An Explanation of Certain
Some Dental Associations have become concerned that certain Dental
'terminology' may be misleading to the public, giving rise to
"unreasonable expectations" in new and evolving dental treatments such
as: Dental Implants;
Cone Beam Computed Tomography (CBCT-Scanner); Implant Computerized
Planning software; and Computer Generated Surgical Guides.
At the Leigh Smile
Center, we don't want our patients and potential patients to be
misinformed by the information on our websites ... or any other dental
website for that matter. In the spirit of complete transparency, we are
always willing to provide you with
factual information about all the dental services we
perform. We do not want any of our patients
to be misinformed or unsure about ANY dental treatment.
Dr. Leigh has been practicing Dentistry since 1975, and has been
performing Dental Implant services throughout his career. He has built
his reputation on open and honest dialogue with his patients, and
providing them with the information they need to make informed
If you have any questions, any questions at all, about any of the
dental services that we perform at the Leigh Smile Center, we want you
to contact us and become INFORMED patients/consumers. If we don't have
the answer to your question(s) immediately, we will do our very best to
find the answer for you. If you have any questions about Dental
Products, Dental Treatments, Dental Terminology, or Manufacturer
Products or Services, we will make every effort to clarify those
"Implants may cost more than other kinds of replacement teeth and might not be covered
by your dental plan. But in most cases this is a one-time cost, unlike
other kinds of tooth replacement procedures." From the website of the Canadian dental Association.
What PATIENTS NEED TO KNOW about the "TEETH-IN-1-DAY" Concept.
(Implant Direct Trademark) "Teeth-in-A-Day"
(Nobel Biocare Trademark)
These phrases, and similar ones, are dental marketing terms that are
trademarked by the Dental companies. Obviously, they have to give a
'name' to the service they are marketing, otherwise how would anyone
distinguish one type of treatment from another. Teeth-In-1 Day, for
example is a registered trademark of Implant Direct Sybron
International. Teeth-In-a Day is a registered trademark of Nobel
Biocare. These terms refer to specific therapies that are commonly known
by Dentists who perform Dental Implant services. If that treatment is
the one that you would choose, your Dental professional would/should
explain all aspects of that treatment, and get your consent prior to
performing the service. As you are aware, the "advertising" of a product
or a treatment almost never gives a complete explanation of
EVERY minute detail. That would be burdensome
and unreasonable, and you probably wouldn't have enough time in a day to
review all that information. Can you imagine having to read a textbook
in order to be completely informed about a common dental service? That
is what you leave to the Dental professional who has been licensed by
the Dental Association. Your Dentist, in consultation with you, will
suggest the most appropriate treatment for your dental needs, and will
explain what you can expect from that treatment.
However, if you have concerns about a dental service, or are unsure
of what it entails, we will be happy to direct you to research
materials, peer-reviewed articles, dental company websites, or dental
organizations. The Internet also provides information on thousands of
dental websites, dental manufacturers, Dental Implant organizations, and
dental associations. No doubt, if you are considering Dental Implants
and costs, you have looked at more than one website and found that the
terminology is the same or similar, and that the costs may be different.
In an effort to "protect the public", Dental Associations may end up
'restricting' dental advertising so much so that
the patient or potential patient gets
too little information. This would be a
disservice to the patient or potential patient. We believe in the
intelligence of the public, and their ability to make their own
decisions and choices about the advertising they read.
"Teeth-In-1-Day" ... what it involves.
On rare occasions, we do replace a missing tooth in a single day with
dental implants. This is easier if the site is edentulous (no tooth
there), and there is an abundance of available bone height and width at
that site. If the Implant, when placed, exhibits excellent primary
stability then we can immediately place a
TEMPORARY Acrylic Crown on the implant .
We follow very strict guidelines when doing this and the temporary
tooth would have to be taken out of
occlusion (the crown height reduced or made ‘Shorter’) so that it
doesn’t contact the opposing tooth, and all lateral excursive contacts
are also removed (no sideways contacts). There is a ‘Progressive
Loading’ concept promoted by Dr. Carl Misch which has had some good
success. But, for the most part, these are just ‘Temporary Solutions’
until, at the proper healing time, the Final Crown is placed.
