Now the "All On 4" Dental Implant System or Mini Denture Implants can permanently secure teeth with the look, feel and functionality of naturally beautiful teeth. Welcome to our comprehensive dental implant center in Houston, TX.  A full upper and/or lower arch reconstruction can be comfortably performed under IV sedation in ONE visit with the All-On-4® Procedure developed by Nobel Biocare. This procedure uses four to six implants with the back implants tilted to increase the bone-to-implant contact, which enables the "immediate function" of the replacement teeth. At our office, only an Implant Surgeon, Prosthodontist/ Restorative Specialist & an Anesthesiologist performs this type of procedure. Our center performs the "All On 4" procedure three to five times a week.

All-On-4 Dental Implants

The "All On" procedures incorporates full arch extractions, avleoplasty (bone re-contouring) bone grafts and the surgical placement of 4 to 6 dental implants that will permanently secure a non-removable bridge comprised of 12 to 14 teeth (per arch).

DENTIQ MATERIALS:

As a comprehensive center, we plan and perform implant procedures for single-site implants to full arch "immediate load" reconstructions using Nobel Biocare, Zimmer, Straumann and BioHorizons implant systems. When bone grafting is indicated, our office incorporates GEM 21S®, which is a completely synthetic grafting system for bone and periodontal regeneration composed of purified recombinant growth factors.

LIFETIME GUARANTEE:

We proudly honor the work that we do for the life of the patient. These are the terms: the patient should complete, and maintain, all clinically necessary treatment; he or she should maintain their regularly scheduled recare visits (3 to 4 x's a yr); and, it should go without saying that the patient should be in good financial standing with our office.

PAYMENTS:

Depending on the case, we ask for a 25 to 50% deposit, or the full prepayment (b) amount at scheduling. In the event that you choose not proceed with treatment, and you make an effort in good faith to give adequate notice, the full case prepayment amount (less 5%, and any treatment that has been rendered) will be refunded within 30 days.

ADJUSTMENTS:

  - 3% adjustment for any amount paid by check (a).  
  - 5% adjustment for the full case prepayment (b).  Note that prepayment is due at the time of scheduling.

FINANCING:

Financing is available for credit qualified patients through GE Money, Citi Health and Chase Health Advance. Short-term financing terms range from 3.9% to 8.9% interest up to 24 months.

ALL-On-4 SCHEDULING:

Two treatment visits: [1] "The Surgery" visit at which time extractions, bone grafts and implants are administered. You will leave this visit w/ a non-removable, implant secured, bridge (4 to 8 hours).  [2] Three to six months later is "The Final Restoration" visit so that the final bridge with reinforced titanium can be placed (4 to 8 hours).
 
  - IV Sedation Administered by a board certified Anesthesiologist: Thanh Nguyen, MD
  - Extractions & Implants Administered by a board certified Periodontist: Raouf Hanna, DMD
  - Principal Dentists: Barbara Johnson, DDS; Edwin Cordray, DDS; John Dominici, DDS; Shreed Sista, DDS

 
 

THE DENTIQ DIFFERENCE:

- Our "Implant Specialist" is a board certified "Periodontist" or "Oral Surgeon" in contrast to a general dentist who calls him or herself a specialist.
- Our "Restorative Specialist" is a board certified "Prosthodontist" or "Implant Restoration Specialist".
- Our "Cosmetic Specialist" is unequaled with the uncanny ability to create naturally beautiful smile designs (see our before & afters).
- Our IV "Sedation Specialist" is a board certified Anesthesiologist.
- Our center performs the "All On 4" procedure three to five times a week.
- Our center performs occlusion (bite) diagnostics with "computer guided pressure mapping" in contrast to old fashioned "bite, or wax paper".
- Our center is a full-service fabrication facility with state-of-the art laboratory technologies.
- Our center honors our work for the life of the patient, since 1963.

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Benefits of Fixed Implant Bridge:

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 and removes the hassle of having to wear a full set of dentures or false teeth.

Many people with dental problems avoid smiling, which cause them to appear less social, and perhaps introverted. The pattern is the same for problems when eating.

Before dental implants, there was no fixed solution available for people who lost all their teeth. They accepted dental dysfunction caused by wearing dentures (false teeth) as a form of disability.

Today, it is possible to replace a full set of teeth with dental implants and a fixed bridge that results in a permanent, stable and high esthetic solution, in as little as 3 days. Immediate teeth have replaced older methods of implant treatment. Modern tooth implant design and state-of-the-art surgical techniques also allow most patients to have fixed teeth supported by only 4 dental implants. This is commonly known as ‘all on 4 dental implants’ and this procedure is the most popular full set tooth implant treatment in our clinic. All on 4 dental implants are a trusted alternative to the problems associated with full dentures, contact our clinic today to book a consultation to discuss how All on 4 implants can benefit both your personal comfort and confidence in a short period of time.

Implant-supported replacement teeth give renewed confidence with unparalleled strength and stability that allows you to eat what you want. The aim of total rehabilitation is to help improve your quality of life, and self esteem. It will also preserve your jawbone and facial appearance.

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Course of treatment

A typical tooth implant procedure for a full set replacement normally involves four to six visits to the dentist. The course of treatment described here is one of several options available. Your dentist will advise you on the best dental solution for you, given your specific condition and individual needs.

PRE-OPERATIVE PROCEDURES
 

 YOUR TREATMENT

Other Considerations

Your smile is essential. What makes it beautiful?

For good aesthetics in a smile there needs to be harmony between the teeth, gums and the lips. It’s not only about teeth. The pink aesthetics (gums & lips) is often what makes the difference between ordinary and extraordinary results.

Gum Aesthetics

Providing you with beautiful teeth may not be enough without healthy-looking gums. In most patients who have lost or are about to loose all of their teeth the gums lack good form that is essential for a beautiful smile. In such patients, prosthetic gum replacement is the only way to ensure predictable results and a beautiful smile. To achieve this, reduction and reshaping of the underlying bone, or ‘alveolectomy’, is preformed at the time of the dental implant placement.

Lip Aesthetics

Want your lips back?

LIP SUPPORT

The bony ridges of the jaws provide support to the lips.  Following extraction of teeth the bone resorbs over time and the lips loose their support. This is one of the most common attributes of an aged look. When dentures are made to replace the teeth, they are made with plastic extensions, or ‘flanges’. The primary function of the flanges is to help with the retention of the dentures, but they also add bulk to the lips. Whether there is too much bulk, as seen in the picture in the top left, or inadequate support, the flanges of a denture may often lead to unnatural aesthetics or fake looking teeth.

LIP FORM

The shape of the lip in many patients is dependent to some extent on the position and orientation of the teeth.

In total rehabilitation on implants, there are no flanges. The reduction and reshaping of the underlying bone, or ‘alveolectomy’, facilitates optimal positioning of the replacement teeth and enables prosthetic gum replacement that mimics the shape of natural bony ridges leading to more natural lip aesthetics.
 

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Alternatives To A Fixed Bridge On Implants:

An alternative to a fixed bridge is a removable overdenture, which is anchored on implants. The old fashioned denture has many disadvantages and should be avoided if possible.

Removable, Implant Anchored Overdenture
A removable full denture that is connected to either a ball or bar attachment, which in turn is anchored on two or more implants in the front part of the jaw.

The implants help keep the denture in place and provide better function and comfort. Cost is usually the reason why this solution is chosen over a fixed bridge – although the end result can’t be compared.

To organize a consultation with a dentist from our highly regarded team to discuss what may be required for a All on Four implant or any other dental implants, please contact us on (03) 9802 2399 or to send us an e-mail click here.

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Single implants may range in cost from $1,000 to $5,000, depending on the aforementioned factors. The cost of full-mouth reconstructive dental implants can range from $24,000 to $100,000.

If treatment is not covered by your dental insurance, or if you don't have insurance, you may be able to enlist the services of a third-party financing company like CareCredit. Qualified candidates can work with a financing company to develop a monthly payment plan that best fits their budget.

