FACTS DO NOT CEASE TO EXIST BECAUSE THEY ARE IGNORED.
Aldous Huxley, complete essays 2 1926 – 29
There are certain rules I find apply to my life; the queue that I am in, whether in the super market or on the road, will be going much slower than the one I did not choose. When I am running late, and let’s be honest, when am I not running late! I will not find my shoes, my phone will have moved from where I last saw it and my car keys will have developed legs and done a runner. Once in my car and ready to go, I will notice that my gas tank is registering near empty and then to add insult to injury I meet every single red light.
The universe has rules as well; the sun always rises in the east, the earth takes 24 hours to rotate on its axis, Christmas Islands will always be the first to celebrate the New Year, apples will continue to fall to the ground and what lives will die.
From time to time we discover that what was previously accepted as the truth has changed, been disproved, or negated by an advancement through a deeper understanding, a manipulation of past results, or research and development. It is almost unbelievable to us now, but, it was believed at one time that the world was flat. Eratoshenes was the first to question this and then Christopher Columbus, with his adventurer’s heart, journeyed beyond the horizon.
Dentistry has made some major improvements in its history; not too long ago it was considered that the removal of all the bride’s teeth was a very generous wedding present!
When Dr. Patty studied oral surgery at Chapel Hill in the 1980’s one of his professors predicted to the class that all they would be doing with dental implants, in the future, would be taking them out.
In 1982 I started working as a dental assistant for a dentist in England. He placed the very occasional dental implant, and I remember the majority failing within two years. In 2003 the oral surgeon I worked with would only place an implant in an area where the bone had healed for months after an extraction. Then when the implant was placed it would be left for months under the gum prior to it being restored.
Great progress has been made with dental implants and they have evolved to be the gold standard of care with the best long term prognosis for replacing a missing tooth. Dental implants are five times stronger than a natural tooth, will not decay, and are not affected by periodontal (gum) disease and the only tooth replacement that will prevent bone loss.
Even with these advancements there are still many different variables that determine what recommendations are made. Patients need to be assessed on an individual, case by case, basis. Some questions that will need answering before any course of treatment is prescribed are:
Where in the mouth is the implant needed?
Is it replacing a single rooted tooth?
Does the tooth have a history of infection?
Is more than one implant required?
What is the quality and quantity of the bone?
There is a lot of talk in the media about ‘same day’ implants and often during our implant consultation we are asked about these claims. We are, in certain, limited circumstances, able to extract a single tooth and place an implant on the same day and even restore it with a NON functioning temporary crown. This means that the ‘tooth’ portion of the implant is for smiling only. It must NOT be used as a fully functioning tooth. If it is, it WILL FAIL. Imagine a garden gate post that has just been placed in the ground with concrete. If I hang the gate on the post straight away and start to use the gate before the concrete is set I am at risk of the post always being a little wobbly. A wobbly garden gate is an annoyance, but still usable, unlike the implant.
Sometimes we have a patient come into the office needing all their teeth replaced, and they are looking for a restoration that will stay in their mouth permanently. They remember seeing a great aunt with her teeth sitting in the glass by her bed and it is not the situation they want to be in. This restoration has many names all around the world; hybrid denture, fixed removable denture, hybrid bridge, all on 4. They are all describing a highly modified denture that is screwed into and is supported in the mouth by 4 to 6 implants. This restoration is removable by the oral surgeon or the general dentist only, not by the patient.
In this case, it is sometimes possible to place the implants and allow the patient to use them, with restrictions, from day one.
It is the number of implants placed in this situation that gives it strength. Dr. Patty describes it like the framing of a room. When just one wall is put in place, it would not take much force to push the wall down. However, with all four walls in place supporting each other a greater pressure would be required to push them over. With 4-6 implants placed a one piece denture is used as a splint, the implants are supported rigidly while the bone has time to heal.
This denture that has been modified and secured into place on the day of surgery is temporary. It cannot be made with the strength required for a permanent prosthesis. For strength, the permanent hybrid prosthesis requires a framework of titanium that is computer generated specifically to fit an individual mouth and the exact position that the implants are placed. The permanent prosthesis will be made after the bone has healed completely.
From the day of surgery patients will be allowed to eat a soft food diet. At this stage, patients must avoid foods that take a lot of effort to bite into, like an apple, or a lot of chewing, like a bagel or steak.
When listening to claims in advertising about same day implants, remember the rule of old:
IF IT SEEMS TOO GOOD TO BE TRUE, THEN IT PROBABLY IS.