What are the treatment options available for those who need to replace all their teeth?

For anyone who has lost their teeth, or for anyone who needs to have their teeth removed, there are only a few options available in dentistry today.

The first option is a traditional removable denture.
The only benefit of removable dentures is that they are inexpensive. The main downside of dentures are they don’t chew as well, they don’t stop bone loss, they can be extremely uncomfortable, and they can alter the appearance of the face if they are not maintained properly.  It is important to note however that there is a big difference between upper and lower dentures. A well-made denture to replace the upper teeth can be comfortable, functional, and esthetic. It can also stay in place much easier than a lower denture. If made well, a patient can get by ok with an upper denture. A lower denture, on the other hand, is very difficult to adapt to. It is recommended if possible to avoid a traditional removable denture to replace lower missing teeth. In many cases, a lower removable denture can be supported and retained by dental implants. Ask your doctor about the overdenture option.  

The second option is an upper denture with a lower All-on-4®.
As mentioned above, one wants to avoid a lower denture if at all possible. This option provides something that works on the upper arch while having the ideal option on the lower arch. This option stops bone loss on the lower arch and allows the patient to chew much better than upper and lower dentures or upper dentures and lower overdentures would allow. Many patients find themselves comfortable with this option over time with no desire to replace the upper teeth with implants. It is important to note that as long as you have enough bone, you can use this option as a transition phase to be comfortable as you make plans to do upper implants down the road. People elect this option to either save money for upper implants later on or as a definitive treatment option.

The third option is an upper and lower All-on-4®.
This option is the best option dentistry offers for anyone who needs to replace their teeth. The benefits of this option are that it preserves bone, functions like natural teeth, feels and looks great, is comfortable, easy to maintain, and can last a long time. The only downside this option is the price. If this works in your budget, it is the closest thing to your natural teeth that dentistry can provide. As mentioned above. This option has two material selections to chose from being the Acrylic/Titanium option and the Zirconia option.

Should I keep or remove my teeth? What should I consider to help make my decision?

There are 3 categories of people who are good candidates for the All-on-4® dental implant treatment option. The first are those who have lost all of their teeth and they aren’t happy with their dentures. The second are those who are about to lose their teeth and they don’t want dentures. These two categories of people are easy to identify.

The third category is a little more difficult. People in this category are those who have had a lot of dental work in the past, who currently still need a lot of dental work, who seem to always have dental problems, or who are tired going to the dentist. This category of patients are difficult in that their teeth are in a condition where the dentist could make an argument to either fix or remove the teeth. This group of people are what we call “borderline patients,” meaning we could go either way and the path of treatment isn’t clearly defined. Everyone values their teeth differently. Some people are so tired of dealing with their teeth that the thought of removing them is wonderful. On the other hand, some want to hold on to their teeth no matter what. The choice is personal and only you can decide what is right for you.

So, what should you consider if you are one of these patients? The first thing to consider is what is the goal? Is it to improve cosmetics, to chew better, to get out of pain, or to finally be done with dentistry? Once we know the goal, then it makes it easier to figure out if you should remove your teeth or fix the ones you have. It becomes easier to figure out which option will help you get where you want to be.

If you decide to invest in keeping your teeth then it becomes imperative to stay committed to a regular hygiene program for the rest of your life. It would be a waste of your time and money to do restorative work now on your teeth, only to have that worked ruined in a few years.

How long will it take to complete treatment, and what is a Full Arch Treatment?

There are two phases to full arch implant treatment. The first phase is the surgical phase and the second is the restorative phase. The surgical phase starts the day of surgery when the teeth are removed, the implants are placed in the bone, and the temporary healing set of teeth are delivered. This entire process is all done the day of your surgery and this process is known as Full Arch Treatment. Instead of healing in removable dentures after your surgery, you will heal in a fixed temporary set of teeth. The surgical phase ends once the implants have fully healed. This takes about 4 months. Once the implants have healed, the restorative phase begins. It is during this second phase that your final set of teeth are made. You will be scheduled for 3-5 appointments over the next 4-6 months to finish this process. At the end of the restorative phase, you will have your final set of teeth and you will be finished with treatment. The entire process takes about 8-12 months.