Advantages of Implant Dentistry

Dental implants are stronger and more durable than their restorative counterparts, such as crowns and bridges that are cemented into place, or dentures that are removable.

Implants offer a permanent solution to tooth loss. When used to support a dental bridge or dental crown because multiple teeth are missing, dental implants represent a cavity-resistant and stable foundation for these restorations. Although there are many restorative options for replacing missing teeth, none have proven as functionally effective and durable as dental implants.

Periodontists and oral surgeons perform the implant surgical procedure itself.

Are You a Dental Implant Candidate?

To determine if you are a candidate for dental implants, seek the advice of a qualified dental professional trained in implant dentistry. Ask about the extent of your dentist's training. Training in implants, crowns and/or oral surgery offered by private organizations may be completed over a weekend, but medical organizations such as the American Academy of Periodontology and the American Association of Oral and Maxillofacial Surgeons offer more extensive training. Since dental implant placement is a type of oral surgery, it is important to ensure that your dentist has the experience and training required for this sensitive procedure.

Dental implantation, which is performed to replace missing teeth, can be done any time after adolescence or when bone growth is complete. Certain medical conditions, such as active diabetes, cancer or periodontal disease, may require additional treatment before the implant procedure can be performed.

To determine if implants are right for you, your dental professional will thoroughly examine your teeth and gums and evaluate bone density and quantity. This may involve X-rays and computer tomography scans (CT scans) to ensure there is sufficient bone structure for placing the implant(s), and to determine exactly where the implant should be placed.

Based on the condition of your oral tissues, oral hygiene and personal habits, and commitment to follow aftercare instructions, your dentist will advise you of the most appropriate dental implant treatment plan. Some patients with insufficient bone or gum tissue require bone or soft tissue grafts and/or the use of small diameter implants (also called mini implants).

Also, if you are a smoker who is considering a dental implant, your dentist will likely advise you to quit before undergoing the dental implant procedure because smokers face a higher risk of implant failure. A higher implant failure rate also occurs in people who take immuno-suppressants.

Success Rates of Dental Implants

Dental implants are among the most successful procedures in dentistry. Although there is no guarantee that a dental implant procedure will be successful, studies have shown a five-year success rate of 95 percent for lower jaw implants and 90 percent for upper jaw implants. The success rate for upper jaw implants is slightly lower because the upper jaw (especially the back area) is less dense than the lower jaw, making successful implantation and osseointegration potentially more difficult to achieve. Implant placement at the back of the lower jaw has the highest success rate for all dental implants.

Dental Implant Risks

Dental implants may fail for a number of reasons, but the cause often is related to a failure in the osseointegration process. For example, if the implant is placed in a poor position, osseointegration may not take place. Dental implants may break, the site in which they were placed may become infected, or the crown restoration on top of the implant may become loose.

Poor oral hygiene can lead to peri-implantitis around dental implants, a disease that is similar to the development of periodontitis (severe gum disease) around a natural tooth. However, dental implant restorations are not susceptible to cavities the way natural teeth are.

Implant Dentistry: New Procedural Strategies

Dentists trained to perform implants, crowns and/or surgery have begun to immediately place dental implants into locations where teeth have been extracted. When successful, this approach can shed months off the treatment time associated with dental implants because the osseointegration process is accelerated.

Candidacy for this type of early intervention depends upon the anatomy of the tooth extraction area. For example, in many cases the extracted tooth site is wider than the implant, making it impossible to place the implant into the site immediately after extraction. Bone or soft tissue grafting would be required to ensure a secure implant fit and placement.

Implant Alternatives: Mini Dental Implants

Another strategy for implant placement within narrow spaces is the incorporation of the mini implant. Mini implants may be used for small teeth and incisors.

Narrower implants may be used for small teeth and incisors. Also, a narrower implant may best serve patients who require stabilization of lower jaw dentures, pre-molar teeth, or a missing tooth that was located in a narrow area. A small number of narrower implants are FDA-approved for the purpose of prosthesis stabilization, including the mini dental implant. Only certain dentists may perform this procedure.

There are some core differences between traditional implants and mini implants:

• Mini implants are approximately half the width of their traditional counterparts.
• The implant is not fully submerged during a narrow implant procedure.
• Should implant failure occur, the small size (that of a toothpick) means grafting is not necessary.
• Mini implants are less costly.
• Mini implants are solid though they do not contain a screw.

[Updated March 25, 2011]

In the early 2000s, implant manufacturer Nobel Biocare collaborated with noted European implant dentist Paulo Malo and began to use computer simulation, bio-mechanics, and clinical research to determine the optimal use of implants for restoring a full upper or lower arch of teeth. The result was a procedure that uses the fewest implants possible, avoids bone graft surgery, and provides high-quality restorative results in the shortest time possible.

All four titanium implants are placed so that the bone will grow around and secure them in place. With only four implants, there is much less invasive and lengthy surgery. Once the implants are in place, the Oral Surgeon attaches abutments to which the new replacement teeth can be secured. The Prosthodontist fits the replacement teeth on the abutments and adjusts the bite for comfort and a beautiful smile.

Traditional approaches to restoring a full arch of teeth usually involved bone grafts, six or more implants, and as many as 18 months of treatment. That meant that a patient often would be without any teeth, or with ill-fitting temporary dentures for more than a year. ClearChoice Center patients always leave with teeth!

With the All-on-4 Dental Implant Procedure, the patient has one or two visits to the office to allow the Oral Surgeon, Prosthodontist, and Restorative Dentists to gather information for a treatment plan (e.g., CAT Scan, X-rays, impressions, photos). Following this consultation, the patient is scheduled for surgery implantation and the new teeth are fitted and adjusted, all in one appointment (even when extractions are necessary). The patient comes to the office in the morning with unhealthy (or no) teeth, and leaves in the afternoon with a beautiful set of fixed, functional teeth.

The patient will return for occasional check-ups over the next several weeks and months. After almost six months, when the gums have fully healed and the implants are fused to the natural bone, ClearChoice Centers will take new impressions of the patient’s mouth and prepare a final, stronger, permanent set of teeth adjusted to a perfect fit--at no additional cost. This helps ensure that the teeth will last for decades, and provide maximum support, beauty, and function to the patient.

Why ClearChoice Uses Nobel Biocare Dental Implants

The Nobel Biocare Mission Statement: At Nobel Biocare, our mission is to be the most desirable partner in science-based solutions that help dental professionals to make a real and lasting difference to the well-being of their patients, empowering them to lead healthier and more satisfying lives.

Read frequently asked questions about the All-on-4 Procedure >>

Dr. Malo found that if he placed all the implants in the anterior of the jaw, where there is usually better bone density, and if those implants were highly angled, they could provide stable support for a complete denture.

The radiograph and diagram below illustrate this technique.

Here is a panographic x-ray of the four angled implants that have been placed.

Placing a denture over
All-on-Four dental implants

You can see above that the implants are highly angled. But notice that the exposed tips of the dental implants, the part sticking out of the bone, are all pointed upward and are relatively parallel.

On the right you can see that when the denture is screwed on, the screws are all placed normally, because the angulation all occurs under the surface of the tissue.

But this technique isn't without its critics. Renowned implant dentist Dr. Arthur Chal of Phoenix who has pioneered other techniques, after thoroughly studying the all-on-four technique, is concerned about its risks. If one of the implants fails, the entire mouth has to be re-done, and he feels that this is an unacceptable level of risk. To read his comments, please see his All-on-Four dental implants page on his website, www.phoeniximplantdentist.com.

Other leading implant dentists have been reporting higher rates of failure with this technique. We advise you, before you have your dentist use this technique for you, that you be sure your dentist is highly experienced and willing to stand behind his or her work.

Please also see more information in Dr. Chal's web site on dental implant failure.

Click here to ask Dr. Hall a question.

Click here for referral to an expert cosmetic dentist.

