Boise Prosthodotics
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"Teeth in a Day"     "All-on-Four"


Teeth in a Day is a phrase used to describe the concept of receiving new teeth or a “new smile” via an interim implant prosthesis the same day dental implants are inserted into one’s jaw.  Also known as "All-on-Four", "Diem 2", "Revitalize"Immediate Load, Fixed Implant Bridge, Fixed Detachable Bridge, and Denture Bridge.  Currently this treatment option is being heavily marked in the dental community, the main reason it is marketed so heavily is the fact that it can provide an excellent solution to those who have lost or soon will loose their teeth and want to avoid dentures.  

DILEMMA WITH TREATMENT
Implant companies are encouraging dentist's everywhere to offer this treatment to their patients because they know the value dental implants can be for so many people.  The dilemma lies in the fact that many dentists want to provide this treatment for their patients, but may not have received the proper training to adequately do so.  In attempts to get some form of training they attend weekend courses that provide various degrees of information regarding the process.  The only formal education and training available regarding the history, techniques, literature/research, and clinical experience are found in advanced dental specialty residency programs.  The most highly trained dentists with respect to this type of treatment are generally Prosthodontists (Dental Specialists.)

ALSO KNOWN AS

All on Four, Diem 2, Revitalize, Immediate Load, Teeth in a Day, Same Day Teeth, Fixed Immediate Implant Bridge, Denture Bridge, Immediate Hybrid or Immediate Load Hybrid, Conversion Prosthesis, etc.

DESCRIPTION OF TREATMENT
Most simply stated, this treatment describes the process of receiving a temporary acrylic (esthetic resin) set of teeth that screw onto 4 to 6 implants the same day the implants are inserted into ones jaw bone.  The concept allows people to avoid experiencing a removable denture and the inherent difficulties of dentures.

WHAT IS THE PROCESS?
It is a miss conception that it only takes one day to get your new implant teeth.  The most important and critical part of this treatment is the planning and preparation process.  It cannot be stressed enough that this treatment needs to be planned and performed by well informed and highly trained dentists.  The process includes these main steps:

1-   Initial Consultation and Examination
2-   Diagnostic Records (impressions, photos, bite registration, Conebeam CT Scan)
3-   Discuss and presentation of plan (review risks of proposed plan, review sequence and guidelines, arrange surgery and teeth delivery)
4.1-   Surgery (remove teeth, insert implants) (2-3 hrs) - same day "Teeth in a Day"
4.2-   Insertion of immediate/temporary acrylic teeth (2-3 hrs) - same day "Teeth in a Day"
5-   24 hr evaluation
6-   1 week evaluation
7-   8 to 12 weeks healing (more time may be needed or requested by the patient)
8-   Fabrication of final prostheses (4-6 visits)  

WHO QUALIFIES FOR THIS TREATMENT?
This treatment is a great option for anyone who desires a highly functional and esthetic option to replace all their teeth.  Candidates may include those who have already lost all their teeth or those who are going to loose all their teeth in the future.  With proper planning most people have adequate bone for the use of strong quality implants of regular size.  Again, the importance of proper planning and understanding of success and failure of implants is critical.  In some situations one's bone may not be adequate for implants.  In many instances success can be obtained by augmenting the bone (grafting of the jaw or in the sinuses) or through the use of more advanced implant techniques and procedures (zygoma or trans-sinus implants).

ADVANTAGES?

The major advantages are related to avoidance of a denture.  As a result most people experience less discomfort immediately following the implant surgery.  There is less pain and an easier transition to the loss of their teeth and the addition of new artificial teeth.  
Improved comfort
Not removable
Better function
Provides a future back up interim prosthesis when repairs may be needed
Preservation of bone around the implants during healing
Predictable
Provides a trial run with new teeth (esthetics and function) prior to fabricating the final teeth

DISADVANTAGES?
Added cost
Chance that the implants may not be stable enough to immediately load
Greater chance that people will overuse/abuse their implants during healing

WHAT ARE THE POSSIBLE COMPLICATIONS?
Sometimes the implants are not be sufficiently tight in the bone as needed to screw a temporary bridge onto them the same day.  When this happens you'll be required to use a temporary denture while the implant heal (about 3 months).
The all acrylic bridges may break during the healing time.  
The screws that hold the temporary bridge may loosen or break.  
The abutments that screw into the implants may loosen.  
Implants may fail.
All of the above listed complications may be minimized and in most cases avoided if proper planning and guidelines are followed.  If they occur most are correctable with minimal affects to the outcome of the treatment.  Screws can be tightened and replaced.  Breaks in the acrylic can be repaired.  If an implant fails early on a new one can be placed and the prosthesis adjusted.  One thing that is important to state is trying to avoid repairs during the critical healing that occurs 2-4 weeks after the initial implant surgery.  At weeks 2-4 the bone is actually weaker adjacent to the implants as a result of the natural healing process and as such any unnecessary movement or torquing of the healing implants should be avoided. 

WHAT ARE THE FINAL TEETH LIKE?
There are actually various options available to restore ones teeth with a final definitive prosthesis.  The final prosthetic teeth should be discussed prior to starting as the different options have different requirements for proper esthetics, strength, implants, and function.  The basic options include for are not limited to:

Hybrid (metal framework screwed to the implants with denture teeth)
Zirconia Pratau Bridge (dense strong full zirconia one piece bridge)
Zurick or Promax or Component Bridge (One piece framework screwed to the implants with individual esthetic crowns cemented to the framework)
Bridges or Implant FPDs (three separate implant bridges of metal and porcelain or zirconia or zirconia and porcelain)

  
Before Implants and Immediate Temporary Teeth Day of Surgery (extractions, Implants) and Immediate Teeth

  
Prior to Surgery and Implants Day of Surgery and Temporary Teeth



  







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