When you are facing the prospect of losing all your teeth or dealing with the frustration of failing dental work, the internet is quick to offer miracle options like “All on 4”, “All on X”, “Teeth in a day” or any other combination of terminology used by the many practices offering rapid, effortless solutions which seem to have no down sides.
The reality is, replacing a full arch of ‘set of teeth’ is not a commodity. It is a highly complex, biomechanical engineering process. For patients seeking a permanent, fixed solution, it is crucial for them to understand the clinical reality behind full arch implant rehabilitation, how it is executed and that the surgery is just the first step towards a predictable, safe outcome, as long as the patient understands that oral health is a lifelong journey, and as with many other things, will require ongoing care and maintenance.
Here is a breakdown of existing marketing for the procedure, and what you actually need to know before committing to a full mouth restoration.
“All on 4” or “All on X” is a concept, Not a Universal Cure
The All-on-4® treatment concept was revolutionary when introduced, utilising four strategically placed implants, incorporating angled titanium implants to support a full bridge of teeth. By angling the back implants, most surgeons could avoid involvement of the sinuses, utilise more dense areas of bone available near the front. This allowed patients to avoid the need for complex bone grafting which was both more invasive, higher risk, with longer treatment times. However, four implants are not necessarily the be all, end all situation, where at times, the anatomy, density of bone, patients bite force and physical span of the jaws may mean that at times, more than four implants would be ideal to ensure the long-term structural integrity of your smile. Patients are not coming to see us at Axis Dental for four implants and teeth, they are coming to see us for a successful, lasting result, performed with surgical expertise and establish a foundation on which to rebuild their oral health. This is why we have simplified the process for patients by categorising the surgical needs through our tiered system. This is to qualify patients for medical, anatomical and physiological criteria, to ensure we can deliver the result with the best result using our surgical expertise. This allows for many combinations within the surgery, based on what will provide the best outcome without additional charges for the patient which we believe is important for peace of mind.
“Teeth in a Day”, Is this final?
One of the most appealing aspects of full arch rehabilitation is the immediacy of the treatment. The ability to leave the clinic with a fixed set of teeth within the same day as your surgery. While accurate, it requires a genuine caveat which patients must understand before proceeding with the procedure. The teeth you receive after the surgery, is in fact what we call an immediate provisional bridge. This must be highlighted, as the bridge you are provided with after surgery is in fact designed and manufactured off the diagnostic set up performed prior to surgery, which utilised factors such as existing dentition, position of teeth, smile line and facial features of the patient themselves. The truth is, as mentioned above, this treatment modality for All on X is used for terminal dentition and there are many instances that the teeth used as reference for your initial design may not be positioned ideally. The provisional bridge functioned to ‘splint’ the teeth together for ‘cross arch stability’, which is a big part of why concepts like All on X works to share the load across the implants. There is still a period of healing which needs to occur (osseointegration), to allow the implants to correctly fuse with the bone, but also a remodelling process which can result in tissue changes or shrinkage. During the initial healing phase, it is critical that the patients’ adhere to a soft diet and avoid excessive bite forces to allow this healing to proceed normally. The final, definitive prosthesis, can be manufactured with more durable materials, allowing changes to both the aesthetic appeal, positioning, colour, as well as closing any spaces which may arise from the healing. Our recommendation here at Axis Dental is to maintain a milled titanium bar as the foundation for whatever choice of bridge material is selected by the patient, to ensure that cross arch stability is always maintained, and load is dispersed across the implants correctly. It is also our recommendation that an occlusal splint or ‘night guard’ is worn to mitigate possible night time grinding to prevent excessive forces being transmitted to the teeth.
Hidden Engineering: Bone profiling
A fact of biology is that as we lose our teeth, it is normal to lose both the supporting structures around those teeth such as the bone, gums, roots, etc. The replacement of those aspects along with the teeth are a critical aspect in restoring a patient with a flawless full arch restoration which is indistinguishable from natural teeth, which are both visually and functionally appealing, but also through our vanity, we also want to disguise the transition line from people being able to see any traces of ‘dental work’. Achieving this seamless aesthetic result is not just a matter of surgical and prosthetic expertise, but ensuring there is adequate space available for the teeth to sit. This may mean that at the time of surgery, even for patients who have been wearing dentures for years, it can be necessary for bone to be removed to allow enough ‘height’ of the restoration to be resilient enough to withstand the forces used to eat and live.
Mitigating Risks Through Planning
Full arch rehabilitation is a profoundly rewarding procedure for both patients and surgeons alike, but it can be clinically unforgiving if complications arise. These complications can vary from broken provisional bridges, speech changes or even implant failures. Typically, these complications can arise from many factors, but here at Axis Dental, we do everything within our power to minimise the risks. We do this with careful planning of the surgical procedure with advanced CBCT (cone beam computed tomography) imaging, digital planning of the prostheses with all parameters such as height, position accounted for with our lab, surgically assessing every step of the surgery with rigorous standards which exceed all minimum standards, and allow us to predictably provide the result we want. However, in the event of a complication, we endeavour to be available at all times to support our patients in any way we can to rectify the complications. From our experience, the largest single factor contributing to complications have been patients not being able to adhere to the soft diet for a prolonged duration. The problem is the teeth can feel so natural and normal, with no symptoms that sometimes the post operative instructions can be forgotten. However, this period of healing is critical for successful long term recovery and healing and will be followed up with our patients on a regular basis until confirmed healing. This rigorous compliance is what drives us here at Axis Dental to ensure we can deliver results for all of our valued patients.
Your Responsibility: Maintenance
Implants are not the same as teeth, they are not subject to cavities, but bone and gum health is critical in maintaining your fixed bridge, same as if they were your own teeth. Periodontal disease which affects teeth, also exists with implants under the term peri-implantitis (inflammation and potential bone loss around implants). Investing time into maintenance is a lifelong commitment to ensure that your teeth are taken care of, both at home and in the clinic for a successful outcome for years to come.
Your Responsibility: Maintenance
Choosing to undergo a procedure like All on X or implant supported restoration is a significant investment in your health, confidence and quality of life. It is crucial you have the confidence in your team to support you with transparency, surgical precision and uncompromising standards of care. We also partner with many other clinics to offer our surgical options, as we know that patients come from all areas and need a lifelong partner for their ongoing care. Come and speak with our team, so we can show you why we feel so confident in both our products, services and teams. Dr Ho-Yeon Choi (DEN0001868953) Dentist (General Registration) Bachelor of Dentistry (USYD)