Toothless (edentulous) jaw and full-mouth reconstruction with implants
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In the past the loss of all teeth inevitably meant wearing full dentures with all the associated consequences: pressure sores, often poor fitting dentures, particularly in the lower jaw, limited chewing function, reduced sense of taste, sometimes gagging or impaired speech.
In addition, the continuous pressure of the dentures causes shrinkage of the jawbone due to accelerated bone loss (also known as bone resorption or atrophy) and thus leads to an even worse fit of the dentures. Poorly fitting dentures do not provide adequate support for the tissues of the face, particularly the lips, which makes the patients look older and encourages the development of premature wrinkles. The psychological effect should not be underestimated either as for many people full dentures symbolise old age.
With dental implants we can now break this vicious circle. Only 2-4 implants fitted with studs or other attachments are sufficient to give a full denture stable support. With more sophisticated constructions it is possible in most cases to anchor a fixed bridge in a completely toothless (edentulous) jaw. The old dream of new fixed teeth has now become reality and enables many people to regain an important piece of quality of life.
Visibly improved quality of life:
57-year-old toothless patient before and after receiving fixed implant-supported replacement teeth.
The good support for the lips and cheeks gives the face a fuller appearance and makes the patient look considerably younger.
For many years now, one of our key areas of expertise has been the rehabilitation of toothless patients and full reconstruction in patients who have to have all their teeth removed. In the following we give you an overview of the most important methods used in our practice for removable and fixed dental restoration in toothless jaws.
Removable dentures on implants
This is the simplest and often the least expensive form of implant treatment for toothless patients. It is suitable particularly for patients who are already wearing dentures but are dissatisfied with their fit. In the case of severe shrinkage of the jawbone – after wearing full dentures for years – removable implant-supported overdentures are sometimes preferable to a fixed restoration. Retainer elements (studs or bar) are screwed onto the implants inserted in the jaw and the dentures clip onto these and sit firmly.
Stud anchors and bar give the dentures a firm hold.
Locator® attachments are special studs with which we can adjust the fit of the dentures precisely to suit the needs of the patient. If the dentures become loose the Locator fittings in the denture can be replaced in just a few minutes.
Of course the dentures still have to be taken out and cleaned after meals. However, the good fit gives the patients a feeling of security and chewing is much more comfortable compared with normal full dentures. In the lower jaw at least two implants are needed, each of which is fitted with one stud. However, we prefer stud constructions with three implants because the denture is much more stable if it is anchored at three points and does not wobble or tilt even when biting with the incisors.
An alternative is the insertion of four implants which are connected with a bar made of a noble metal or titanium. The prosthesis then clips onto the bar with great precision. The advantage of bar-retained dentures is that they are immediately functional. Only one day after implantation the patient is given the dentures and can immediately chew normally with them; there is no long waiting for the implant to integrate. In the upper jaw we do not recommend studs for removable dentures but prefer bar-retained dentures on 4-6 implants. However, a fixed restoration with an implant bridge is usually better.
Example II from our practice
Removable tooth replacement on implants
This 39-year-old patient, a former photo model, had had major reconstruction done several years ago in Eastern Europe. All her teeth had been crowned. Unfortunately the work had been done so badly that the patient had developed massive periodontal disease and tooth decay under the crowns. When she came to see us she was suffering from severe depression because she was ashamed to show her teeth in public.
All the teeth in the upper jaw had to be removed. On account of the considerable bone loss we decided in this case to fit bar-retained dentures on 8 implants. The extractions, bone augmentation and implant placement were performed in the same session under general anaesthesia.
After the successful rehabilitation: The patient has rediscovered her smile and overcome her depression.
Fixed implant bridges in the toothless jaw - Fixed teeth in one day
More and more patients today want implant treatment which does not involve removable dentures but provides "permanent teeth" which look and feel just like natural teeth. In the past, this kind of full reconstruction with dental implants was a very major procedure as it involved placing 6 to 8, sometimes 10 implants in each jaw, and bone augmentation was often also necessary. This meant that the treatment was very expensive and unaffordable for many patients. In addition, the whole treatment often took as long as 12 months, with tedious healing phases during which the patients had to put up with removable full dentures, before the final bridgework could at last be fitted.
Today, thanks to the advances in modern implantology we can offer our patients solutions which are considerably less time consuming, more comfortable, safer and less expensive.
With the All-on-4™ method we can provide immediate fixed tooth replacement with only four implants per jaw. The back implants are placed at an angle of 30-45 degrees. This means that we can usually manage without bone augmentation and allows us to steer clear of critical anatomical structures such as the maxillary sinus in the upper jaw and the sensory nerve in the lower jaw.
