Traditional Fixed Implant Options

Fixed implant solutions mean that the teeth are not removable from the implants.  This means that the teeth feel like they are part of the jaw, similar to natural teeth.  There are three different traditional fixed implant solutions.

The first is replacing each tooth with an implant and implant crown.  The benefit of this option is that each new implant tooth can be repaired without affecting the other teeth.  Also, done properly, the esthetics can be really nice.

However, in order to achieve great esthetics, it is sometimes necessary to remove teeth and place implants even when there may be years of usefulness remaining in a patient's natural teeth.  It is unfortunate that certain aggressive dentists and specialists advise their patients to extract their remaining teeth when the amount of damage to their bone doesn't justify such a great sacrifice.  Also, it is almost impossible to achieve esthetic results using an implant for each tooth in the lower front area.  This is because, implants should be placed approximately 3 millimeters apart in order to preserve the bone and gums around them.  So, most implantologists end up placing a bridge across the bottom front using just two implants.  The question is, if this approach is good enough for the lower front part of the mouth, why not in other areas?

The financial cost of this approach is also the most expensive, often costing greater than $50,000 for each arch.

The second approach is an older technique called a hybrid prosthesis.  This technique has evolved over the years.  It began in the lower jaw and was essentially a metal reinforced denture screwed onto 5 implants placed in the front of the lower jaw.  It was thought at the time, that there needed to be a space between the gums and the bottom of the hybrid prosthesis, so, bone would often be removed to accomplish this.  Because of this removal of bone, hybrid prostheses were not preferred for the upper jaw, since removing this much bone would cause a problem with speech and facial appearance.

In the past decade, this approach has changed.  Now, bone is left in place, and the hybrid prosthesis is fabricated to touch the gums.  Cleansability does not seem to be a problem so long as certain design characteristics are properly met.  The main benefit of a hybrid prosthesis is that you can avoid major bone and skin grafting in many areas of the mouth.  The cost is also less than the "implant for each tooth" option, with fees ranging from $35,000 to $45,000 per arch.

The limitations with this approach are that plastic versions of this prosthesis wear out relatively quickly, especially if the patient is chewing against implants or natural teeth.  Also, the prosthesis can be difficult to remove and repair.  Another problem is that during repairs, a new temporary may need to be made while the permanent prosthesis is being fixed.  Thus, the longevity to cost ratio is rather poor.

The third type of traditional fixed implant solution is more recent, and is a variation of the hybrid prosthesis.  It is called All-On-Four (trademarked by Nobel Biocre).  You may have seen it promoted heavily by Nobel Biocare, an implant manufacturer, as a quick and easy solution.  It is mentioned in its own category as it is heavily marketed as a computerized solution that is quick and painless.

While the use of computer generated surgical guides does decrease treatment time, it also has built in risks.  The greatest risk is that the guide is improperly made, resulting in the placement of implants in less than ideal bone conditions.  Another risk is that if one of the four implants should fail over time, the prosthesis has to be remade after another implant is placed.  This is because three implants cannot adequately support so many teeth without increasing the risk to the remaining implants.

The same limitations that face the hybrid prosthesis also apply to this approach.  Teeth may wear down prematurely, and the longevity to cost ratio is poor.  Current fees for this method range from $15,000 to $40,000 per arch depending on how much marketing and other non-clinical costs are necessary to actually perform each case.  The dentists who offer this solution for $15,000 often do not market heavily.  The ones who charge $40,000 per arch often are on television and other expensive advertising mediums.  The sad truth is that the only major difference between the expensive All-On-Four and the less expensive All-On-Four is the price.

The main criticism besides the high initial and later repair costs for so few implants, has been the skepticism that four implants can last a patient's life time.  While no implant solution can be guaranteed to last a lifetime, it has been suggested that supporting a full arch restoration on less than 6 implants may lead to premature bone loss or breakage of the implant components, especially in patients who have a history of grinding or gritting their teeth.

Our solution is the culmination of decades of trial and error in regards to the ideal price and performace ratio.  To learn more about it, please click on the LM Bridge link.

For more information, call us today.

Modern Dentistry
(630) 466-7445