All-on-4 is a dental implant solution that allows a fixed denture to be placed using only four dental implants. The way that the implants are placed eliminates the standard healing time that applies to other types of dental implants. Thus, the All-on-4 surgery procedure, when performed in an office with substantial staffing and resources, can be conducted in one day, making the drive for out-of-town dental implant patients a more reasonable option.

There are several parts of the All-on-4 dental implant process. For eligible candidates the surgery can be conducted in one day, but the procedure can be done in as few as two appointments.

1.     Consultation – The initial visit where specific needs are addressed and a solution prescribed.

2.     3D CAT Scanning and Cone Beam Scanner – Through state-of-the art technology, the surgery is planned.

3.     Impressions – Where the proper molds are created for the dental implants to make the teeth for the patient.

4.     Education – Education consultants provide feedback and information for each patient, in order to make certain proper care and upkeep are given post-surgery.

5.     Surgery – The day of surgery the implants are placed and new teeth are attached to the dental implants.

The Fitzgerald Dental Implant Center is able to conduct each of these parts of the process onsite, thus minimizing the number of trips the out-of-town patient must take. With onsite education consultants, a dental surgeon, and implant dentist, the Fitzgerald Dental Implant Center is able to take a patient from start to finish.

The All-on-4 is available to clients that after the initial consultation have shown to be eligible candidates. The procedure will not be available for those patients that will require bone grafting or another surgical procedure before implants can be placed.

The initial consultation will determine whether or not the patient is a candidate for the All-on-4 dental implants procedure.

For more information on the benefits and drawbacks of the All-on-4 procedure view: Is All-on-4 Right for you?

Those who replace their dentures with All-on-Four dental implants will never have to remove their replacement teeth again for cleaning because their new teeth can be cleaned and maintained just like a natural set of teeth.

If you are looking at the possibility of having to wear dentures but choose All-on-Four dental implants, you will never have to experience the crippling effects of loose dentures, being unable to eat the foods you enjoy, messy adhesives, removing teeth at night, the embarrassment of dentures slipping during speech or smiling or the bad breath associated with wearing dentures.

All-on-Four Dental Implants Technique

In most cases, patients lacking the bone volume required to support traditional implants are able to enjoy the many benefits of a permanent solution to missing teeth with this procedure.

More at All-on-Four FAQs

Beautiful New Teeth in One Day
Due to the rigid structure of the replacement teeth and the cross-stabilization provided by the dental implants, you can go home that same day with a new set of teeth, even when extractions of failing teeth are required.

Gentle oral sedation assures each patient maximum safety and comfort throughout the procedure. In addition, the entire process, including any necessary extractions, can be completed in one day with minimal recovery time. The result is a fully functional set of teeth that looks and feels natural, enhances self-confidence and allows individuals to once again experience the foods and activities they enjoy most.

More at All-on-Four What to Expect

Less Downtime
The All-on-Four technique delivers the maximum results in the shortest time with minimal discomfort. Most patients experience only minor soreness the next day and can eat a light meal that same evening. In most cases, you may even return to work the next day.

Benefits with All-on-Four

• Requires minimal recovery time
• Reduces overall cost when compared to single implants
• Eliminates the need for bone grafting, in most cases
• Allows for easy maintenance through proper oral hygiene
• Restores the ability to eat all types of foods
• Relieves the many frustrations of removable appliances
• Ensures long-term results with the potential to last a lifetime
• Renews a youthful appearance through bone level stabilization
• Creates a whole new smile in just one day
• Enhances self-confidence and overall quality of life

All-on-Four Cost

• Approximate cost upper or lower arch - $27,500 - $35,000
• Approximate cost for both arches - $50,000
  (when done at same time)

If All-on-Four dental implants are not within your budget, we can provide other more affordable options for your dental treatment. Learn more about our Budget-Friendly Dental Procedures.

This involves placing a titanium screw (the dental implant) into the bone under the gum. The implant is slowly screwed into the bone using a guide. This process is done using local anesthetic, and is painless and takes about 45 minutes. Dental Implants with screw-like threads such as those made by Nobel Biocare or Endopore are treated with special materials on the screws to enhance or accelerate bone growth and

The cost of placing the single tooth dental implant is typically between US $ 1500 - US $ 2200, depending on the specific situation. Typically, a single non complicated implant the cost is $ 1850. For a LIMITED TIME (thru August 30, 2011), StarBrite Dental is offering a single Implant placement for only $ 1,400.  Click below to request the free consultation appointment.

Who Is a Candidate for Dental Implants?

With the exception of growing children, there may be a dental implant solution for you. Whether you need to replace one tooth, several teeth, or all your teeth, dental implants may be the solution for people of all ages. The following is a list of health conditions that can benefit from implants:

Existing Medical Conditions- If you currently have routine dental treatment, you can generally have an implant placed. Your doctor will let you know if you have a certain condition in which an implant would not be appropriate. Patients with chronic diseases such as high blood pressure and diabetes are usually successful candidates for dental implant treatment.

Gum Disease- Patients who have lost their teeth to periodontal (gum) disease have been successful recipients of dental implants.

Currently Wearing Dentures- Patients who wear dentures or removable bridges are eligible to have them replaced with dental implants. The implants can also be used to stabilize and secure dentures, making them much more comfortable.

Smokers- Smoking may lessen the success rate of implants although smokers have also been successful recipients of implants.

Bone Loss- Bone loss is a common occurrence for people who have lost teeth or had periodontal disease. Cosmetic dentists are trained and experienced in grafting bone to safely and permanently secure implants.

Dental Implant Procedure

New advancements in technology have given choices for the types of implant procedures that are offered. There is the traditional implant and the mini dental implant. The differences are explained below.

The beauty of dental implants is that they are virtually indistinguishable from other teeth. The science behind this lies in the connection between the dental implant and the living bone. Implants can be placed in one sitting but require a period of osseointegration. Osseointegration is the process in which the bone fuses with the implant. In the first step, the dentist surgically places the implant in the jaw, then a healing process of anywhere from three to six months takes place for it to anchor and heal. Once the implant has anchored with the jawbone the dentist can then attach an extension, but first must uncover the implant under the healed gum tissue. After this has been completed the extension, called a post, is attached to the implant. In some cases, the post may be attached during the initial procedure. When the post is in place, your dentist then will make a crown, which has a size, shape, color and fit that will blend with your other teeth. When the crown is completed it is attached to the implant post.

Mini dental implants are recommended for patients who already have dentures but experience difficulty with their loose fit. This procedure involves a short process that locks the loose dentures into place. Because of the small size of the implants (they are about the diameter of a toothpick) more people can qualify for the option. After the mini dental implants are installed, the top of the implant which is shaped like a ball snaps into the metal housing of dentures. The dentures can be removed for cleaning, and are easily attached for a tight fit.

Mini Dental Implants have these fundamental differences to traditional:

• They are about half the width of traditional implants
• They are not fully submerged during a narrow implant procedure
• If the implant procedure fails, grafting is not necessary
• They are less costly
• They are solid though they do not contain a screw
• Mini dental implants are primarily used to secure removable teeth. They cannot have a crown placed on them

Dental Implant Recovery

The recovery time associated with dental implants varies on the complexity of the procedure. Generally healing from the surgical procedure to place the dental implants takes up to six months, while the fitting and seating of the crown(s) can take up to two months. Follow-up appointments with your dentist will reveal the healing times of individual cases and treatments. Most people can expect mild soreness, bleeding, or swelling which can be treated with first aid and over the counter medicines. Generally patients can expect to function normally within a day or two.

Once an implant has been placed however, maintaining diligent oral hygiene habits is required to ensure proper fusing of the implant and bone structure. Failure to routinely brush and floss is a leading cause of implant failure, and infection can occur if the implant and surrounding areas are not cleaned properly. Smoking is also frowned upon as it is attributed to high failure rates with dental implants and should be avoided following implant procedures.