This temporary tooth would stay in place for about 5 months in the
Upper Arch (Maxilla) and 2 months in the Lower Arch (Mandible). The bone
in the lower arch is usually denser than the upper arch. Then the
Temporary Crown would be replaced by a Final Definitive Crown (what
patients usually refer to as a Permanent
Crown). Keep in mind that to fabricate the Final Crown we require
either an Impression of the Implant (called a Transfer Impression) or a
Scan of the site with the Implant Abutment (post) in position.
**** Always remember that there are certain inherent 'risks'
involved in “LOADING” the New Implant Immediately (even with a temporary
crown) and you could damage the implant’s bone support or lose the
implant altogether. Most of the Single Implants that we place at our
Center are NOT Loaded
Immediately. (This probably keeps our success rate higher.)
When we send the information to our Laboratories, it takes about 2 weeks
before the finished crown is returned. The Crown can then be
‘Cemented’ onto the Implant Abutment (our preferred method) or, in some
cases, the Crowns can be made to be ‘Screw-Retained’ (we are doing more
of these lately). There are Pros & Cons to each technique, which can be
explained to you fully by us or your own Dentist.
MULTIPLE TEETH REPLACEMENT (IN-A-DAY)
... what it involves.
***** THE FOLLOWING STEPS are used for patients with
no teeth, who already wear complete dentures.
This treatment is usually called
“Teeth-in-1-Day” in Implant Dentistry. That is a fairly recent name
given to one particular type of Implant placement utilizing four (4)
Implants (“ALL-OVER-4”), two of which are placed in an angled
orientation (to avoid either the Maxillary Sinuses or, in the lower
arch, the Inferior Alveolar Nerve and Mental Foramen). In other types of
Surgery, sometimes 6 or 8 or as many as 10 Implants can be used to
replace teeth in a single Arch. Everyone’s mouth is different so there
are many different ways to complete the case. The
INITIAL Appliance, however, is
One (the one you get on the day of
***** Actually, the PROCESS for ‘Teeth-In-A-Day’ (A Nobel Biocare
‘Slogan’ invented by Prof. Malo of Spain) takes Several Visits (usually
6 to 8).
THE FOLLOWING ARE THE STEPS INVOLVED AT THE LEIGH CENTER:
Patient APPOINTMENT #1.
This is the Consultation Visit where we get to know our
patient, examine the patient’s mouth, discuss their chief complaint and
provide various standard treatment options to hopefully solve their
problems and improve the situation to their satisfaction. We usually take any required radiographs (in our Center this is a
CBCT Scan) in order to diagnose the problem more thoroughly. We also
send all our scans to an OMFR (Radiologist) Specialist to further
evaluate the findings of the scan. At this visit Study Model Impressions
can also be taken. We also provide a
complete, typed Fee Quotation Estimate that
covers all the costs involved in the treatment. (Sometimes other records
are required before a final treatment plan can be decided.)CBCT Scan
Machine (renders 3-dimensional images)
Patient APPOINTMENT #2.
This is the Records Visit where we usually do the following:
In order to place the Implants for this
type of treatment we require a Computer Generated Surgical Guide (these
are made for us by a Scanning Center in the USA). These guides allow for
minimally invasive surgeries.
place Radiopaque “Markers” on your Complete Denture and then take a CBCT
Scan of your Jaws with the Denture in position.
- Then we
take a Scan of the Denture by itself.
- We send these 3D
X-Ray Images to Atlanta, Georgia via the internet.
then book a “Planning Session” with the Scanning Center in Atlanta to
review your case.
- We provide a Patient Instruction &
Information Folder with all the standard Informed Consent Forms
required, and Diet & Home Care suggestions as well as the Prescriptions
necessary for the Surgical Treatment.
BEFORE YOUR NEXT APPOINTMENT WE DO THE
In a few days we go on line with our Technical Representative using
Planning Software and decide what type and size of Implants will fit
your jaw and in what positions we should place them in the available
***** IN SOME CASES, A PATIENT DOESN’T HAVE ENOUGH BONE TO PLACE
THE IMPLANTS WITHOUT A BONE GRAFTING TREATMENT BEING PERFORMED FIRST.
(We can discuss this with the patient
and inform them of the various common treatments available). BONE
GRAFTING TAKES 5 TO 6 MONTHS TO HEAL PRIOR TO IMPLANT PLACEMENT.
Ask us about Alberta Health Care's Bone Grafing Program.
