‘Same day teeth’ or ‘All on 4’, both involve the same treatment, extracting teeth and placing replacement teeth on implants on the same day. However, with fees exceeding thousands of pounds, how effective is this treatment? We asked Dr Tim Doswell of The Smile Spa, Stockton-on-Tees.
Firstly Tim, could you please explain what are ‘same day teeth’ and ‘all on 4’?
All on 4 specifically describes a bridge supported by just 4 implants and can be done in either jaw. Teeth are extracted and implants placed during the same appointment, the bridge, normally temporary, is then placed on the implants. The vast majority of research on this technique however is on the lower jaw. Typically the upper jaw bone is softer, therefore requiring 6 implants or ‘All on 6’, for extra support.
Same day teeth, involves extracting a tooth or multiple teeth and placing the implant on the same day.
Why are these techniques becoming so popular?
Same day teeth are increasingly popular because, under the right circumstances, they allow patients to go from having either no teeth, or a mouthful of failing teeth to a set of fixed functional teeth in the same day. From a patient’s perspective, this is obviously hugely beneficial as traditional treatment techniques using implants usually take months to complete and usually involve wearing a temporary denture.
So why aren’t all implants and teeth placed on the same day?
The fact is, around only 2% of patients are suitable because there are a number of conditions to meet in order for the procedure to be successful. Firstly, the patient should be physically fit and generally healthy with healthy gums, as gum disease will increase the chances of implants failing.
Bone density is also a key factor to be assessed. Patients with low bone density will not have enough bone to support the implants, so when the teeth are attached the implants will start to fail quickly.
Aesthetically, same day teeth do not achieve a great final finish, the reason being that the gum line recedes when teeth have been removed. So the teeth that are placed that day are likely to start to show gum recession, with possible exposure of implant. If you have a high smile line, (you can see your gums) then the likelihood is same day teeth are not going to look very good after a relatively short time.
Are the teeth really placed in the same day?
Technically yes, teeth are placed the same day, but the teeth we fit at The Smile Spa, are purely a temporary solution until the implants have bonded with the jaw and the gums have settled down. All on 4 patients have a temporary denture fitted until the implants are securely bonded to the bone ready for the final fixed bridge to fit.
So the final fit will take place a few months later?
Yes, at The Smile Spa, we believe that appearance is just as important as the function of your teeth. We want you to be confident in your smile, so we will wait until healing has taken place before placing the final teeth to avoid poor aesthetics.
How should implants be maintained?
It is very important that patients have an excellent oral hygiene routine. Peri-implantitis is a term used to describe the disease which can affect dental implants and is caused by poor cleaning around the implant. In addition to a home routine, regular checkups by a dentist are recommended with an annual review specifically of the implant is advised to ensure the bone density is not receding.
Tim, you lecture on the subject of implant dentistry to fellow dentists, what would you say to anyone considering having a same day teeth or all on 4 procedure?
There are lots of dentists performing the technique and who are highly capable, the main issue is finding out your suitability. Do your gums bleed on brushing? Is your bone density high enough to support an implant? Have you discussed the long term aesthetics of your particular case? Is the dentist advising 6 implants for the upper ‘All on’ procedure? If the dentist isn’t asking these questions or advising other courses of treatment first such as Periodontal Therapy to improve the gum health, then they are not doing the right thing by you.
I always imagine the patient is a friend or family member and ask myself would I suggest this is the right treatment for them, it’s a good reality check to have.