Dental Implants Cost

Dental implants can get very expensive depending on the type of implementation, the dentist performing the procedure, insurance, and the number of teeth involved in the procedure. Each surgical step incurs its own costs, as do the fixtures. Single implants typically range anywhere from the $1,000 to $5,000. Full sets of dental implants can range from $25,000 to $100,000.

Success Rates

Dental implants are amongst some of the most successful procedures in dentistry. It is important to choose an experienced cosmetic dentist or oral and maxillofacial surgeon to perform the procedure. Success rates are lower for smokers because they face a higher risk of implant failure. Smokers will likely be asked by their dentist to give up smoking before the procedure to avoid the risk of failed osseointegration. On the plus side dental implants that are properly maintained can last upwards of 40 years.

Dental implants vary in cost depending on the style of implant, but they can generally cost anywhere from $1,500 to $4,000. Calculate the cost of dental implants with ...

Permanent Teeth in Just one Day!

All-on-4 dental implants was developed in the 1990s as a way to best restore the full arches of the upper and lower jaws. The procedure uses only four implants to secure all teeth in place hence, the name All-on-4. All-on-4 was developed by implant manufacturer Nobel Biocare and European implant dentist Paulo Malo using bio-mechanics, computer simulation and clinical research. Their results provided patients with high quality full teeth restoration without the use of bone grafting in the shortest time possible. The All-on-4 procedure provides especially effective restoration of the upper jaw because longer and stronger implants can be secured in the back part of the jaw.

Previous treatments required patients to receive a total of six or more implants, with treatment extending throughout 18 months of treatment. The patients were then forced to leave the office without any teeth or a poor fitting temporary denture for over a year! With the All-on-4 procedure, we make sure our patients leave our office smiling- with a brand new set of replacement teeth!

All-on-4 Dental Implant Procedure

In order for your dentist to properly evaluate your case your will initially require a consultation and diagnostic appointment in order to best determine the treatment path necessary for your case. This includes determining whether or not your case will require extractions, gathering the appropriate information via X-rays, Panoramic scans and impressions and any other photos required. Directly after this consultation, the patient is scheduled for implant surgery in which the new replacement teeth are fitted and adjusted all in one appointment, including any necessary extractions.

Four titanium implants are placed in the jaw in such a way that the bone will envelop and secure them into place. The implants that are placed in the back part of the jaw are angulated to achieve maximum advantage to the existing bone structure. Once the four implants are secure, the abutments will be attached so that the replacement teeth can be fastened and adjusted for maximum comfort and function giving you a brand new radiant smile. Because only four implants are used in the procedure, the entire process is much less invasive and involves less surgical time than previous treatments.

The beauty of this new procedure is the sheer convenience. Special implants were developed for this treatment allowing for the immediate fitting of replacement teeth to the abutments. This means that with only four implants, patients can leave their dental office with a full set of new replacement teeth within only one appointment! No bone grafts necessary! The teeth are permanent and fixed so there is no need for patients to be without teeth or to endure temporary dentures for an extended time period. The patient is enabled to come for a morning appointment and leave that same afternoon with a brand new radiant smile!

How to Maintain your Permanent Dentures

Occasional check-ups will take place over the course of several weeks and months to ensure that that the gums have properly healed and that the implants have successfully been fused to the bone structure. The result is a brand new long lasting smile with maximum comfort, support and functionality. Most importantly, patients will walk out of our office with a boost of self-confidence and an irresistible urge to smile more often leaving any previously feelings of discomfort or self-awareness behind.

Because dental implant surgery requires a team of professionals, the surgery can be a costly one. Consider the materials needed to create implant prosthodontics as well as the potentiality of bone grafting.

Basic dental implant pricing and fees range from $1,250 to $3,000 per tooth. However, if a patient requires additional things such as bone regeneration and sinus elevation, dental implants can increase from $15,000 to $30,000.

Many dental offices offer dental implant financing plans, allowing patients to finance as much as 100% of surgery fees.

When speaking with your implant dentist, ask him/her to include detail when breaking down surgery fees. 

Find Dental Implants Dentists Here

Dentures website contains information about dentures, prosthodontics, dental implants, implantology and surgery.

Affordable Dentures website contains information about affordable dentures, dental plate, stay plate, false teeth and gnashers.

Affordable Dental Implants affordable dental implant service and low cost dental care.

Implant Dentistry dental implant news and updates.

Tooth implants are considered the ultimate dental restoration solution for tooth replacement, especially when only a single tooth needs to be replaced.

Traditionally, the best dental restoration for a single missing tooth was a three-tooth bridge, better known as a three-unit

For instance, the fabrication of a three-unit bridge required the teeth on both sides of the gap to be whittled down to allow for the false teeth to be slipped over the top of the teeth. Because the three teeth were linked together, they could not be cleaned in the same way as normal teeth. In addition, they required special dental cleaning tools in order to maintain healthy gum tissue.

Today, dental implants are the first choice to replace missing teeth and dental restoration. In the case of a single missing tooth, a tooth implant can be placed by the implant dentist in the jawbone area of the missing tooth. The implant will serve as a replacement for a tooth root and an individual dental crown. The total apparatus is referred to as a single-tooth implant crown.

Once in place, the dental implant crown will look, feel and function like your natural teeth. They are cleaned and flossed just like your natural teeth, and best of all, they do not require any special tools to clean around them, like bridges. Although tooth implants will not decay, they require that you maintain impeccable oral hygiene.

Does a Dental Implant Crown Last Forever?

Even though dental scientists are developing advanced materials to create a more durable crown, the old adage "nothing lasts forever" also applies to dental implant crowns. Because each patient is different, dental implant crowns last a varied amount of time depending on the patient.

Dental crowns that were thought to last only 3 to 5 years can last 10 to 20 years if meticulously cared for. On the other hand, dental crowns that should last for ten or more years can last only two years in a mouth that is neglected.

The dental implant cost factor is hard to determine precisely. The bottom line is that no one can tell you how long a tooth implant will last, but if you take excellent care of your mouth and see your dentist every six months, you stand a better chance of extending the life of your dental implants and other dental restorations.

How Does the Cost of a Dental Implant Crown Compare to a Three-Unit Bridge?

The cost of a three-unit bridge can range from $2,000 to $3,000. The cost of single tooth implants is approximately $3,000. If teeth associated with a dental bridge fail due to recurrent decay or periodontal disease, ordinarily, dental restoration must be done on the entire dental bridge and possibly add a new filling or build-up of the teeth.

The cost of any foundations under a new dental bridge will add to the dental restoration and tooth replacement cost. If and when an dental implant crown has to be reconstructed, most likely, it would be due to the wearing away of the dental crown material.

The only dental restoration cost would be for that of a new dental implant crown and would not incorporate any adjacent teeth. The dental implant cost over your lifetime would be much less than compared to a three-unit bridge, and is the most natural replacement for a missing tooth.

By Benjamin O. Watkins, III, DDS

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There is a lot of information on what are dental implants, crown and bridge procedures with pictures and video's.  Plus key Educational links with dental inplant information and additional video's on dental implant solutions.  Like All-on-4, NobelGuide, Zygoma, NobelReplace, NobelSpeedy, NobelActive and Procera zirconia, zirconium ceramic porcelain crowns. Including Social links and a Dental Blogger.

In addition, there are many links to YouTube, MySpace, My Blogger and become a Facebook Fan.  Social network sites help promote your business, market your services and since these are searchable sites.  They bring you more exposure and web site traffic.

While a basic implant is typically $1,250. to $3,000., depending on your circumstances additional costs for things such as in the case of a posterior mandible, bone regeneration, sinus elevation, and wide diameter or narrow diameter implants quickly escalate to as much as $15,000 to $30,000. for the complete procedure for the upper or lower jaw.