Then the Computer Generated Surgical
Guide is fabricated utilizing all the information collected from the
CBCT Scans. Surgical Guides are like a Mouth Guard with round metal
‘Sleeves’ at the Implant sites. When the Guide is in the mouth the
Implant drills fit into the sleeves at the correct positions for Implant
Of course Implants can be, and often are, placed without Surgical
Guides (we perform a large number without guides). However, in our
Center, experience has taught us that Surgical Guides make the more
complicated surgeries easier for us and the patient.
There are two different types of Guides that we use the most:
- A BONE-SUPPORTED GUIDE (for
some of the larger more complex cases).
- A TISSUE-SUPPORTED GUIDE (The one we use for most
of the “ALL-ON-4” type of Surgeries)
Patient APPOINTMENT #3
is the Dental Implant Surgery Visit. We do all our Implant
Surgery using Local Anaesthetic. The average amount of time for the
placement of four (4) Implants is about 40 minutes.
If a Tissue-Supported Guide has been used there will be
If a Bone-Supported Guide has been used or the process
was performed “Free-Hand” you will require sutures.
We usually like to leave the sutures in place for about 10
to 14 days.
Here is where the “Teeth-in-A Day” or "Teeth-In-1 Day
(Misnomers) Concept comes in.
At this juncture you have
- You can just let the surgical site heal for 10
days until we remove the sutures, and wear your original Upper or Lower
Denture (as a temporary denture) for the remainder of the Healing Period
with Soft Tissue Conditioning Liners in them (we do this for you). There
is NO Charge for this service.
The usual Healing time for Osseointegration (Bone healed around the
Implants) is 5 Months in the Upper Jaw and only 2 Months in the Lower
- We can retro-fit your existing denture, or a new
one, to fit (Screw-Retained) over your new Implants on the same day as
the surgery. So you leave the office with
“fixed” TEMPORARY TEETH (Made of Acrylic). There is a cost
to the patient for these “Teeth-in-A-Day”, as they are called in Implant
Dentistry. This is
NOT the Final
4. Patient APPOINTMENT #4. (This takes
place when the Implants have healed sufficiently to load them with a
This is the first “Prosthetic Appointment
We attach Implant “Impression Transfers” to your Implants
and take a Final Transfer Impression with an accurate Polyvinylsiloxane
material. We then connect the Transfers to the Analogs (Implant
Replicas) and seat them back into the Final Impression. Then the
Impression is ‘poured-up’ in dental stone with a soft-tissue simulated
area around the implants (Like gums).
Patient APPOINTMENT #5.
Our Laboratory sends us the ‘VERIFICATION JIG’ which is used to
verify that the positions of the implants on the final Master Working
Model and in your mouth are Identical. Once the Accurate and PASSIVE fit
of the JIG is verified, we take the Bite Registration for the Patient’s
Vertical Dimension. Then our Laboratory fabricates a Wax Set-Up of the
Upper or Lower Denture or both.
Patient APPOINTMENT #6.
The Denture Wax Set-Up is tried in the
patient’s mouth. Any necessary adjustments are made to the look and
occlusion of the denture.
This Wax Set-up along with the Master working Model are sent to a
Laboratory for the Fabrication of the TITANIUM Framework.
Patient APPOINTMENT #7.
We usually like to try the Final Titanium Framework in the patient’s
mouth to verify a correct fit (with or without the Acrylic Teeth in Wax)
Patient APPOINTMENT #8. (Final Appointment)
The Final “ALL-OVER-4” Appliance
(What is known as a “HYBRID Appliance”) is attached to the Implants in
the patient’s mouth. This Appliance is a ‘Screw-Retained’ (Fixed/
Removable Type of Implant Appliance). It is solidly fixated in the
patient’s mouth and there should be no movement. (It can however be
removed by the Dentist or his/her staff for maintenance at any time.)
The fit and occlusion are checked.
A Final Digital Panorex X-Ray is taken to check the frame fit.
Final Photos are taken.
Instructions are given.
Home Care & Hygiene Instructions can be given by our Hygienists.
THE ABOVE STEPS ARE FAIRLY NORMAL IN
THIS TYPE OF IMPLANT TREATMENT. The ABOVE steps are the ones usually
performed in the process known as “Teeth-in-1-Day” or “ALL-OVER-4”.
***** SO I THINK YOU CAN SEE THAT THE FINAL DEFINITIVE
APPLIANCE TAKES A LOT MORE THAN ONE DAY. On the other hand, however, it
is possible for you to leave the office on the Surgery Day with
stable Temporary Teeth in your mouth.
Patients may prefer this so that they are not without teeth
until the final appliance is placed.