All On 4 Dental Implant Houston Case Of The Week

This has been an interesting week bringing unique opportunities and challenges for my all on 4 dental implant cases. Though I didn’t start any All on 4 cases this week but I saw many that were in their healing and restorative stages. My time was consumed with orthopedic dentistry [bone regeneration] of almost every type and routine dental implant placement at my dental implant clinic in Houston.
The All On 4 Dental Implant Case
Wednesday I was a guest on Great Day Houston hosted by Debra Duncan and I took a 23 yr old nurse with me. She required full mouth extractions because of rampant dental decay, 4 upper and 4 lower dental implants, and new set of upper and lower teeth; typical All on 4 dental implant. Debra Duncan has been a great friend of my practice and has been very helpful in getting the word out about All on 4 dental implant in Houston. Our intention was to make people aware that not everyone who needs All on 4 is 40 yrs old or more. Many of my patients who need All on 4 dental implant are younger and some are even in their early 20’s.

Based on the calls my office has received I believe our mission was accomplished. In the field of dental implants surgery seems to get all of the “glory”. I don’t know why but even I tend to study and report on it more. But the surgery is really the easiest part of the procedure and of course has nothing to do with what the patient wants. People want beautiful teeth that look and function naturally and are dependable. Ideally they’ll never know a dental implant is even there. With single unit dental implants this isn’t very difficult but with full arch cases it certainly can be.

Complications With All On 4 Dental Implant
I find the most common complication by far, with the All on 4 dental implant system, to be breakage of the transitional and even the final appliances. With natural teeth when we close our mouths a proprioceptive signal lets us know how hard and in what position our mouths are closing. With full mouth dental implants most of this awareness is lost. Consequently we can bite very hard or in odd positions without knowing it and that can lead to broken appliances. I expect that for the rest of my career I will be exploring opportunities to mediate this.

Solutions for Complications With All On 4 dental Implants
If a patient is a severe grinder of their teeth at night or has shown signs of extreme clenching during their sleep it is probably best to restore at least one of the archs with a removable appliance that is tissue supported but implant retained such as a “locator” attached overdenture. This would be a better choice than a bar supported overdenture because proprioception is improved and when the appliance is removed at night there is nothing to grind or clinch against the opposing appliance. But what do you do to compensate for when then patients parafunctional habits are miscalculated and opposing fixed appliances are fabricated or a fixed appliance is made to function against an arch of natural teeth?

Many things help but none of them are good enough. Occlusion needs to be designed with ½ mm of overbite in the anterior with traditional anterior guidance in protrusive. Flat plane teeth with balanced lateral movements rather than cuspid rise is preferable. All of that sounds great but for many reasons it is rarely achievable in full so almost every case has at least a few compromises. When constructed against natural teeth many compromises are the rule. All patients with fixed dentistry should wear a night guard. Simple soft guards are fine if the patients TMJ will tolerate them but NTI’s work very well also. This would solve most of the problems if only patients would wear them consistently. Though intuitively I would expect a high quality acrylic tooth to be superior to a porcelain tooth experience has not shown a difference in breakage.

However, since the porcelain teeth wear longer I normally prefer them. Of course all final All on 4 dental implant appliances have milled titanium frameworks and this prevents breakage of the appliance. Though if the framework is not extended adequately beyond the most posterior abutement that portion of the appliance may break off. Unfortunetly, even when everything seems perfect teeth will still sometimes debond or break. Meticulous lab work and occlusal equilibration helps but to date our greatest opportunity to improve this service for our patients remains in developing more satisfactory appliances. For now the traditional All on 4 dental implant with a fixed hybrid prosthesis is the most extraordinary service dentistry has ever been able to provide for those who have lost all of their teeth or who are going to lose all of their teeth.

Houston dental Implants A Real Story: Removing Failing Dental Implants & Replacing with All-On-4 Dental Implants

This is a real experience at the Brueggen Dental Implant Center, commonly known as the “Houston Dental Implants” - we did a lower All-on-4 dental implants case for a 60 yr old gentleman from Colorado.

A brief description of the condition of the patient provided by Houston Dental Implants:

He was in town on personal business and learned about Houston Dental Implants from a T.V. ad. His medical history was non-contributory. Dentally, he was wearing an upper and lower denture. There was a mobile and failing unilateral subperiosteal implant on the lower left, and one had previously been removed on the lower right. Subperiosteal implants are placed beneath the “gums” and rest on, but not in, the bone.

Subperiosteal implants are used when there is inadequate bone volume to place a dental implant into the bone, and the treating doctor is not aware or trained in other options. They experience a very high failure rate. I have removed a number of subperiosteal implants but have never placed one.

These implants were placed in Colorado about 15 years ago when the upper and lower dentures were made. It was the doctor’s hope to attach the lower denture to the subperiosteal implants, but unfortunately, that was never possible.

This patient was displeased with the fit of his false teeth. Even with thick denture adhesives, he was unable to eat, and the lower was unstable even in speech. He was a very active gentleman and very frustrated with his situation because his previous dentist had told him that he did not have enough bone for dental implants.

How did Houston Dental Implants made the life easier for the 60 year old, active gentleman?

Houston Dental Implants took a cat scan (a very sophisticated x-ray designed to allow precise measurements of bone in all dimensions) and determined that he did have enough bone for dental implants if the All-on-4 dental implants (a full set of upper or lower teeth fixed to 4 dental implants) technique was used.

Consultation revealed that financially doing this on the upper and lower was not feasible, so we elected to do a new denture on the upper and the All-on-4 dental implant procedure on the lower. Our in-house lab pre-made the upper denture, so when he arrived at Houston Dental Implants in the morning; we were able to deliver that before I began the surgery.

Using conscious oral sedation, I began the surgery at 9:30 A.M. The failing subperiostel implant was removed, 4 endosseous dental implants were placed, and the surgery was completed at 10:55 A.M.

Impressions were taken for the lab and at 4:30 P.M., the patient was ready to leave with his new upper denture and new lower non-removable teeth attached to 4 implants.

His healing and recovery should be uneventful, and I anticipate making his final set of teeth in 6 months. Houston Dental Implants was hopefully able to minimize his dental troubles forever.