, and the functional and esthetic benefits are instant.
When speaking with many of our restorative colleagues in Boston, Newton, Framingham, and the Metrowest communities, I occasionally hear them say “my practice doesn’t have edentulous patients“, or “we don’t make dentures”. This would imply that the demographic profile of these practices does not include a major component of the general population. Yet, we know that millions (if not billions) of dollars are spent annually on denture adhesives, and that the national dental clinics that focus on denture fabrication are thriving. And, let us not forget that many people with hopeless teeth due to severe gum disease or decay oftentimes avoid treatment because of fear of having to wear a complete removable denture. The “All-On-4” treatment is the perfect solution for these patients as they can have their natural teeth replaced by non-removable, fixed implant-supported teeth on the same day in one dental appointment.
In our practice, we see “All-On-4” patients from all communities, even the most affluent. After all, dental and periodontal diseases do not discern one community from another. With this in mind, we urge all clinicians to “open their eyes” to the benefits of immediate dental implant restorations as another tool to help enhance the lives of our patients.
Have any of you had similar experiences? Please share them with the community.
Cary Feuerman, DMD
PERIODONTAL ASSOCIATES
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