I’m Dr. David McFadden, Board Certified Prosthodontist in Dallas, Texas. I would like to explain some important aspects of restoring missing teeth with dental implants. For patients who are currently missing all of their teeth or are soon to be missing all of their teeth, there are three different implant treatment types that I want to discuss. Many dental implant practices propose the extraction of all the teeth to make room for implants. At the Dental Implant Center, we do not believe in that. We think a good tooth is still worth keeping. We like to work around a good tooth with implants whenever it is possible. In many ways, the three implant treatments are similar, in that patients end up with a great smile, but I want you to focus on the differences.
Option #1 which I call the highest level option is that of a fixed implant restoration. This is where we put crowns and bridges directly on the implants. Most people have had crowns or bridges on their natural teeth. This treatment is very similar to that form of dentistry. The first treatment option for patients missing all of their teeth is to have crowns and bridges placed back in their mouth but on implants instead of on teeth. For example, if a person is missing three teeth we could use two or three implants. If three implants, we could replace the missing teeth with three individual crowns. If two implants, we could replace the missing teeth with a 3-unit implant bridge. To take this to the next level, the best treatment that we can render with implants is the one that uses this same concept for the whole arch of teeth. We might have four bridges in one arch, but it would replace 12-14 teeth on a limited number of implants. These teeth are “fixed” meaning they stay in your mouth at all times. This option looks, feels and functions just like healthy natural teeth.
The second option that we have to offer patients missing all the teeth in one arch is what is called a hybrid prosthesis. The popular name for this has become the All-On-4 treatment or the Teeth-in-a-Day treatment. This is wildly popular in the United States. It is a denture-type prosthesis that is larger than the first option that I discussed. It is an entire prosthesis on a titanium base that has plastic teeth. This is the next level – the second level or the second tier of treatment. It is screwed into place, or it is cemented into place, and neither of these first two options can be removed by the patient. They are highly functional, and they are very comfortable. The slight negative of this treatment option is that it does not feel like natural teeth. At the Dental Implant Center we recommend this option mostly in the lower jaw. There are problems with a hybrid prosthesis in the upper jaw, mainly that the front denture teeth often break and that speech can be permanently changed.
That brings us to Option #3. Option #3 is a removable implant prosthesis. It is a denture that actually snaps down onto the implants. Four implants are preferred in this situation, but two can be used as well. The denture actually snaps into place and is stable because of the attachment between the abutment and the attachment inside the denture. It is as stable and retentive as we, the dentists, want to make it as the attachments come in seven different levels of retention. The decision on how much retention is the correct amount is determined by the dentist and the patient. It is still a very fine option, and more of our patients do this than either of the other two. It is the most cost effective. The downside though is that it is large. An implant overdenture is almost the size of a denture and is removable.
Our last option to discuss is the old style restoration of teeth, and that is just a complete denture. Many people remember their grandparents or their parents having dentures in a cup. Most people struggle to use dentures because they move when the patient eats and speaks. There is nothing to retain it and nothing to keep it in place. People are constantly trying to balance their dentures as they are chewing, as they are speaking, or as they are laughing. This treatment is an old-fashioned style of tooth replacement. It is still available for folks, and we can still make them look very nice, but they are not very comfortable, and they are not very functional. So, we call this the final option for people missing all of their teeth.
One of the most common questions that we get in implant dentistry is, “How much does it cost?” That is a great question because the ranges vary tremendously. It is a lot like buying a car… all of us want the best car we can afford. Therefore, like cars, we try to offer a wide range of treatment options so patients have many from which to choose.
It is very important for those who need tooth restoration to understand all four options. Many offices, especially the corporately owned dental offices, only offer one treatment, and that treatment is the hybrid denture. That is the treatment they have found to be the most profitable for their model. I certainly want patients to steer clear of those places where they are only getting one option. The right way to treat a patient is to explain all their options – different price points, different functional levels, and different comfort levels. That is what we strive to do at the Dental Implant Center.
There is also a misconception about the beauty of dental implants or what we call the esthetic outcome. A lot of practices claim that implants never look as good as teeth and that they have a more prosthetic look to them. Our goal at the Dental Implant Center is that when you smile there is no difference between a beautiful set of natural teeth and the implant treatment that we render for you.
In summary, I would like to invite you to our practice of Board Certified Prosthodontists so that we can help you understand all of your options and pick the one that is best for you.