Acrylic vs Zirconia, what do I need to know?

When someone loses all of their teeth, the only options to replace them are with removable traditional dentures, or with dental implants. With dental implants, there are two types of teeth that can be used, Acrylic/Titanium and Zirconia.

Acrylic/Titanium
has been used for decades in dentistry. Some benefits of this material are it is highly esthetic, easy for your dentist to make, easy to repair and adjust, and is less expensive. The downsides of Acrylic/Titanium are that the teeth can chip/break, wear down over time, and stain.

Zirconia
was developed to combat some of the downsides of Acrylic/Titanium.  Zirconia is ideal in many ways but like anything else, it has pros and cons. Benefits are that is is easy to clean, feels more lifelike, doesn’t chip or break, and it doesn’t wear. The downsides to this material are that the esthetics can be compromised, it is more expensive, it is more technique sensitive, and is difficult to adjust and alter once it is made. Your dentist will discuss with you what material works for you considering your needs, habits, goals, and budget.

What maintenance or upkeep is required?

General recommended maintenance required for long term success is to have a cleaning every 6 months. Your dentist will recommend a custom hygiene schedule for you as to whether you need more or less frequent visits. At each hygiene visit, your dentist will provide an oral cancer screening, remove and clean the teeth, inspect the teeth for wear, update your x-rays, clean the implants, and make sure everything is tight. It is important for you to maintain regular hygiene visits to maintain your warranty.

What are possible downsides to treatment? What could go wrong?

For someone who is investing a significant amount of time and resources into the All-on-4® treatment, what are the risks you should know?

There are 3 main areas of concern:

Implant Failure:
Even though dental implants have an extremely high success rate (95-98% succeed), dental implants can and do fail. From the time the implant is placed to the time, your final set of teeth will be delivered, is roughly 8-12 months. This allows us enough time to see if the implant has properly integrated. If an implant fails during this period of time, we have to do another surgical procedure to remove the failed implant and replace it with a new one. The downside to you the patient is that it requires another 4 months of healing which delays your final set of teeth an extra 4 months. There is usually no extra cost to replace it when an implant fails this way. Once an implant integrates, there is a high chance that it will be there for life. Failures after a year are what are known as late-term failures. This type of failure is rare and is usually contributed to difficulty with hygiene and keeping it clean. This is why regular cleanings are so important. If a late-term failure occurs, there is usually a fee to correct the problem.

Tooth Wear and Breakage:
The second type of problem that can occur is tooth breakage. The acrylic/titanium bar restoration teeth are made of acrylic.  The benefits of these teeth are that they are beautiful and easily repairable. The downside of acrylic teeth is that they are breakable. Even though they don’t break often, they can break. If the teeth break, it usually is more of an inconvenience in that you need to go to your dentist for a repair procedure which can take up to an hour. There is usually no fee required to do this. The normal lifespan of your new teeth is about 5-7 years and typically after that, you’ll need to have the teeth replaced at an additional charge of usually $2000-2500 per arch. This does not mean that the implants and the titanium bar will need to be replaced, just the teeth themselves. Some teeth wear out faster (2-3 years) while others wear at a slower rate (10-15 years). The wear rate depends, in part, on your hygiene habits. It’s kind of like changing tires on your car, you’re not buying the whole car again, you are just replacing the tires.

What do I do if I am not a candidate? What options do I have?

While most people are candidates for the procedure, there is a small percentage of people who cannot or should not have the procedure done. The main two reasons someone may not be a candidate for this procedure are bone loss and health history.

Bone Loss:
A CT scan will tell your doctor how much bone you have. In some cases, bone grafting can be done to add bone to those who have minimal bone quantities. Bone grafting does increase the healing time as well as treatment costs. For those who have minimal or below minimal bone requirements, placing dental implants can pose a high risk for future implant failure. For those who don’t have enough bone for a fixed implant restoration should consider an implant removable overdenture or traditional removable dentures.