After placement of the 4 implants (any remaining teeth can be removed in the same session) a previously fabricated provisional bridge is screwed onto the implants. The patient leaves our practice with fixed functional teeth. About three months later the final bridge is then installed.
All scientific studies consistently show a very high success rate for implant bridges using the All-on-4™ technique. All-on-4™ bridges are just as durable and reliable as constructions with six or more implants. In addition, we can avoid bone augmentation, which is often stressful for the patient and not without risk, and can considerably reduce treatment times and costs. For all these reasons we prefer the All-on-4™ method for full reconstruction with implants.
Because of our extensive experience with this method we are convinced of the longevity of the All-On-Four-prosthesis and grant our patients a 10 year guarantee against implant loss.
In the case of extreme bone loss in the upper jaw, e.g. after wearing full dentures for decades, there is sometimes no bone left at all and normal implantation is therefore impossible. A good alternative to extensive bone grafting is the zygomatic implant.
Further extensive information on fixed teeth in one day are available here.
Example I from our practice
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43-year-old man with advanced severe gum disease. Because of anxiety the patient had delayed the treatment for years. When he finally consulted us numerous teeth were loose. The patient suffered from severe chronic pain and had serious psychological problems. The examination showed that there was already very marked bone loss. All the teeth had to be removed. The patient, who had come to us from abroad, wanted full mouth reconstruction under general anaesthesia. As a person in the public eye it was important to him that the treatment time was as short as possible and that he had "fixed teeth" from the start.
In an operation under general anaesthesia we removed all the teeth and immediately placed 4 implants per jaw in the upper and lower jaws using the All-on-4™ method. Through the special approach of this procedure we were able to do without major bone augmentation or grafting in spite of the bone loss. This meant that the implants could be immediately loaded with fixed provisional prosthesis 4 hours after the operation and spared the patient months of waiting with provisional removable dentures.
Example II from our practice
In this 49-year-old patient, advanced gum disease had led to pathologic tooth migration. The pressure of chewing had resulted in a fan-shaped arrangement of the teeth. The top pictures show the situation before the treatment. The patient, who attached great importance to a well-groomed appearance, was understandably miserable about her situation and wanted a full-mouth reconstruction. In an operation under general anaesthesia we removed the upper teeth and, in the same session, placed four implants using the All-on-4™ technique. On the same day, some hours later, the patient was given a fixed provisional denture which was screwed onto the implants (immediate function). In the lower jaw we were able to save most of the teeth through periodontal treatment. Only one implant was necessary here. The bottom pictures show the patient with the final tooth replacement three months after the operation.
Example II from our practice
8 implants in the upper jaw
Examples I and II show the All-On-4 method with a fixed bridge on four implants. In particularly demanding cases it is sometimes better not to fit the jaw with a dental replacement consisting of one piece but to use separate individual ceramic implant bridges instead. For this very elaborate procedure 8 implants usually have to be placed in the upper jaw, while in the lower jaw six implants are usually sufficient. Our aim is always immediate function (immediate loading) in the region of the front implants in order to spare the patient a tedious healing phase of several months with removable provisional bridgework.
This 65-year-old woman consulted our practice because she was increasingly unhappy with the cosmetic appearance of her 20-year old bridges in the upper jaw. At the first examination we found that the dental substance under the bridges was severely damaged by tooth decay. The prognosis of the pivot teeth under the crowns was so poor that it did not seem advisable to make new bridges for the existing teeth. The patient therefore decided on full reconstruction with extraction of all upper teeth and replacement with 8 implants and 4 separate ceramic bridges. For the reconstruction of the lower jaw we planned 3 implants and restoration of all teeth with single all-ceramic crowns.
First we performed careful planning on the basis of X-rays, models and photos. A computed tomographic scan (CBVT) permitted a three-dimensional analysis of the jawbone and virtual simulation of the implantation on the computer.
The operation was performed under general anaesthesia. At the same time as removing the teeth we were able to place eight stable implants in the upper jaw; for the back right implant bone augmentation (sinus lift) was necessary. In addition we performed gum augmentation with a gum graft in order to strengthen the gum tissue around the implants and prevent gum loss. At the end of the operation a previously fabricated fixed provisional bridge was firmly screwed on to the front six implants while the two back implants were allowed to heal without loading.
After six months the implants had become fully integrated into the bone so that we were able to install the definitive replacements. After taking an impression, individual ceramic posts (abutments) made in the dental laboratory were screwed onto the implants in the upper jaw. We then cemented the four separate metal-free all ceramic bridges onto these ceramic abutments.
Chapter overview: Implants
- What is an implant?
- Single-tooth implant
- Implants in the toothless jaw
- Bone augmentation
- New surgical procedures
- Immediate implants
- Risks and complications of dental implants
- Costs and guarantee of implant treatment
- Questions and answers about dental implants
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