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Implant Bridges: What is the process?

Why Choose the Dental Implant Center

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  • Double Board-certified in Prosthodontics & Implantology
  • Over 10,000 Dental Implants placed
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It involves initial consultation, treatment planning, tooth removal (and sometimes bone grafting procedures), then implant placement, temporary prosthesis placement and healing time.  Once the implants have integrated with the bone and are fully healed, the final steps are: abutment placement, final impressions, try-in of final teeth and finally, delivery of final teeth.

Our Same Day Approach Protocol For Implant Bridges (1 Surgery)

The big “sell” for All-On-4 patients with getting their “teeth-in-a-day” is that it’s all done at once. All teeth extracted, all implants placed, and temporary teeth screwed in, all on the same day.

Patients wanting true implant bridges who still have most or many of their teeth, and who still have a good amount of bone height and bone width, very often can also have the “teeth in a day” experience. If there is good bone volume and stability and the first few implants we place are stable enough to support a temporary bridge, patients can have all their teeth removed, have all the necessary implants placed on that same day (as is done with the All-On-4), and have bridges attached to and supported by the implants that same day, keeping those precious pink gums in the right position and esthetically correct for a beautiful smile. The difference is not the “all in a day” experience: the big difference is the absence of large amounts of bone removal, and the preservation of the bone and the maintained shape of the tissues around each of the teeth that are removed. The temporary teeth they leave with and the final prosthesis they ultimately end up with both put pressure on the gums to maintain the shape of their gum line, resulting in a very natural-looking result, as well as a prosthesis the patient can clean on their own without the need for periodic removal of and cleaning of the prosthesis by their dentist. Both the temporary and the permanent bridges are different than those for the All-On-4 Implant Denture.

For implant bridges, each one of the implants must be placed strategically to fall in precisely the right position and angle for the small, individual tooth units of the bridge to fit over them in exactly. This must be done with great care to both look right, and to not compromise anything with the healing. (With the All-On-4 Implant Denture, the prosthesis itself is much bulkier, so the implants don’t need to be as strategically placed, because there’s plenty of room within the walls of the prosthesis for them to fall in imperfect positions. This may even be in between teeth or slightly toward the tongue or cheek). So, as you can see, as is demonstrated by the pictures below, just why that protocol of placing the implants wherever you can, is so much easier to perform. It’s easier for the doctor (but not necessarily better for the patient.)

View of the upper palate before final implant bridge is screwed in.
This view shows the patient’s palate with implants placed in very strategic positions, to fall directly under the teeth being made on them. This allows for a thinner and more natural-sized prosthesis. Also, notice the scalloping of the tissues. This is vitally important in the bridge fitting well and in keeping things looking natural and being easy to clean.

 

Occlusal view of implant bridge shows how the implants must be placed in very precise locations
This view of the Implant Bridge in the mouth, demonstrates the need for precise implant placement. Once these are screwed in, a white composite material is placed into the holes and sealed.

TREATMENT STEPS AND TIMELINE

  • Initial assessment and consultation.
  • Records.
  • We make temporary teeth prior to surgery using models etc. that were gathered during our records visit.
  • Surgery: Extractions, implants, delivery of fixed (not removable) acrylic temporary bridges like the one below.
  • 2 ½-3 months later we check healing, then make final impressions for the final bridge.
  • Try in bridge in wax and make any desired changes.
  • Deliver the final bridge.
Temporary bridge, made in our lab on the day of surgery to match other teeth as closely as we can with the acrylic shades available to choose from, and to fit tight up against the gums to form/maintain the scalloping of the tissues and keep the papillae intact.

Now, for patients whose bone is not ample enough or strong enough to immediately provide reliable support for fixed (screwed in) teeth when their implants are placed, Dr. McFadden has developed a “phased approach”, which takes longer, but the end results are the same as for those who got implant bridges and did have good bone and initial implant stability.

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Our Phased Approach Protocol For Implant Bridges (2 Surgeries)

Since the qualifications for this treatment involve having enough healthy bone and gum tissue, let’s review a few key important factors.  The papillae (the little “V” shaped section of gum tissue between each tooth) is necessary for a great esthetic result. When teeth are removed, this little “V” shaped wedge of gum tissue between the teeth, flattens out and disappears. It can NOT be regrown once it is gone. So, the preservation of this little piece of tissue is critical.

The benefits of Implant Bridges over Implant Dentures (especially in the upper arch), are obvious, but require the patient’s own gum tissues to be healthy and pink and scalloped, keeping that papillae intact. Fixed bridges are the only way to do that once the teeth are removed. Although temporary dentures would serve as an esthetically adequate means for temporary teeth while the implants heal, wearing them instead of a temporary bridge would mean we would lose that precious papillae, as it would flatten out very quickly after tooth removal without anything there pressing against it to maintain that shape. We need those scalloped tissues for the final prosthesis!  So, what do we do if the bone isn’t strong enough and the implants aren’t stable enough to support teeth without risking failure or shifting during healing?

This is where it gets interesting: We do it in phases. We decide which teeth can still be used temporarily to hold in a fixed temporary bridge while we remove the worst ones, and we place some of the implants we intend to place and don’t attach anything to them right away. We leave them alone, and simply give them time to heal. Are you with me so far?