Health Concerns:
Most health issues don’t disqualify someone from getting the procedure done but rather delay the procedure until the health risks are under control. There are however some health conditions that would disqualify someone from being a candidate. If you have serious health concerns, you should talk to your dentist about other possible options. For those missing all of their teeth, the best option might be traditional removable dentures or implant retained overdentures.

Will I need medical clearance?

It is important to know up front during the consult that if everything goes as planned, your next appointment will be a comprehensive exam followed by your surgery as soon as a few weeks after the exam. The most important consideration for everything to work as scheduled is your health and making sure you are healthy enough for the surgical procedure. We do not want to risk anything when it comes to your health. In some cases, extra medical clearance is needed by your doctor, or by the surgeon who will be placing your implants, or both. While you may be a great dental implant candidate, you may not be a great surgical candidate if you have certain medical conditions. If you fall into this category, please note that it in most cases you can still have the procedure, but it will just take extra time while we work with your family doctor to make absolutely sure that you are ready for surgery and we can provide you with the best possible outcome.

What consists of a soft diet and why is it so important?

After implant surgery, the dental implants will act to secure your new teeth in place. They will feel as though you could eat anything at first. While this is true later on, for now a soft diet is crucial to the success of your dental implants integrating, or “fusing” to the bone. Even though the teeth feel solid at first, the dental implants in the bone which support the teeth are not solid yet. The implants become solid through a process called “osseointegration” which takes about 4 months from the time they are placed. Right after surgery, or during the beginning of this healing process the bone is somewhat soft and the dental implants can technically move inside the bone if too much force is applied. The reason a soft diet is a key component of healing is that while the bone is soft, we need to keep the implants as still as possible. If you were to chew something hard and the implant were to move in the bone, even slightly, then the bone won’t heal and harden around that implant which could result in failure. A soft diet allows you to chew foods to get the nutrients you need, without the need to use a lot of force to break the food down. This in turn keeps the implant stable and still, which allows the better chance for bone to harden around the implant resulting in success.

What do I need to know about bone loss and why does it matter?

When teeth are in a healthy state, they are held in place by the bone in your jaw. One of the main reasons this bone is present is it serves the function of holding the teeth in place. As long as disease or destructive processes are absent, the bone will stay in place to hold the teeth in place. This is the ideal state.

When teeth are removed for any reason, it has an effect on the bone. When teeth are gone, the bone no longer has the need to hold the teeth in place. When the function of holding the teeth in place is no longer needed, the bone begins to shrink and in a sense dissolves away. It begins to atrophy. If someone loses one tooth, then the bone in that one area will shrink. If someone loses all of their teeth, the bone on the entire jaw will shrink. The speed and amount that the bone shrinks are different for everyone. Some lose bone fast while others lose bone slowly.

So why does all of this matter? The main concern is to first understand that this process is taking place and will continue to take place throughout your life. The second thing to understand is that it is ideal to get an implant in the area before the bone shrinks too much. In some cases, if the bone has shrunk to the point where there is not enough for implant placement, bone grafting (addition of bone) can be performed. Keep in mind that this will increase treatment time 3-6 months as well as the costs and possible complications of treatment.

For someone who has lost all of their teeth, the main concern is that as bone loss continues to progress through life, it makes it more and more difficult to wear a denture comfortably. With denture wearers, eventually the bone loss could get to the point where not only is it impossible to wear a denture, but it is also impossible to place an implant. This is the worst scenario for someone missing all of their teeth and a situation that anyone should avoid.

The beauty of dental implants is that the bone responds to an implant in a similar way that it acts with a tooth. The implant maintains the bone where it is placed. In summary, the goal is to place implants when you have the bone to do it. Once the implants are in place, now for the rest of your life you will be able to attach and fix teeth to them You will be able to smile, eat, laugh, and carry on with your life comfortably and confidently without having to worry about bone loss and the problems that can come with it.