Trends are not always better. When a concept or product gains popularity because of its coolness, convenience, or conversations on social media, it may simply be an idea that is being sold by the few who benefit from it—a trend that may be easier, faster, and more profitable for the seller but not necessarily in the best interest of their customers. This is even more concerning in medicine or dentistry where treatments are irreversible, and the patients have to live with the consequences of relying on poor recommendations.
A 40-year-old patient came to us for evaluation of pain following replacement of his entire mouth with dental implants. My first reaction was how did a 40-year-old person lose all of his teeth and end up in the position of needing dental implants to begin with! It’s rather unusual unless someone has had severe gum disease, severely carious teeth that cannot be restored, or traumatic loss of their teeth.
Most of the patient’s upper implants were infected and loose, his upper temporary prosthesis was loose, his upper jaw bone was significantly reduced in height, and there was poor quality of gum tissue around the implants. His lower teeth were excessively extruded as noted during smile. He said that 3 months prior, he went to a dental implant center to discuss replacement of his few missing teeth and to get fillings for several teeth with caries. A week later, they extracted ALL of his teeth, cut down his upper and lower jaw bone, and gave him a fixed temporary set of teeth supported by the implants. He was told this is easier and cheaper for him.
I asked him to share his X-rays before his treatment, and that’s when I realized he had been a victim of a trend: The widely advertised “All-on-4″ or Teeth-in-a-Day.” Here is how it works: All teeth are extracted, the bone and gum tissue are cut down to create room for the prosthesis, and the patient is given a temporary set of teeth on the day of the surgery. Sounds great, doesn’t it? Except that it isn’t great. Not for this patient. Perhaps good for a denture user or some one with bone loss from gum disease- But not this patient. The patient paid over $50,000 to be instantly crippled. This is as horrific as a seeing a patient with a below-the-knee amputation needlessly getting their entire leg removed to make room for a one-size-fits-all full prosthetic leg!
The fact is that practically all of the patient’s teeth could have been saved, and those with caries restored. He did not need to have his teeth extracted or his jaw bone reduced, and he certainly did not need the full-arch treatment. And even if he had more severe caries and non-restorable teeth or restorable teeth but did not want to go through endodontics and restorative treatments, he could have had full-arch replacement of his teeth with dental implants WITHOUT removing any of his jaw bone. He was given no options, no alternatives, and no other possibilities. He was given the only treatment that the center does—easy, fast, and profitable for them—with no thought about the impact on this young man’s life.
The proper treatment for many patients is preserving their existing teeth and only replacing what is missing. And patients who have non-restorable teeth but otherwise normal bone and gum tissue must be treated differently than those with advanced bone loss from gum disease or from the use of removable dentures over time. In many instances, patients with normal or mildly deficient bone can be easily treated by contemporary bone regeneration procedures, which create the foundation for dental implants and a set of teeth that resemble their own. In these cases, after the extraction of non-restorable teeth, the sites are augmented to support the dental implants, whether placed immediately or in delayed fashion, to help create a set of teeth with natural form and appearance.
This approach is not easier or faster or more profitable for the dentist, but it is absolutely the right thing for patients who simply want to improve their smile, eat better, and live a healthier life. Let’s not let trends get in the way of what is right. We should expect dental professionals to provide patient-centered treatments. If you have non-restorable teeth but have relatively healthy bone and gum tissue, a pink-free full-arch dental implant-supported bridge would be your best treatment for a results that will most resemble the look and feel of your natural teeth. Don’t get fooled by attractive marketing of implant centers whose solutions will not fit yours.