Master, College of Conscious Sedation American Dental Society of Anesthesiology
Advanced Systemic Health Care through the Mouth
All your dental treatment needs met in one location
Michael A. Starkey, DDS MS and The Team
The more bone you have the easier the implant procedure in the case below no incisions were required to place implants. Patient elected to have a snug fitting over denture held by the implants
In our practice you can have a full arch of teeth done on the same day. Or you can even have a missing tooth replaced with an implant and crown in about an hour.
And under certain circumstances you can have a tooth pulled an implant placed and a crown put over the implant. You can see how that was done on our Gallery page.
For a single tooth implant it is rather straight forward when there is adequate bone. But often times bone grafting is required. You can also see bone grafting procedures on the Gallery page along with completed full and partial arch bridge work on implants.
What is done prior to surgery is a complete workup involving a 3D scan, a second opinion from a third party, Dr. Ben, who is a radiologist at Creighton. This is to assure the patient and the dental surgeon both that the plan is prudent and that there are no other obstacles or issues to be addressed first. Dental Radiologists are much more skilled in interpreting 3 D scans than dentists or even oral surgeons. There is a surgical guide made from models or from the scan this is enables the surgeon to properly orient the dental implant in the jaw and it reduces the time required for the patient to be in surgery.
The patients teeth are made ahead of appointment based on models and scan so after implants are placed either a fixed bridge is placed or a fixed removable over denture is placed. Voila- our patient leaves with teeth.
Here is the important point to understand: The patient leaves with teeth. The teeth are made of acrylic. We do NOT make the final set for this appointment. The final bridge can be acrylic and what we place may be all that the patient wants. It can last for years or months depending on the method we have the lab use to fabricate your bridge. However a ceramic bridge or a porcelain to metal bridge is the long term solution. It is more natural takes up less space, closer to the size of regular teeth. The reason we do not place ceramic bridge the same day is #1 assurance of fit. The ceramic bridge is precision fit. #2 Your gums will need to heal along with any bone grafting.The result is shrinkage and then the bridge will not fit ideally.
Here is a second point to consider. When the surgeon places implants and teeth there has to be enough bone to place the implants. Celerity comes from not having to graft bone. In fact it saves the patient money. It is a good result. However if bone grafting is advisable or the patient wants to keep the dental ridge or reconstruct the ridge so that the teeth are more natural size and reduces or eliminates pink porcelain that is designed to make fake gum tissue then the surgeon usually cannot place final implants.
What I do is place provisional implants and maybe the final implants. But the final implants which are larger diameter and meant for long term must be "buried." Meaning they are placed under the gum tissue so the gum and bone can properly heal around the implants. Dr. Starkey will place smaller provisional implants and when possible use your final regular diameter implants to hold on to your immediate fixed bridge.
The patient wears this first bridge from 6 months up to a year. Then there is another surgery to place regular diameter implants as needed and remove the provisional implants reseat bridge or make new temporary bridge and wait an additional 2 to six months. To summarize the bone graft treatment to preserve or rebuild ridge takes much more time. A year to two years. And it is more expensive.
Most patients elect to have the non bone graft implant bridge due to the shorter time period, less surgery, and less expense. But sometimes if there is not enough bone then the longer treatment method is required. You can still get an immediate fixed/removable bridge at the first surgery however. With rare exceptions such as pencil thin ridge.
That is why it is best to wait any where from six weeks to six months to have your final bridge work done. But that is the easy part. It is a matter of taking impressions and getting proper bite. Here is the procedure summarized.
1. check healing take x ray to make sure. Take new impression, take bite relationship.
2. Second visit is to try in the implant posts to make sure they line up properly and do a bite check to confirm proper alignment
3. 3rd is the wax trial. If it looks good then we send to lab and the lab will fabricate ceramic which is a synthetic gem stone actually. You would have heard of it as zirconium. There will be instances when procelain fused to metal is more appropriate for extremely hard bites or lack of room or to make implant bridge that is such a precision fit you can slide it on in the morning. It fits snug and solid an does not move. BUT the precision fit on implant posts allows patient to remove the bridge to clean implants and the bridge work outside the mouth. This state of the art dentistry. The disadvantages are the special instruments required to make the bridge and implant a near perfect fit make the bridge work more expensive. Also in some cases the gum tissue interferes with reseating the denture. Those are cases where cosmetics is of extreme importance and the teeth implants need to appear to emerge from the gum tissue.
You are invited to call Dr. Starkey 402.926.4848 to discuss implants
and bridge work or single tooth implants.
4th After wax trial and making sure the color and bite and shape of teeth and gums is satisfactory to the patient we have the lab process the case. It takes one to two weeks.
5th You finally get your natural looking ceramic teeth. The synthetic gem stone I was telling you about known as zirconium.
BUT there is one more decision the patient gets to make. And we actually discuss this much earlier in treatment and that is whether you want to have the bridge cemented on as we do with regular teeth or if you would rather have the bridge screwed on. The special is for cement on teeth. The advantage of cement on teeth is that the fit can be off a small amount on the fit. Also with no screws the bridge is more natural looking. The screw on bridge is slightly wider than the cement on bridge to make room for screws. And while we hide the screws with composite the composite can stain and there can still be a noticeable difference. You can see that result on the gallery page.
Teeth in a Day
Teeth in a Day or a Tooth in an hour
Implants placed and fixed/removable bridge or a single crown can be done in one visit.
A single implant and crown is pretty straight forward. While a fixed bridge on implants takes planning and preparation and accurate diagnoses.
A tooth in about an hour
Extractions & Implants Placement of fixed acrylic bridge Final bridge
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