‘Teeth-in-A-Day’ is a treatment approach that consists of extraction of teeth, immediate placement of dental implants, and immediate delivery of the temporary restorations, all on the same day, providing you with the benefits of immediate function and aesthetics. Our current technology and techniques makes this a reality in today’s dentistry. Patients can come in the office with no teeth or failing teeth that have to be extracted and leave with dental implants and restorations. If teeth have already been extracted previously, then implants are placed routinely and restored on the same day.
Teeth-in-A-Day begins with design and fabrication of a transitional teeth (whether in a single crown, bridge, or complete set of teeth) and a computer-assisted planned, designed, and fabricated surgical guide. Following teeth extractions, the dental implants are placed using the surgical guide. Tissue is then managed by either bone or gingival graft as necessary and the transitional restoration is tightly secured to the implant.
Teeth-in-A-Day may be a treatment option in the following scenarios:
- Single extractions or missing tooth
- Multiple extractions or missing teeth
- Complete extractions or missing teeth
Am I a Candidate for Same-Day-Teeth?
- Immediate implants are most predictable when they are placed in single rooted teeth. These include incisors, canines, and some premolars. They should be avoided in the molars due to the risk of increased complications and failure.
- The bone surrounding the extracted tooth which will support the implant must be intact with no major bone loss or defects. In this case, it is best to graft the site, restore the bone and place the implant later, once the graft has healed.
- There should be no infection or pus present. Placement of implants in a site with infection has high failure rates and will not heal properly.
- The diameter of the extracted tooth should be relatively smaller than the implant being used. This is important, because proper implant healing requires direct contact between the implant and bone and good stability. If the implant is loose in the extracted site, it will fail.
Teeth-in-A-Day May be Considered If:
- Implants are placed in single rooted teeth immediately following extraction
- There is no infection
- There is adequate bone present
- The implants can be placed with good stability
Teeth-in-a-Day Should be Avoided If:
- The extracted sites planned for immediate implant are molars (with some exceptions)
- There is significant infection
- There is significant deficiency of bone
- The implants can not be held tightly in the bone because of the wide diameter of the extracted teeth
- The implants are unstable for any reason
Immediate implants refer to the situation in which implants are placed immediately following teeth extraction. This approach is highly predictable and successful ONLY if it is done in the right site with certain conditions.
Immediate Implants may be Considered If:
- They are placed in single rooted teeth. These include incisors, canines, and some premolars. They should be avoided in the molars due to the risk of increased complications and failure.
- The existing bone is relatively healthy and abundant. The bone surrounding the extracted tooth which will support the implant must be intact with no major bone loss or defects. In this case it is best to graft the site, restore the bone, and place the implant once the graft has healed.
- There is no infection or pus present. Placement of implants in a site with infection has high failure rates and will not heal properly
- The diameter of the extracted tooth is relatively smaller than the implant being used. This is important, because proper implant healing requires direct contact between the implant and bone and good stability. If the implant is loose in the extracted site, it will fail.
Immediate restorations refer to the situation in which a temporary restorations in form of a crown, bridge, or denture are placed on implants on the same day. Obviously, the advantage of this treatment is a patient having teeth right away, supported by the implants, providing them with good aesthetics and perhaps function and avoiding use of other forms of temporary teeth such as a removable flipper. But it is important to realize that immediate restorations, while successful, should only be considered in certain situations. Otherwise, they will result in implant failure and loss. Here are the general principles for immediate restorations:
- The oral surgeon placing the implant will inform the restoring dentist whether the implant is stable enough for restoration on the same day. If not appropriate, then the implant should be allowed to heal first and with the restoration placed at a later time.
- Immediate restorations are most predictable when they are placed as multi-unit bridges or dentures on several implants.
- In the case of single implants, the temporary crown should be placed with caution and if possible, bonded to adjacent teeth for additional support. The key is to avoid excessive forces on the implant during its healing
- The implants must be very stable in the bone. If the bone is soft or implants are not very stable, then placement of immediate restoration can cause them to fail.
- The immediate restoration is for the most part for cosmetic purposes. Patients must adhere to a very soft diet during healing and avoid excessive forces on the implants and its restorations. The restorations should clear the bite, so that they do not touch the opposing teeth.
- Once the immediate temporary restoration is placed, it should be left alone during the entire healing phase (3-6 months). Any manipulation during early phases of healing will result in failure and loss of the implants. When appropriate, the temporary restorations may be adjusted as needed to help shape the surrounding gum tissue for a better aesthetic and functional result.
In summary, immediate restorations may be placed if:
- Implants have great stability (tight in bone)
- There are multiple implants being splinted together during healing
- Biting pressure can be avoided during the healing phase
- The restoration is used mostly for cosmetic purposes and not to chew
- Implants are given adequate healing time before being manipulated
Treatment Stages and Process
The Teeth-In-A-Day treatment is a collaborative effort between the oral surgeon and the restorative dentist who provide the implants and the teeth all on the same day. The oral surgeon offers expertise in placement of the dental implant and the restorative dentist will fabricate the actual teeth. The treatment sequence is:
- The oral Surgeon obtains CBCT (cone beam CT Scan) to assess quality and quantity of bone.
- The restorative dentist completes clinical evaluation and takes impressions for study models and design, as well as assess the bite and aesthetic requirements. An interim denture is then fabricated and tried in the patient for proper fit and assure patient is happy with its aesthetics and design.
- The surgeon then uses the CBCT for a 3-dimensional computer assisted planning with virtual implant placement in the computer model of patient’s jaw bone. A surgical guide is then fabricated using 3-D printing.
- The surgeon places the dental implants using the surgical guide with optimal precision and accuracy.
- With Teeth-In-A-Day concept, the restorative dentist immediately restores the implants with a temporary fixed set of teeth. The bite is adjusted and patient goes home with fixed teeth supported by the implants
- The implants are allowed to heal for 3-4 months before fabrication of the final teeth.
- The restorative dentist then takes final impressions and fabricates the final fixed hybrid prosthesis. The bite is adjusted and the new teeth are checked for overall comfort, function, and aesthetics.
When immediate implant restoration is not possible or recommended, then the implants are allowed to heal for 3-4 months before final teeth are made. Patient continues using the transitional denture in the interim.