Next: Considerations for people interested in dental implants

1. Introduction to dental implants section
2. Dental implants - an overview
3. Who is a candidate for dental implants?
4. Dental implants - Procedure description
5. Types of tooth implants
6. How much do dental implants cost?
7. Things to consider - Advantages and disadvantages of dental implants
8. Dental implants - Before and after photos
9. Personal stories from people who have had dental implants
10. Choosing the color of the dental implant crown
11. Discuss dental implants on our message board

 A guide to the costs of dental implants and dental implants.

OsseoNews.com Editor’s Note: For additional discussions on the All on 4 concept, please see this post: All On 4 Technique

Virtually all dental implants placed today are root-form endosseous implants, i.e., they appear similar to an actual tooth root (and thus possess a "root-form") and are placed within the bone (endo- being the Greek prefix for "in" and osseous referring to "bone"). The bone of the jaw accepts and osseointegrates with the titanium post. Osseointegration refers to the fusion of the implant surface with the surrounding bone. Dental implants will fuse with bone, however they lack the periodontal ligament, so they will feel slightly different than natural teeth during chewing.

Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws.

Dental implants can be used to support a number of dental prostheses, including crowns, implant-supported bridges or dentures.^[1] They can also be used as anchorage for orthodontic tooth movement. The use of dental implants permits undirectional tooth movement without reciprocal action.

[edit] History

The Maya civilization has been shown to have used the earliest known examples of endosseous implants (implants embedded into bone), dating back over 1,350 years before Per-Ingvar Brånemark started working with titanium. While excavating Maya burial sites in Honduras in 1931, archaeologists found a fragment of mandible of Maya origin, dating from about 600 AD. This mandible, which is considered to be that of a woman in her twenties, had three tooth-shaped pieces of shell placed into the sockets of three missing lower incisor teeth. For forty years the archaeological world considered that these shells were placed after death in a manner also observed in the ancient Egyptians. However, in 1970 a Brazilian dental academic, Professor Amadeo Bobbio studied the mandibular specimen and took a series of radiographs. He noted compact bone formation around two of the implants which led him to conclude that the implants were placed during life.

In the 1950s research was being conducted at Cambridge University in England to study blood flow in vivo. These workers devised a method of constructing a chamber of titanium which was then embedded into the soft tissue of the ears of rabbits. In 1952 the Swedish orthopaedic surgeon, P I Brånemark, was interested in studying bone healing and regeneration, and adopted the Cambridge designed ‘rabbit ear chamber’ for use in the rabbit femur. Following several months of study he attempted to retrieve these expensive chambers from the rabbits and found that he was unable to remove them. Per Brånemark observed that bone had grown into such close proximity with the titanium that it effectively adhered to the metal. Brånemark carried out many further studies into this phenomenon, using both animal and human subjects, which all confirmed this unique property of titanium.

Dr. Leonard Linkow placed his first dental implant in 1952, four months after he graduated from dental school. By 1992, Dr. Linkow had placed over 19,000 dental implants and stopped counting. He retired from private practice in 2002 leaving a body of work that included 12 books and 36 patents. Many implant dentists refer to Dr. Linkow as the father of modern implant dentistry.^[2]

Meanwhile an Italian medical doctor called Stefano Melchiade Tramonte, understood that titanium could be used for dental restorations and after designing a titanium screw to support his own dental prosthesis, started to use it on many patients in his clinic in 1959. The good results of his clinical studies on humans were published in 1966.^[3]

Although Brånemark had originally considered that the first work should centre on knee and hip surgery, he finally decided that the mouth was more accessible for continued clinical observations and the high rate of edentulism in the general population offered more subjects for widespread study. He termed the clinically observed adherence of bone with titanium as ‘osseointegration’. In 1965 Brånemark, who was by then the Professor of Anatomy at Gothenburg University in Sweden, placed his first titanium dental implant into a human volunteer.

Contemporaneous independent research in the United States by Stevens and Alexander led to a 1969 US patent filing for titanium dental implants.^[4]

Over the next fourteen years Brånemark published many studies on the use of titanium in dental implantology until in 1978 he entered into a commercial partnership with the Swedish defense company, Bofors AB for the development and marketing of his dental implants. With Bofors (later to become Nobel Industries) as the parent company, Nobelpharma AB (later to be renamed Nobel Biocare) was founded in 1981 to focus on dental implantology. To the present day over 7 million Brånemark System implants have now been placed and hundreds of other companies produce dental implants. The majority of dental implants currently available are shaped like small screws, with either tapered or parallel sides. They can be placed at the same time as a tooth is removed by engaging with the bone of the socket wall and sometimes also with the bone beyond the tip of the socket. Current evidence suggests that implants placed straight into an extraction socket have comparable success rates to those placed into healed bone.^[5] The success rate and radiographic results of immediate restorations of dental implants placed in fresh extraction sockets (the temporary crowns placed at the same time) have been shown to be comparable to those obtained with delayed loading (the crowns placed weeks or months later) in carefully selected cases^[6]

Some current research in dental implantology is focusing on the use of ceramic materials such as zirconia (ZrO₂) in the manufacture of dental implants. Zirconia is the dioxide of zirconium, a metal close to titanium in the periodic table and with similar biocompatibility properties.^[7] Although generally the same shape as titanium implants, zirconia, which has been used successfully for orthopaedic surgery for a number of years, has the advantage of being more cosmetically aesthetic owing to its bright tooth-like colour.^[8] However, long-term clinical data is necessary before one-piece ZrO₂ implants can be recommended for daily practice.^[9]

[edit] Composition

A typical implant consists of a titanium screw (resembling a tooth root) with a roughened or smooth surface. The majority of dental implants are made out of commercially pure titanium, which is available in 4 grades depending upon the amount of carbon and iron contained.^[10] More recently grade 5 titanium has increased in use. Grade 5 titanium, Titanium 6AL-4V, (signifying the Titanium alloy containing 6% Aluminium and 4% Vanadium alloy) is believed to offer similar osseointegration levels as commercially pure titanium. Ti- 6Al-4V alloy offers better tensile strength and fracture resistance. Today most implants are still made out of commercially pure titanium (grades 1 to 4) but some implant systems are fabricated out of the Ti-6Al-4V alloy.^[11] Implant surfaces may be modified by plasma spraying, anodizing,^[12] etching, or sandblasting to increase the surface area and osseointegration potential of the implant.

[edit] Training

There is no specialty recognized by the ADA for dental implants. Implant surgery may be performed as an outpatient under general anesthesia, oral conscious sedation, nitrous oxide sedation, intravenous sedation or under local anesthesia by trained and certified clinicians including general dentists, oral surgeons, periodontists, and prosthodontists.

The legal training requirements for dentists who carry out implant treatment differ from country to country. In the UK, implant dentistry is considered by the General Dental Council to be a postgraduate sphere of dentistry. In other words it is not sufficiently covered during the teaching of the university dental degree course and dentists wishing to practice in dental implantology legally need to undergo additional formal postgraduate training. The General Dental Council has published strict guidelines on the training required for a dentist to be able to place dental implants in general dental practice.^[13] UK dentists need to complete a competency assessed postgraduate extended learning program before providing implant dentistry to patients.

The degree to which both graduate and post-graduate dentists receive training in the surgical placement of implants varies from country to country,^[14][15][16] but it seems likely that lack of formal training will lead to higher complication rates.^[17]

In the United States, several implant training courses are available through most major manufacturers. These hands-on courses emphasize treatment planning, case selection, implant placement protocol, restorative techniques, and marketing strategies.

[edit] Surgical procedure

[edit] Surgical planning

Prior to commencement of surgery, careful and detailed planning is required to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the shape and dimensions of the bone to properly orient the implants for the most predictable outcome. Two-dimensional radiographs, such as orthopantomographs or periapicals are often taken prior to the surgery. Sometimes, a CT scan will also be obtained. Specialized 3D CAD/CAM computer programs may be used to plan the case.

Whether CT-guided or manual, a 'stent' may sometimes be used to facilitate the placement of implants. A surgical stent is an acrylic wafer that fits over either the teeth, the bone surface or the mucosa (when all the teeth are missing) with pre-drilled holes to show the position and angle of the implants to be placed. The surgical stent may be produced using stereolithography following computerized planning of a case from the CT scan. CT guided surgery may double the cost compared to more commonly accepted approaches.

