Immediate Tooth Replacement (All-on-4) vs. Delayed Tooth Replacement (Conventional Implant Placement)

Many of our patients come in to see us after having consultations with other doctors. There are so many ways to complete treatment and every doctor is trained differently and has different philosophies on how to give patients the smile they want. Some doctors have been recommending the same treatment for decades that works in their hands while others are doing the latest, researched treatments using the newest technology. The newer technology and treatment protocols in implant dentistry have all been changed to allow patients to have a faster “time to teeth”, less downtime, and less invasive treatment. We want our patients to never have to put their teeth in a glass of water!

How were implant reconstructions done in the past?

The world of implant dentistry has been reconstructing full-arches of teeth for decades with good success. Let’s give an example of a patient that comes in with an upper jaw of failing teeth that are loose, infected, and esthetically unsightly. Traditionally, the treatment plan would consist of something like this:

1. The teeth would be extracted as step one. When teeth are lost, the bone is lost with it making it more difficult to place implants. In the maxilla (upper jaw) the sinuses also expand making it more difficult to place implants in the upper jaw.
2. Traditional treatment for a case like this would involve sinus lifting and bone grafting to prepare the jaw for implant placement. Sinus lifting is a procedure by which bone is placed at the floor of the sinus so that it can heal and implants can be placed. Bone grafting is a technique where cow, human, or synthetic bone is mixed with the patient’s own bone to grow the lost jaw bone. When sinus lifting and bone grafting was done, the patient would have to wait to heal on average 6-9 months. At this time, the patient would need to wear a removable denture or no teeth are all!
3. Once the bone was healed, the implants could then be placed and left to heal under the gums for another 6 months to allow the bone to heal around the implant.
4. After the implants are healed, the implant would be “uncovered” by opening up the gums in the area and a “healing abutment” would be placed. This would be allowed to heal for 1-2 months.
5. Then the impressions could be made on the implants and the final restoration could be tried-in for the patient. The total treatment time would be on average 2+ years!

How are implant reconstructions completed now?

We have cut down the “time to teeth” for our patients significantly to the point where they never have to wear a removable denture unless they come in with one. Let’s take the example case that we spoke about above: a patient that comes in with an upper jaw of failing teeth that are loose, infected, and unsightly esthetically. Now, how we would complete this in a few steps.

1. Make the temporary implant denture: this takes 3 appointments scheduled a week apart where we plan the new smile by making digital impressions, photos, and measurements.
2. Implant Placement: this is the magical date! The diseased teeth would be extracted, implants are placed, and the patient leaves with a fixed set of teeth that looks great and doesn’t come in and out.
3. Final Implant teeth fabrication: 3-6 months later, digital impressions, photos, and measurements are made to make the final set of implant teeth.

With this new style of immediate tooth replacement, or the All-on-4 technique, the patient will never be without a fixed set of teeth and the total treatment time is less than 6 months! That is way better than two years of treatment with the traditional route. Also, the immediate tooth replacement treatment requires little to do bone-grafting, sinus lifts, or downtime.

Which way is the best way to treat full-arch implant dentures?

Although both treatment options will work and give great long-term results, the new way of doing full-arch implant therapy is less invasive and require less downtime. This allows our patients to enjoy their life with their new confident smile faster and with less discomfort! We also want our patients to never have to put their teeth in a glass of water!