To Replace All Teeth


Options to Replace All Missing Teeth

Options to replace All Missing Teeth
 

 


If you are losing your teeth, or have already lost your teeth, there are two basic ways to replace your natural teeth with dental implants:


    
Option 1.  Implant teeth that are removable.

    Option 2.  Implant teeth that are fixed (or permanent).

Every type of implant treatment can be grouped into one of these two basic types of tooth replacements.  .

These are the two basic choices: removable teeth and fixed teeth.  A  more detailed description of each type is listed below.

When you discuss your treatment options with your dentist, always ask them the following question:

    Will my implant teeth be removable?  And I will have to take them

One confusing part is the various names that are used.  Some examples are:  But they all can be grouped into one of two types of teeth.

 

When treatment is complete, you want to be happy and satisfied with the result.  If you keep this basic distinction in mind, it will go a long way to.....

Removable implant teeth are clipped or snapped onto the implants
Fixed implant teeth are firmly anchored to the implants

There are many names that are currently used to describe the ways that implants can be used to replace missing teeth: a few examples are Hybridge, Teeth in an Hour, Smile in a Day, Overdenture, and All-on-Four.  But all of these treatments can be grouped into one of these two types of teeth: removable teeth or fixed teeth. 

A general overview of each type is listed below.
 

So ask you dentist and be clear on what your choices are:  removable teeth or fixed (permanent) teeth.
When you discuss your choices with your dentist, keep this simple distinction in mind.

How can implant teeth be removable??

People are often surprised to learn that implant teeth can be removable. 

It is important that you understand the type of teeth your dentist has recommended because the result of you decision is something that you will live with for the rest of your life and will affect your daily life experiences., that you will live with on a daily basis.

There are two basic types of teeth that use dental implants to replace all of a person's natural or missing teeth.  Dentists refer to these replacement teeth as "restorations"

            1.  Removable teeth........that clip or snap onto the implants

            2.  Fixed teeth........that are firmly anchored to the implants


A general description of each type of replacement is listed below.  More detailed information for each type can be found by clicking on the appropriate link.

The primary decision that any patient needs to make is do they want teeth that are "removable" or "fixed".  Once a patient makes this decision, the process of choosing a treatment option is greatly simplified.

That's it!!  Only two basic choices:  removable teeth, clipped onto implants.....or fixed teeth, firmly anchored to implants. 

Every type of replacement teeth that use dental implants can be grouped into these two categories.  Whatever implant option you begin to discuss with your dentist, make sure you ask them, make sure you understand if the teeth are removable, or they are fixed before you proceed any further with your discussion.

Source of confusion:
Point of clarification:
 also need to know that this classification of "Removable" and "Fixed" teeth refers to whether or not the patient can remove their teeth


"Removable" teeth can be removed by the patient.
The terms "Removable" and "Fixed" refer to whether or not the teeth can be removed by the patient.

You should also know that these terms, "Removable teeth" and "Fixed teeth", refer to how these teeth feel and function when they are in the patient's mouth.  It also refers to how they need to be cleaned by the patient who wears these teeth. 

This is very important to understand this difference, because even "fixed teeth" can be removed from the patient's mouth by the dentist so that they can check the implants and make necessary repairs to the teeth if that were to be needed.
 
The option that someone would ultimately choose would depend  upon how they answer the following question: "What is Important to Me?"  Click on that link if you would like to learn about what factors you should consider when you answer this question.  You might want to learn about those things you should think about before you go any further in determining what option will be best for you.

  

Basic Implant Options for Replacing All Teeth:

    1.  Removable teeth:
Overdenture to be seated on ball attachments for complete tooth replacement



Overdenture to be seated on ball attachments

            -the completed teeth look, and feel like a removable denture

            -the teeth clip onto the implants using "attachments" (called "Locators", "Balls" or "Clips")
            -the teeth need to be removed from the mouth so they can be thoroughly cleaned
            -the teeth move similar to removable dentures, only less
            -eating, speaking, and comfort are improved by 30-40% compared to a removable denture
 
   
    2.  Fixed
teeth:
Fixed Bridge on Implants for complete tooth replacement


Fixed Bridge on Implants

            -the completed teeth look, and feel like a permanent bridge

            -the teeth are connected to the implants by screws or cement
            -the teeth remain in the mouth and are cleaned like real teeth
            -the teeth do not move and are firmly attached to the implants
            -eating, speaking and comfort are very similar (90%) to natural teeth.