[edit] Basic procedure

In its most basic form, the placement of an implant requires a preparation into the bone using either hand osteotomes or precision drills with highly regulated speed^[18] to prevent burning or pressure necrosis of the bone. After a variable amount of time to allow the bone to grow on to the surface of the implant (osseointegration), a crown or crowns can be placed on the implant. Unlike conventional dental implants, Mini dental implants may be loaded immediately and still have a high survival rate (94%).^[19][20] The amount of time required to place an implant will vary depending on the experience of the practitioner, the quality and quantity of the bone and the difficulty of the individual situation.

[edit] Detail procedure

At edentulous (without teeth) jaw sites, a pilot hole is bored into the recipient bone, taking care to avoid the vital structures (in particular the inferior alveolar nerve or IAN and the mental foramen within the mandible). Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblast or bone cells by overheating. A cooling saline or water spray keeps the temperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit). The implant screw can be self-tapping, and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone). Typically in most implant systems, the osteotomy or drilled hole is about 1mm deeper than the implant being placed, due to the shape of the drill tip. Surgeons must take the added length into consideration when drilling in the vicinity of vital structures.

[edit] Surgical incisions

Traditionally, an incision is made over the crest of the site where the implant is to be placed. This is referred to as a 'flap'. Some systems allow for 'flapless' surgery where a piece of mucosa is punched-out from over the implant site. Proponents of 'flapless' surgery believe that it decreases recovery time while its detractors believe it increases complication rates because the edge of bone cannot be visualized.^[21][22] Because of these visualization problems flapless surgery is often carried out using a surgical guide constructed following computerized 3D planning of a pre-operative CT scan.

[edit] Healing time

The amount of time required for an implant to become osseointegrated is a hotly debated topic.^[23] Consequently the amount of time that practitioners allow the implant to heal before placing a restoration on it varies widely. In general, practitioners allow 2–6 months for healing but preliminary studies show that early loading of implant may not increase early or long term complications.^[24] If the implant is loaded too soon, it is possible that the implant may move which results in failure. For conventional implants, the subsequent time to heal, possibly graft, and eventually place a new implant may take up to eighteen months. For this reason many are reluctant to push the envelope for healing.

[edit] One-stage, two-stage surgery

When an implant is placed either a 'healing abutment', which comes through the mucosa, is placed or a 'cover screw' which is flush with the surface of the dental implant is placed. When a cover screw is placed the mucosa covers the implant while it integrates then a second surgery is completed to place the healing abutment.

Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for esthetic reasons. Some implants are one piece so that no healing abutment is required.

In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labeled "Immediate Loading". In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the implant while it integrates with the bone.

[edit] Surgical timing

There are different approaches to place dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction implant placement.
2. Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
3. Late implantation (3 months or more after tooth extraction).

According to the timing of loading of dental implants, the procedure of loading could be classified into:

1. Immediate loading procedure.
2. Early loading (1 week to 12 weeks).
3. Delayed loading (over 3 months)

[edit] Immediate placement

An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants.

Most data suggests that when placed into single rooted tooth sites with healthy bone and mucosa around them, the success rates are comparable to that of delayed procedures with no additional complications.^[25]

[edit] Use of CT scanning

When computed tomography, also called cone beam computed tomography or CBCT (3D X-ray imaging) is used preoperatively to accurately pinpoint vital structures including the inferior alveolar canal, the mental foramen, and the maxillary sinus, the chances of complications might be reduced as is chairtime and number of visits.^[27] Cone beam CT scanning, when compared to traditional medical CT scanning, utilizes less than 2% of the radiation, provides more accuracy in the area of interest, and is safer for the patient.^[28] CBCT allows the surgeon to create a surgical guide, which allows the surgeon to accurately angle the implant into the ideal space.^[29]

[edit] Complementary procedures

Sinus lifting is a common surgical intervention. A dentist or specialist with proper training such as an oral surgeon, periodontist, general dentist or prosthodontist, thickens the inadequate part of atrophic maxilla towards the sinus with the help of bone transplantation or bone expletive substance. This results in more volume for a better quality bone site for the implantation. Prudent clinicians who wish to avoid placement of implants into the sinus cavity pre-plan sinus lift surgery using the CBCT X-ray, as in the case of posterior mandibular implants discussed earlier.

Bone grafting will be necessary in cases where there is a lack of adequate maxillary or mandibular bone in terms of front to back (lip to tongue) depth or thickness; top to bottom height; and left to right width. Sufficient bone is needed in three dimensions to securely integrate with the root-like implant. Improved bone height—which is very difficult to achieve—is particularly important to assure ample anchorage of the implant's root-like shape because it has to support the mechanical stress of chewing, just like a natural tooth.

Typically, implantologists try to place implants at least as deeply into bone as the crown or tooth will be above the bone. This is called a 1:1 crown to root ratio. This ratio establishes the target for bone grafting in most cases. If 1:1 or more cannot be achieved, the patient is usually advised that only a short implant can be placed and to not expect a long period of usability.

A wide range of grafting materials and substances may be used during the process of bone grafting / bone replacement. They include the patient's own bone (autograft), which may be harvested from the hip (iliac crest) or from spare jawbone; processed bone from cadavers (allograft); bovine bone or coral (xenograft); or artificially produced bone-like substances (calcium sulfate with names like Regeneform; and hydroxyapatite or HA, which is the primary form of calcium found in bone). The HA is effective as a substrate for osteoblasts to grow on. Some implants are coated with HA for this reason, although the bone forming properties of many of these substances is a hotly debated topic in bone research groups. Alternatively the bone intended to support the implant can be split and widened with the implant placed between the two halves like a sandwich. This is referred to as a 'ridge split' procedure.

Bone graft surgery has its own standard of care. In a typical procedure, the clinician creates a large flap of the gingiva or gum to fully expose the jawbone at the graft site, performs one or several types of block and onlay grafts in and on existing bone, then installs a membrane designed to repel unwanted infection-causing microbiota found in the oral cavity. Then the mucosa is carefully sutured over the site. Together with a course of systemic antibiotics and topical antibacterial mouth rinses, the graft site is allowed to heal (several months).

The clinician typically takes a new radiograph to confirm graft success in width and height, and assumes that positive signs in these two dimensions safely predict success in the third dimension; depth. Where more precision is needed, usually when mandibular implants are being planned, a 3D or cone beam radiograph may be called for at this point to enable accurate measurement of bone and location of nerves and vital structures for proper treatment planning. The same radiographic data set can be employed for the preparation of computer-designed placement guides.

Correctly performed, a bone graft produces live vascular bone which is very much like natural jawbone and is therefore suitable as a foundation for implants.

[edit] Considerations

For dental implant procedure to work, there must be enough bone in the jaw, and the bone has to be strong enough to hold and support the implant. If there is not enough bone, more may need to be added with a bone graft procedure discussed earlier. Sometimes, this procedure is called bone augmentation, or guided bone regeneration. Mini dental implants are particularly useful in the endentulous arch with minimal remaining bone facio-lingually.^[30] In addition, natural teeth and supporting tissues near where the implant will be placed must be in good health.

In all cases careful consideration must be given to the final functional aspects of the restoration, such as assessing the forces which will be placed on the implant. Implant loading from chewing and parafunction (abnormal grinding or clenching habits) can exceed the biomechanic tolerance of the implant bone interface and/or the titanium material itself, causing failure. This can be failure of the implant itself (fracture) or bone loss, a "melting" or resorption of the surrounding bone.

