What is “Teeth-in Day,” or “All-on Four” Dental Implants?
“All on Four”–There is a considerable amount of literature online about the “All-on Four” or “Teeth-in-a Day” concept. As a dentist with over 30 years of dental implant surgical and restorative experience I can offer a number of practical, and academic observations (no hype).
Who is a candidate for “All on Four” or “Teeth-in-a -Day” or “Teeth Tomorrow” Dental Implant Therapy?
First we have to describe explicitly what those, often marketing terms, really mean. ‘Teeth-in a Day” means replacing the remaining teeth in a given (upper or lower) arch with a dental implant prosthesis within the period of a single appointment. Dr. Gibbs personally does not advocate this for clinical reasons preferring the Teeth Tomorrow protocol (stronger and more hygienic).
Replacing all teeth with dental implants is a solution what dental professionals call a terminal dentition—where all teeth are hopeless and terminally involved. It also replaces dentures with firmly fixed implant bridges that cannot be removed by the patient and functions like “normal”teeth.
In clinical reality, the biomechanics and biological requirements of tooth replacement usually require more than four dental implants for long term success. This needs to be individually determined by a skilled and experienced dental Implantologists and discussed as an option with the patient.
TO BE ABLE TO DO THIS ON A SHORT TERM BASIS—a number of clinical requirements need to be determined (such as bone dentistry, medical requirements, local anatomical needs, etc.) In a course at the California Dental Institute, along with the Nevada School of Dentistry, over 20 clinical criteria were studied that needed to satisfied to have this option feasible and reliable clinically.
Also it is VITAL to know the nature of what type of dental implant bridge can be placed . It is typically a full denture that is “converted” to a screwed down bridge. Although FAR superior to a denture, it is still susceptible to breakage and usually needs to replaced after a short (3 month) time period.
“Teeth Tomorrow”–A Superior Longer Term Solution
There are many problems with immediate “Teeth in a Day” dental implants bridges:
1) They are made of acrylic and not uncommonly the entire bridge may fracture (not always easy to fix).
2) The teeth are also usually made of acrylic and may fracture off or chip. This may require laboratory repair. The patient may be with any teeth for a few days during repair
3) Acrylic long term is a patient’s mouth may absorb stains and toxins. This can be unsightly, and retain orders
The best long term solution utilizes advanced dental ceramics and a material known as Prettau® Zirconia. It is extremely stain resistant, resists fracture or chipping, and can easily a patient’s lifetime. Dr. Gibbs utilizes a system know as Teeth Tomorrow, and is the only system currently available with a 100% 5 years proven record.
It is a wonderful to see a patient with a “terminal dentition” suddenly be able to smile again! It is wonderful to eliminate the need for dentures!
“Teeth-all-on Four” Dental implants Tooth Replacements
“Teeth-all-on Four” means replacing all of the remaining teeth as above with just four dental implants. In an attempt to maximize the remaining (often minimal) bone the back implants may be angled forward to achieve more bone support (see diagram) and eliminate teeth not supported by dental implants (think poor bio-mechanics.) The best-case scenario with this concept is to maximize the remaining bone to avoid anatomical complications such as the mandibular nerve in the lower jawbone, or the maxillary sinuses in the upper jawbone.
In an ideal situation teeth can be removed, or an existing denture replaced in a single appointment–commonly called “teeth in a day.” The doctor works with a dental lab technician to join the dental implants to the dental implant bridge and the patient can leave th office smiling and chewing again!
Options related to Immediate Replacement for Missing teeth ( “All-on One,” “Teeth in a Day”)
In reality—patients should be advised—final determination of the number and time frame may not be accurately determined until the day of surgery. I have often said (very accurately) that only “one person” can give promises, and “he” is not doing dentistry—we do what is best for the patient!
The VERY best “All-on-Four” or “Teeth-in-a Day”Dental Implant Bridge is the Teeth Tomorrow advanced zirconia bridge. It may cost slightly more initially, but the long term saving in costs of likely repairs and inconvenience makes the Prettau® Zirconia bridge a wise choice. The initial cost of these advanced restorations and procedures must be weighed against the ongoing costs, projected failure rates of conventional dentistry, time away from worm, and discomfort facing the patient with teeth that appear (or are) hopeless.
Need for Dental Sedation or Advanced Anesthesia
Although Dr. Gibbs at SmileGlenEllyn in Glen Ellyn has experienced in dental anesthesiology and IV sedation, this is not required for these procedures. The patient comfort level and anticipated difficulty is discussed with the patient and a choice is determined.