Part of the difficulty with understanding / and choosing an implant option comes from the confusion that is created by the various names that are used to describe the same, or very similar treatments.

To help you overecome this problem, the terms and descriptions used in the tables below are those that you are likely to hear when you speak with a dental professional, or read information that you may receive in their offices.



The option that someone would ultimately choose would depend  upon how they answer the following question: "What is Important to Me?"  Click on that link if you would like to learn about what factors you should consider when you answer this question.


Removable  Teeth
(clipped onto implants)




Professional                    Overdenture                    Overdenture                    Overdenture
      Name


  Implants                        Mini-Implants               Regular Implants             Regular Implants
      Used
               

   Type of                               "Ball"                              "Locator"                             "Bar"
Attachment                     


Number of                              4 - 6                                   2 - 4                                  2 - 4
  Implants


 Expected                        What can you simply say for each of these, or just say nothing?
 Length of
   Service

 Complete
Treatment
     Time
(see notes below)


      Costs
(see notes below)


Notes on complete treatment time

1.  You should know that the treatment needed to replace all of a person's missing teeth is a process.  
      It does not occur overnight, or even in 1-hour.

     There will always be periods of time when the dentist, the surgeon, and the patient are waiting.....
     waiting for the bone, the gum tissue and the mouth to adapt before the next step in the process
     can begin.

2.  The times listed do not include the additional time needed for the following procedures:


            
a.  Extractions:                                 add minimum 3 months

            b.  Bone regeneration:                    add minimum 6 months
                 (bone grafts / sinus grafts)


      As you think about your treatment options, you should remember that the current condition of
      your mouth may require some additional treatment prior to implant treatment.


Notes on costs

1. Fees listed include:

        -a new denture
        -all attachment costs, including attachment installation
        -all laboratory costs if needed


1.  high variability are primarily due to the following:

    -number of implants used to support the implant teeth
    -need for bone regeneration (bone / sinus grafts)
    -laboratory costs associated with the construction of the implant teeth

2.  Fees listed are for all treamtent needed to provide the patient with a complete set of teeth and include:

    -the dentist's fee: including all treamtnet needed to provide the patient with the provisional and permanent teeth
    -the surgeon's fee: including the placment of the implants and the permanent abutments
    -accessory fees:  3D-CAT scan, surgical and radiographic guides

3.  the following procedures are not included in the fees listed and should be discussed with your dentist or surgeon is they are recommended:

        -extractions
        -bone regeneration  (bone grafts / sinus grafts)
        -iV sedation
        -Computer-guided implant surgery (
Guided Surgery)


Fixed  Teeth
(anchored to the implants)


     Option                                                              Fixed Teeth
                                                                        
(anchored to the implants)


 Professional                           All - on - Four                         Traditional / Staged                 
       Name                                   Procedure                                    Procedure                                    


     Implants                           Regular Implants                         Regular Implants
        Used 
(see notes below)     


   Number of                                      4                                                  5 - 10
     Implants


     Common                                    None                                        Bone Grafts                         
    Additional
   Treatments
(see notes below)


      Loading                                Immediate                                    Immediate
      Options                                                                                              or
(see notes below)                                                                                            Delayed


     Complete
    Treatment                            4 - 7 months                                4 - 18 months
         Time
(see notes below)


 Expected                        What can you simply say for each of these, or just say nothing?
 Length of
   Service



       Costs                                  $23 - 25,000                              $35,000-50,000    
(see notes below)

        
                                                                                                                                                                                   

The table above assumes that the patient has already lost all of their teeth and is already wearing a full denture.


Notes:

On Implants Used:

    1.  Mini-implants are not used to support fixed bridges
         They are only used to retain loose dentures

On Loading Options:

    Immediate-load Treatment:  (Immediate Function)
                
        -an option where a provisional (temporary) bridge is attached to the implants
the same day they 
         are installed in the patient's jaw.    


        -the use of this treatment is generally dependent upon the following 2 factors:

            -the presence of enough dense bone to support the implant bridge
            -the ability of the surgeon to firmly anchor the implants in the jaw bone

        -All-on-Four treatment, except for rare instances, is always an immediate-load procedure

        -the following names also refer to Immediate-load Treatment:

            -Teeth in an Hour        -Smile in a Day
            -Teeth in a Day            -Same Day Teeth


        -a permanent bridge is made 3-6 months later (after the provisional bridge is placed)

    Delayed treatment:  (Traditional / Staged Treatment)

        -an option where a provisional (temporary) bridge is attached to the implants after a healing
         
period of 3-6 months

        -this treatment is usually recommended for patients who need extended healing times
          for the following reasons:
            
                -patients with soft jaw bone  (osteoporosis)
                -patients who needed bone regeneration (bone grafts) prior to implant placement

        -a permanent bridge is made 3-6 months later (after the provisional bridge is placed)



On Common Additional Treatment:

1.  Bone grafts are frequently needed to regenerate bone to support additional implants.  In choosing a treatment, how many implants are needed for a successful result?  What does science say?.