The dentist must first determine what type of prosthesis will be fabricated. Only then can the specific implant requirements including number, length, diameter, and thread pattern be determined. In other words, the case must be reverse engineered by the restoring dentist prior to the surgery. If bone volume or density is inadequate, a bone graft procedure must be considered first. The restoring dentist may consult with the oral surgeon, periodontist, endodontist, or another trained general dentist to co-treat the patient. Usually, physical models or impressions of the patient's jawbones and teeth are made by the restorative dentist at the implant surgeons request, and are used as physical aids to treatment planning. If not supplied, the implant surgeon makes his own or relies upon advanced computer-assisted tomography or a cone beam CT scan to achieve the proper treatment plan.

Computer simulation software based on CT scan data allows virtual implant surgical placement based on a barium impregnated prototype of the final prosthesis. This predicts vital anatomy, bone quality, implant characteristics, the need for bone grafting, and maximizing the implant bone surface area for the treatment case creating a high level of predictability. Computer CAD/CAM milled or stereolithography based drill guides can be developed for the implant surgeon to facilitate proper implant placement based on the final prosthesis' occlusion and aesthetics.

Treatment planning software can also be used to demonstrate "try-ins" to the patient on a computer screen. When options have been fully discussed between patient and surgeon, the same software can be used to produce precision drill guides. Specialized software applications such as 'SimPlant' (simulated implant) or 'NobelGuide' use the digital data from a patient's CBCT to build a treatment plan. A data set is then produced and sent to a lab for production of a precision in-mouth drilling guide.^[31]

[edit] Success rates

Dental implant success is related to operator skill, quality and quantity of the bone available at the site, and the patient's oral hygiene. The consensus is that implants carry a success rate of around 95%^[32]

One of the most important factors that determine implant success is the achievement and maintenance of implant stability.^[33] The stability is presented as an ISQ (Implant Stability Quotient) value. Other contributing factors to the success of dental implant placement, as with most surgical procedures, include the patient's overall general health and compliance with post-surgical care.

[edit] Failure

Failure of a dental implant is often related to failure to osseointegrate correctly. A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2 mm a year after.

Dental implants are not susceptible to dental caries but they can develop a condition called peri-implantitis. This is an inflammatory condition of the mucosa and/or bone around the implant which may result in bone loss and eventual loss of the implant. The condition is usually, but not always, associated with a chronic infection. Peri-implantitis is more likely to occur in heavy smokers, patients with diabetes, patients with poor oral hygiene and cases where the mucosa around the implant is thin.^[34]

Currently there is no universal agreement on the best treatment for peri-implantitis. The condition and its causes is still poorly understood.^[35]

Risk of failure is increased in smokers. For this reason implants are frequently placed only after a patient has stopped smoking as the treatment is very expensive. More rarely, an implant may fail because of poor positioning at the time of surgery, or may be overloaded initially causing failure to integrate. If smoking and positioning problems exist prior to implant surgery, clinicians often advise patients that a bridge or partial denture rather than an implant may be a better solution.

Failure may also occur independently of the causes outlined above. Implants like any other object suffers from wear and tear. If the implant(s)in question are replacing commonly used teeth, then these may suffer from wear and tear and after years may crack and break up, although this is a very rare occurrence. The only way to minimize the risk of this happening is to visit your local dentist for regular reviews.

In the majority of cases where an implant fails to integrate with the bone and is rejected by the body the cause is unknown. This may occur in around 5% of cases. To this day we still do not know why bone will integrate with titanium dental implants and why it does not reject the material as a 'foreign body'. Many theories have been postulated over the last five decades. A recent theory argues that rather than being an active biological tissue response, the integration of bone with an implant is the lack of a negative tissue response. In other words, for unknown reasons the usual response of the body to reject foreign objects implanted into it does not function correctly with titanium implants. It has further been postulated that an implant rejection occurs in patients whose bone tissues actually react as they naturally should with the 'foreign body' and reject the implant in the same manner that would occur with most other implanted materials.^[36]

[edit] Contraindications

There are few absolute contraindications to implant dentistry. However, there are some systemic, behavioral, and anatomic considerations that should be assessed.

Particularly for mandibular (lower jaw) implants, in the vicinity of the mental foramen (MF), there must be sufficient alveolar bone above the mandibular canal also called the inferior alveolar canal or IAC (which acts as the conduit for the neurovascular bundle carrying the inferior alveolar nerve or IAN).

Failure to precisely locate the IAN and MF invites surgical insult by the drills and the implant itself. Such insult may cause irreparable damage to the nerve, often felt as a paresthesia (numbness) or dysesthesia (painful numbness) of the gum, lip and chin. This condition may persist for life and may be accompanied by unconscious drooling.

Uncontrolled Type II diabetes is a significant relative contraindication as healing following any type of surgical procedure is delayed due to poor peripheral blood circulation. Anatomic considerations include the volume and height of bone available. Often an ancillary procedure known as a block graft or sinus augmentation are needed to provide enough bone for successful implant placement.

There is new information about intravenous and oral bisphosphonates (taken for certain forms of breast cancer and osteoporosis, respectively) which may put patients at a higher risk of developing a delayed healing syndrome called osteonecrosis. Implants are contraindicated for some patients who take intravenous bisphosphonates.

The many millions of patients who take an oral bisphosphonate (such as Actonel, Fosamax and Boniva) may sometimes be advised to stop the administration prior to implant surgery, then resume several months later. However, current evidence suggests that this protocol may not be necessary. As of January 2008, an oral bisphosphonate study reported in the February 2008 Journal of Oral and Maxillofacial Surgery, reviewing 115 cases that included 468 implants, concluded "There is no evidence of bisphosphonate-associated osteonecrosis of the jaw in any of the patients evaluated in the clinic and those contacted by phone or e-mail reported no symptoms."^[37]

The American Dental Association had addressed bisphosphonates in an article entitled "Bisphosphonate medications and your oral health,"^[38] In an Overview, the ADA stated "The risk of developing BON [bisphosphonate-associated osteonecrosis of the jaw] in patients on oral bisphosphonate therapy appears to be very low...". The ADA Council on Scientific Affairs also employed a panel of experts who issued recommendations [for clinicians] for treatment of patients on oral bisphosphonates, published in June 2006. The overview may be read online at ada.org but it has now been superseded by a huge study—encompassing over 700,000 cases—entitled "Bisphosphonate Use and the Risk of Adverse Jaw Outcomes." Like the 2008 JOMS study, the ADA study exonerates oral bisphosphonates as a contraindication to dental implants.^[39]

Bruxism (tooth clenching or grinding) is another consideration which may reduce the prognosis for treatment. The forces generated during bruxism are particularly detrimental to implants while bone is healing; micromovements in the implant positioning are associated with increased rates of implant failure. Bruxism continues to pose a threat to implants throughout the life of the recipient.^[40] Natural teeth contain a periodontal ligament allowing each tooth to move and absorb shock in response to vertical and horizontal forces. Once replaced by dental implants, this ligament is lost and teeth are immovably anchored directly into the jaw bone. This problem can be minimized by wearing a custom made mouthguard (such an NTI appliance) at night.

Postoperatively, after implants have been placed, there are physical contraindications that prompt rapid action by the implantology team. Excessive or severe pain lasting more than three days is a warning sign, as is excessive bleeding. Constant numbness of the gingiva (gum), lip and chin—usually noticed after surgical anesthesia wears off—is another warning sign. In the latter case, which may be accompanied by severe constant pain, the standard of care calls for diagnosis to determine if the surgical procedure insulted the IAN. A 3D cone beam X-ray provides the necessary data, but even before this step a prudent implantologist may back out or completely remove an implant in an effort to restore nerve function because delay is usually ineffective. Depending upon the evidence visible with a 3D X-ray, patients may be referred to a specialist in nerve repair. In all cases, speed in diagnosis and treatment are necessary.

[edit] Market

In the United States and the United Kingdom, there is no exclusive specialty in 'implantology'.

Any practitioner who carries out implant treatment, whether in the surgical insertion or the final provision of the prosthesis, must be adequately trained. Legal training requirements differ between countries.