A few months later, you come back, we now use THOSE implants, which are now fully integrated in bone and good and strong. We then use THEM to hold the temporary bridge, and go ahead and remove the rest of the teeth (the ones that held the first temporary in place), and place the rest of the implants in those sites and then give THEM time to heal. So, this means you’ll have an extra surgery, and you’ll be in temporaries for a longer period of time, but it allows you to keep your precious gum tissue in the proper form, and to give the implants time to full heal and become strong before placing heavy chewing forces on them.

It does take a few months longer, and yes, it does cost a little more than Implant Dentures, but the result is a much better restoration.

If you are someone who grinds or clenches your teeth, yes, you must wear a nightguard to protect your temporaries from constant breakage, but, again, the end result is a FAR BETTER result. We have yet to have a patient tell us, “Gee, I really wish I’d have just done the All-On-4 instead of Implant Bridges”. On the contrary: Every one of them has been so proud of themselves for being patient, adhering to a more careful eating approach while in temporaries, and of waiting through an extra surgery visit, but they’ve all been so happy to end up with something that really does look, feel and function like natural teeth, (with the exception of not being able to floss between each and every tooth)!

The temporary bridgedelivered on the day of surgery on teeth
The initial temporary bridge is supported by a few selectively retained teeth to serve as support while the first round of implants are healing.
The 2nd temporary bridge,altered to be supported by the implants that were placed at the first surgery
The new temporary bridge delivered at the 2nd surgery, when the rest of the teeth are removed, is now supported by the implants that were placed at the first surgery.
No bone grafting needed Bone grafting necessary
FINAL Prosthesis Full Implant DENTURE Full Implant BRIDGE Full Implant BRIDGE (STAGED APPROACH) Full Implant DENTURE Full Implant BRIDGE










Temporary Teeth TEMPORARY REMOVABLE DENTURE FIXED TEMPORARY BRIDGE (Screwed in) TEMPORARY REMOVABLE DENTURE FIXED TEMPORARY BRIDGE (Screwed in)
Details & Approx. Timeline






1 surgery About 4 months
Case where implants ARE STABE at 1st surgery & can hold temporary bridge.





Typical scenario 1 surgery About 5 - 6 months
Case where implants ARE NOT STABLE ENOUGH at 1st surgery to hold temporary bridge.




Typical scenario 2 surgeries About 8 – 9 months







2 surgeries About 9-10 months
Worst case scenario where NO implants could be placed without bone grafting PRIOR to ANY implant placement- longest possible scenario.


3 surgeries About 18 months
Jan Assessment & Records Prepare for surgery Assessment & Records
Prepare for surgery
Assessment & Records
Prepare for surgery
Assessment & Records
Prepare for surgery
Assessment & Records
Prepare for surgery
Feb SURGERY

Extractions - all

Implants (same day)

Temporaries: Temporary denture (removable)





wait 3 mos
SURGERY

Extract all teeth

Place all implants same day

Temporaries: Temporary fixed bridge (held in by the implants, because they were solidly anchored in bone at placement).





wait 3 mos
SURGERY #1

Extract some teeth, keep selective teeth to temporarily hold the temporary fixed bridge in place (while implants heal)

Place some of the implants at this visit.

Temporaries: Temporary fixed bridge (held in by the few teeth we kept for this purpose)




wait 3 mos
SURGERY #1

Extractions - all

Bone grafting in all sites needed.

Temporaries: Temporary denture (removable)






wait 5 -6 mos
SURGERY #1

Extract some teeth, keep selective teeth to temporarily hold the temporary fixed bridge in place.

Bone graft areas where teeth were removed, and any other sites where needed if teeth are already missing.

Temporaries: Temporary fixed bridge (held in by the few teeth we kept for this purpose)

wait 5- 6 mos
May Final Impression for final denture. Final Impression for final bridge

Temporaries: Keep wearing temporary bridge.
SURGERY #2

Extract remaining teeth.

Place the rest of the implants.

Use implants from 1st surgery to support temporary bridge and alter it to fit on the implants instead of the teeth that were holding it on before.

wait 3 mos
June Deliver final denture Try-In Final Bridge
July Deliver Final Implant Bridge SURGERY #2

Place all implants.

Temporaries: Keep wearing temporary denture




wait 3 mos
SURGERY #2

Place implants in sites where bone grafting was done at 1st surgery. Temporaries: Keep wearing temporary bridge from 1st surgery, still held in by the selective teeth we kept to hold the temporary bridge while things heal

wait 3 mos
Aug Final Impression for final bridge

Temporaries: Keep wearing temporary bridge from 2nd surgery. May be altered to sit on all implants now that they ae all healed.
Sept Try-In Final Bridge
Oct Deliver Final Implant Bridge Final Impression for final denture

Temporaries: Keep wearing temporary denture until final is back from the lab
SURGERY #3

Remove all remaining teeth.

Bone graft in sites where teeth are removed at this visit and

Use the implants that were placed at the last surgery to hold temporary bridge.

wait 5-6 mos
Nov Deliver Final Implant Denture
March Place the rest of the implants in the sites where bone grafts were done at 3rd surgery.

Wait 3 mos
Jun Final Impression for final bridge

Temporaries: Keep wearing temporary bridge from 3rd surgery. May be altered to sit on all implants now that they are all healed.
July Try-In Final Bridge
Aug Deliver Final Implant Bridge
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