On Complete Treatment Time:

1.  You should know that the treatment needed to replace all of a person's missing teeth is a process.  
      It does not occur overnight, or even in 1-hour.

     There will always be periods of time when the dentist, the surgeon, and the patient are waiting.....
     waiting for the bone, the gum tissue and the mouth to adapt before the next step in the process
     can begin.

2.  The times listed do not include the additional time needed for the following procedures:


                E
xtractions:                                 add minimum 3 months

                Bo
ne regeneration:                    add minimum 6 months
                 (bone grafts / sinus grafts)


      As you think about your treatment options, you should remember that the current condition of
      your mouth may require some additional procedures prior to implant treatment.


3.  Traditional implant treatment frequently requires bone regeneration (bone grafts, sinus grafts)
      prior to implant placement.  These procedures will add time to the overall process:

                Bone regeneration:                    add minimum 6 months
                 (bone grafts / sinus grafts)

4.  All-on-Four treatment does not require bone graft procedures.

     All-on-Four was developed to eliminate the additional cost, time, and complications associated
     with bone graft / sinus graft procedures.



     Please keep this in mind as you consider your treatment options

 

On Costs:

1. high variability for traditional implant treatment is primarily due to the following:

    -number of implants used to support the teeth
    -need for bone regeneration (bone / sinus grafts)
    -laboratory costs associated with the construction of the implant teeth

2.  Fees listed are for all treamtent needed to provide the patient with a complete set of teeth and include:

    -the dentist's fee: including all treamtnet needed to provide the patient with the provisional and permanent teeth
    -the surgeon's fee: including the placment of the implants and the permanent abutments
    -accessory fees:  3D-CAT scan, surgical and radiographic guides needed for the treatment

3.  the following procedures are not included in the fees listed and should be discussed with your dentist or surgeon is they are recommended:

        -extractions
        -bone regeneration  (bone grafts / sinus grafts)
        -iV sedation
        -Computer-guided implant surgery (
Guided Surgery)

 

Many of these names were created merely to attract a patient's interest or promote some aspect of that type of treatment.



The following information is extra material from Kobza:


(Patients missing all teeth)   Generalized dental disease / problems

        -"Many, or most of my teeth are unhealthy and need to be extracted":  
            -(failing dentition): this category includes people with:
 
                    -failing bridgework
                    -generalized advanced bone loss from periodontal disease
                    -generalized root cavities
                    -fractured roots
                    -teeth with failed root canal treatments
            -people in this category have what dentists call "a failing dentition".
            -Select:  Missing All Teeth


        -"I have already lost my teeth, and my dentures are uncomfortable
            -(edentulous patients)
            -Select:  Missing All Teeth

        -"I cannot wear my dentures, and I have been told I do not have enough bone for implants"
            -(patient with minimal bone levels)
            -Select:  Missing All Teeth



        (Patients missing multiple teeth)  Localized dental disease / problems  

        -"My permanent bridge has failed, and I don't have enough (support) teeth (to make / for) a new one"
            -Select:  Missing Multiple Teeth

        
-"Some of my teeth are unhealthy and need to be extracted":
            this category includes people with:
                    -teeth with advanced bone loss
                    -teeth with very deep cavities
                    -teeth with failed root canal treatment
            -Select:  Missing Multiple Teeth



        
(Patients missing single teeth)  Isolated dental disease / problems

        -"I lost one of my teeth in an accident"  (avulsed tooth)
            -Select:  Missing Single Teeth

        
-"I have any unhealthy tooth that needs to be extracted"
            -this category includes people with:
                    -fractured teeth
                    -teeth with failed root canal treatment
                    -teeth with very deep cavities

            -Select:  Missing Single Teeth

Copy of above original text:

(Patients missing all teeth)   Generalized dental disease / problems

        -"Many, or most of my teeth are unhealthy and need to be extracted":  
            -(failing dentition): this category includes people with: 
                    -failing bridgework
                    -generalized advanced bone loss from periodontal disease
                    -generalized root cavities
                    -fractured roots
                    -teeth with failed root canal treatments
            -people in this category have what dentists call "a failing dentition".
            -Select:  Missing All Teeth


        -"I have already lost my teeth, and my dentures are uncomfortable
            -(edentulous patients)
            -Select:  Missing All Teeth

        -"I cannot wear my dentures, and I have been told I do not have enough bone for implants"
            -(patient with minimal bone levels)
            -Select:  Missing All Teeth



        (Patients missing multiple teeth)  Localized dental disease / problems  

        -"My permanent bridge has failed, and I don't have enough (support) teeth (to make / for) a new one"
            -Select:  Missing Multiple Teeth

        
-"Some of my teeth are unhealthy and need to be extracted":
            this category includes people with:
                    -teeth with advanced bone loss
                    -teeth with very deep cavities
                    -teeth with failed root canal treatment
            -Select:  Missing Multiple Teeth



        
(Patients missing single teeth)  Isolated dental disease / problems

        -"I lost one of my teeth in an accident"  (avulsed tooth)
            -Select:  Missing Single Teeth

        
-"I have any unhealthy tooth that needs to be extracted"
            -this category includes people with:
                    -fractured teeth
                    -teeth with failed root canal treatment
                    -teeth with very deep cavities

            -Select:  Missing Single Teeth


 

The following material is from the Nejat website on AO4

:

ALL TEETH MISSING

Benefits of a fixed bridge on implants
When all teeth are missing or in such condition that they need to be replaced, a fixed bridge anchored to dental implants is the best permanent solution

Before dental implants, there were no fixed solution available for people who lost all their teeth. Today, it is possible to replace a full jaw with dental implants and a fixed bridge that results in a permanent, stable and high esthetic solution.

Treatment:
The treatment procedure and number of visits is largely dependent on the specific conditions. But all in all, 8-10 visits should be enough to have a fixed bridge installed. Most patients report that they were much more comfortable following the procedure than they had anticipated.


 

COURSE OF TREATMENT

INSTALLING THE FIXED BRIDGE– STEP-BY-STEP

The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.

   
1: Before the procedure
The dentist determines what needs to be done and prepares both himself and the patient for the coming treatment procedure.
2: Installing the implants
The first step is installing dental implants to replace the lost tooth roots. In this case, five implants are used. Temporary teeth are attached that enable you to eat and function like normal while waiting for the permanent bridge to be installed.
   
3: Attaching the bridge
The final bridge is securely installed on top of the implants. With a full jaw replacement like this, it normally takes 2-3 visits to have the bridge completely attached.
4: End result
Your new teeth should be hard to tell from natural – both for you and others. People who have had traditional dentures before getting a fixed bridge often describe this as an overwhelming and very positive experience.

 


 
ALTERNATIVES TO A FIXED BRIDGE

  Removable Overdenture.....using "Ball" attachments
  Removable Overdenture.....using a "Bar" attachment 
 

New Additions:

have a spread sheet like Nejat with the following options:

    -complete denture
    -overdenture
    -fixed bridge
        -AO4
        -Traditional (other name)

spread sheet factors:  (see Nejat spreadsheet)

    -cost
    -time
    -procedures needed
    -chewing efficiency

                                        Removable Options                                            Fixed Options

  Removable Denture Overdenture
(Ball Attachments)
Fixed Bridge on Implants Smile in a Day™ /Teeth in an Hour™
(same day teeth)
Cost  (2012) 1500-2500 Much less than Implant Bridge Much more than Denture Same as Implant/Tooth Bridge
Treatment Time 2-6 weeks 2-6 weeks 3-18 months 1 hour
Appearance Good Good Excellent Excellent
Life Expectancy 3-10 years
(Ongoing maintenance & Adjustments)
Lifetime (Only need to replace silicon housing) Lifetime Lifetime
Effect on Chewing Poor Good Like healthy, natural teeth Like healthy, natural teeth
Stability Very Poor Dependent on number of implants placed, and how far spaced from each other Like natural teeth Like natural teeth
Ease of Cleaning Simple (must take teeth out at night) Moderate Like Natural Tooth Bridge Like Natural Tooth Bridge
Palate Covered Yes 1/4 Coverage No No
Comfort Very Poor Good Like natural teeth Like natural teeth
Speech Change Improves with time Minimal None None
Preserves Bone No Dependent on number of implants placed Yes Yes