In 2008, in the UK the General Dental Council (GDC) laid down strict training requirements^[41] for dentists involved in dental implantology. Any dentist in the UK who wishes to train in the field of dental implantology must take part in an extended learning program which covers a detailed theory syllabus, as approved by the GDC,^[42] in addition to formal supervised surgical training and mentoring. Dentists must not take part in implant dentistry in the UK until they have been approved by the training provider as having passed a formal competency assessment. Failure to comply with the GDC regulations may result in a dentist being removed from the Dental Register and hence losing the right to practice dentistry in the UK.^[43]

[edit] See also

• Mini Dental Implants
• Oral and maxillofacial surgery
• Prosthodontics
• Periodontist
• Bone grafts in Dental Implantology
• Dental bridge
• Osseointegration
• Osseoincorporation
• Dental tourism
• Gold teeth
• American Association of Oral and Maxillofacial Surgeons
• European Association for Osseointegration
• British Society of Oral Implantology

[edit] References

[edit] External links

• American Academy of Implant Dentistry
• Academy of Osseointegration, professional association of implant dentists
• ITI:International Team for Implantology, professional association of implant dentists
• American Academy of Periodontology, dental implants guide
• Association of Dental Implantology UK
• International Congress of Oral Implantologists
• South African Society for Periodontology
• Dental Implant Education

• Nelson S, Thomas G (May 2009). "Bacterial Persistence in Dentoalveolar Bone Following Extraction: A Microbiological Study and Implications for Dental Implant Treatment". Clinical Implant Dentistry and Related Research 12 (4): 306–14. doi:10.1111/j.1708-8208.2009.00165.x. PMID 19438939. 

How do All-On-Four Dental Implants compare to traditional implants?
All-On-Four Dental Implant procedures utilize only 4 implants, whereas traditional implants utilize anywhere from 5 to 8 implants in one arch. Because the posterior implants of the All-On-Four procedure are placed at an angle, it allows for increased support by using the natural support of your bone.

Also, traditional implants often require bone grafting, a process that can take 6 months or more. The All-On-Four Dental protocol requires no bone grafting for most patients, with a success rate that is equal to or better than traditional implants.

All-On-Four Dental Implants save you from unnecessary surgery and discomfort, as well as time and money.

What makes Dr. Brueggen qualified to perform All-On-Four procedures?
Dr. Brueggen has performed dental implant procedures since the 1970s and has become a leader in the Houston area because of his expertise in the field. He has studied under the pioneer of the All-On-Four protocol, Dr. Paulo Malo.

Every patient is different and can be complex due to health issues and unique bone conditions. But, Dr. Brueggen has seen it all and can provide each patient with a solution that will be safe and effective for them.

Furthermore, the Brueggen Dental Implant Center is fully equipped with imaging equipment, an on-site lab and an experienced team to provide you with the best care possible.

How many All-On-Four Dental Implant Procedures has Dr. Brueggen performed?
Dr. Brueggen has been performing dental implant procedures for over 30 years. The All-On-Four protocol was pioneered in Europe. Published papers began appearing around 1994. At the time, it seemed a radical concept defying many long held beliefs. Dr. Brueggen was immediately intrigued by the concept, though skeptical, and began following the literature. After reviewing 10 years of published data suggesting astonishing results, primarily from Dr. Paulo Malo the pioneer of the All-on-Four technique, Dr. Brueggen began to believe that perhaps this young surgeon from Portugal might be on to something.

In 2005, Dr. Brueggen was privileged to be invited to a lecture given by Dr. Malo in California. After meeting Dr. Malo, studying his body of evidence, and questioning his methods, Dr. Brueggen was convinced that this was a compelling new method for alleviating the crippling effects of total tooth loss. Dr. Brueggen asked Dr. Malo if he could come to Portugal and study with him and he agreed. Early in 2006, Dr. Brueggen went to Portugal and began an in depth study of both the surgical and prosthetic protocol. Immediately upon returning home, Dr. Brueggen began offering this procedure and now works with All-on-Four cases routinely with patients from all over the world. He feels that, in most cases, it provides a better and more permanent solution for his patients.

What is his success rate with All-On-Four Dental Implants?
Published studies show a 98.2% success rate using All-On-Four Dental Implants on the lower arch, and a 97 - 98% success rate using them on the upper arch.

Dr. Brueggen agrees with those studies. In rare occasions, an implant can fail to integrate. In that instance, Dr. Brueggen will discuss your options with you and determine the best solution. In most cases, it simply requires placing the implant in a slightly different position.

Who is the ideal candidate for All-On-Four Dental Implants?
The ideal candidate for the All-On-Four Dental Implant procedure is someone who is currently wearing dentures or will need dentures in the future and is in good health with little bone deterioration. If you or Dr. Brueggen are concerned about any health issues, he will contact your physician to discuss your medical condition and determine if this procedure is right for you. Dr. Brueggen will obtain medical clearance from your doctor, if your doctor feels that it is acceptable to proceed with the procedure. It is rare for a medical condition to interfere with your ability to have this procedure.

However, because of his expertise, Dr. Brueggen has been able to work with all types of bone conditions and those who might have been turned away from other dentists. In this instance, Dr. Brueggen might have to place additional implants to counteract the bone loss or perhaps help you to grow more bone, but no matter what, Dr. Brueggen will personally evaluate your case to provide you with the best possible results.

If Dr. Brueggen feels that you are not a good candidate for All-On-Four Dental Implants because of health concerns or severe bone loss, don't worry; Dr. Brueggen is an expert in all types of dental implants. There are always alternative procedures to meet your needs.

Where will my replacement teeth be made?
Your brand new smile is crafted in our on-site lab. Every part of your procedure, from beginning to end, is created under one roof and Dr. Brueggen personally oversees each step to ensure the best results possible.

Will my results look natural?
Dr. Brueggen uses the latest concepts in smile design to create your new smile. Dr. Brueggen takes your facial features, skin tone, age, and personality into consideration when creating your new permanent set of teeth to ensure that they are congruent with your features. It is important that they are the right size, shape, color, and proportion. A common mistake made by dentists inexperienced with the subtleties of the prosthetic demands, is to show a line, when smiling, where the artificial gums meet your natural gums. This is evaluated by Dr. Brueggen during the surgical planning to ensure that this junction is not visible during smiling or speech and you have the most natural outcome possible.

Prior to the fabrication of your final set of new teeth, Dr. Brueggen makes sure that you are pleased with the size, shape, color, proportion, and comfort of your new teeth. Many patients comment that their new teeth are more beautiful than their permanent teeth ever were. You can be confident in your new smile.

From beginning to end, what should I expect with my All-On-Four Dental Implant procedure?
Each patient is different, and therefore, can expect different timelines, but a general guideline for the All-On-Four Dental Implant Procedure is:

• 1-2 visits for initial consultation and to prepare x-rays and impressions
• 1 visit to place the implants and new teeth and extract any teeth (if necessary)
• Come back for post op visits as required usually 2
• 1 visit four months after placing implants for new impressions for the permanent set of teeth
• 1 visit six months after placing implants to place permanent set of teeth

Why don't I get my permanent set of teeth the day my implants are placed?
As with any surgery, you need time to heal. So, once the implants are placed, you are given a temporary set of teeth or long-term provisional prosthesis made of acrylic resin, which places less stress on your gums and implants. With this set of teeth, you take it easy. You can eat solid foods, but we ask you to only eat foods that can be cut with a fork or that you do not have to tear with your front teeth (like apples).

Once your gums have healed and the implants have stabilized, Dr. Brueggen will place your permanent set of teeth, which will be made of acrylic or porcelain and will have a titanium frame that allows you to enjoy all of your favorite foods.

What if I just need implants on my bottom arch? What do I need to do have All-On-Four
Dental Implants on both arches?
It is perfectly fine to have All-On-Four Dental Implants on only the lower or upper arch. However, if you feel you might need dentures on both eventually, it is typically best to perform the procedure at the same time to achieve better results, and save you time and money. But in certain cases, we can schedule separate procedures to meet your financial and health needs.