Same Day Teeth on Implants

                                   Delivering an Immediate Implant Tooth to Replace your Failing Tooth

                                                                                           Or

                                 Replacing a complete set of teeth with a implant supported set of teeth

 

Come to one of the most experienced Oral & Maxillofacial Surgeons in Implant Dentistry in the Southeast.  Over 25 of years of experience doing full arch reconstructions, replacing completely missing dentitions to full dentitions with a complete new set of teeth.  Our combination of Dr. Loetscher’s experience and our experienced in-house lab technician is provide an immediate tooth/teeth protocol second to none. 

Through CAD/CAM technology, we are now able to remove a failing tooth, place your dental implant, scan its position with laser optics, and mill a highly esthetic provisional tooth to be delivered in 70-90 minutes.   Single teeth up to whole dental arches can be provided with this technology.  The fixed temporary tooth or teeth not only look great, they also initiate the critical sculpting and maturation of your gingial tissues for your final crowns.  Importantly, this eliminates wearing removable type temporary teeth (such as Flippers and Essex retainers).   

 

Dr. Loetscher and his lab technician have developed this protocol utilizing this amazing technology, one of the only oral & maxillofacial surgeons in the US offering this protocol.  After removing your tooth, and placing an implant into it’s site, the state-of-the-art Trios intra-oral digital scanner first scans the implant in your mouth in approximately 2-3 minutes.  The data is downloaded into software where our dental technician designs your provisional tooth.  This design is forwarded to our advanced Austrian made Amann Girrbach mill, where the tooth is milled out of PMMA (a highly esthetic acrylic).  This is all done on-site This highly esthetic tooth is then basically screwed onto your implant.  This same process works for larger areas of missing teeth, from several teeth to whole arches. 

This same scan can also be used to deliver the final ceramic crown to be placed on your implant 3-5 months later, after the implant has become fully osseointegrated in your jawbone.   Patients love this because this eliminates the impression needed to fabricate a crown.   Your restorative dentist is involved in this final step, delivering the final crown, and verifying its occlusion. 

 Click on Photos to Enlarge
 

cara_Trios

                    

 
 
 
               Lab Technician, Larry, standing next to
               our Amamn Girrbach Ceramill Motion
                           2-state of the art mill.     

 

Whole Dental Arch Implant Reconstructions

The following principals apply to reconstructing a whole arch of teeth (example upper jaw -maxilla or lower jaw-mandible).

24 Hour Old to New Teeth

In the past year we have developed extremely cost efficient techniques to remove your existing failing or poor teeth with a complete new set of teeth – either a highly esthetic provisional set, or a more durable and beautiful “Final” set of teeth.   The provisional teeth are made out of PMMA (Poly-methyl-methcrylate Acrylic” which is a highly esthetic material, a step above denture teeth, and very durable.  The next day “Final” set of teeth is milled on site, and is a hybrid of a Kevlar/Pektolon superstructure, overlayed with a nanoceramic set of teeth, which provides longevity, and esthetics.  The other option is to have a provisional set of teeth delivered immediately, and your dentist then fabricates a restoration with Zirconia teeth, which esthetically is on the scale of fine jewelry. 

Dr. Loetscher has been restoring complete arches of teeth since the early 90’s, and is truly one of the most experienced surgeons in the area.  He has been working with the some of Atlanta’s top dentists and prosthodontists for years, and has gained considerable experience in full mouth restorations.  Combined with his full time in house lab technician, whom has been designing teeth and bridges for over 14 years, they now have unmatched capability to deliver superb quality restorations.  Their techniques have evolved significantly over the past 36 months to deliver these in a cost-effective manner as well. 

 

Why use Dr. Loetscher

  1. Most experienced Oral & Maxillofacial Surgeon in Implant Dentistry in the area.
  2. Modern up to date surgery center – clean, well equipped, with full anesthesia capabilities including IV Sedation and Full General Anesthesia.
  3. In house lab – with full milling and production capabilities.
  4. Experience has led to efficiency which has let to high value and cost-effective pricing.

The range of options with our Global Fee Structure is as follows:

Lower Jaw (Mandible)

  • $17,500– Remove all teeth, place 4 or 5 implants, deliver a beautiful computer designed milled PMMA fixed bridge the next day. Includes general anesthesia or IV sedation for the surgery.
  • $20,000– Same as above – only the fixed bridge is delivered the same day. The bridge is pre-made and converted at the time of surgery. 
  • $22,500– remove all teeth, place 4-5 implants, deliver a beautiful computer designed & milled “Final” fixed bridge the next day. This bridge will have a Kevlar/Polymer framework for strength, and nano-ceramic teeth for glistening aesthetics and durability. 
  • $30,000– Same as above, only your final bridge will have ziroconia teeth, delivered by your dentist several weeks later. You will wear the temporary bridge we deliver the day after surgery until the highly aesthetic Zirconia bridge is delivered. This will either be a monolithic Zirconia bridge, or a hybrid bridge with a titanium superstructure and Zirconia teeth. 

Upper Jaw (Maxilla)

  • $20,000– Remove all teeth, place 5-7 implants, deliver a beautiful computer designed milled PMMA fixed bridge the next day. Includes general anesthesia or IV sedation for the surgery.
    • $18,000if significant bone grafting is not required (Sinus lifts or Bone Grafts).
  • $23,000 – $22,500– Remove all teeth, place 4-5 implants, deliver a beautiful computer designed & milled “Final” fixed bridge the next day. This bridge will have a Kevlar/Polymer framework for strength, and nano-ceramic teeth for glistening aesthetics and durability. 
  • $33,000– Same as above, only your final bridge will have Ziroconia teeth, delivered by your dentist several weeks later. You will wear the temporary bridge we deliver the day after surgery, until the highly aesthetic Zirconia bridge is delivered. This will either be Monolithic Zirconia bridge, or a hybrid bridge with a titanium superstructure and Zirconia teeth. 

Egg-Shell Maxilla (Atrophic Maxilla): For those who have been wearing an upper denture for many years, and at least 4 implants cannot be placed to stabilize a temporary bridge: 

  • $19,500– We reconstruct the extremely atrophic maxilla with 6-8 implants, using BMP bone grafting or iliac crest grafting. You wear your denture for 4-6 months, then the implants are uncovered, and restored. A temporary bridge can be placed for $1,800, or a more permanent bridge placed – depending on materials – for $5,500 to $15,000 extra. 

When a highly aesthetic final bridge is being delivered by your dentist the price may vary. We have many dentists we have worked out set pricing with. Part of this variation comes from the different materials and labs that are chosen to do the work. 

 
 
 

Nomenclature:

Hybrid Prosthesis:  

A hybrid prosthesis is a whole set of teeth on either 4 or 5 implants in the lower jaw, or 6-8 implants in the upper jaw.   It is screwed into place, and is not removable, except by your dentist.  It is referred to as a hybrid because on top of the implants there is a metal or zirconium bar or “superstructure” which is screwed into the implants and distributes the bite forces across the implants.  On top of the superstructure are set the teeth, either in acrylic, zirconia, or porcelain, and along these are the gums or gingiva.  The pink gingiva is fabricated from either composite resin or porcelain.   The beauty of the Hybrid prosthesis is it allows a whole set of teeth on a smaller number of implants, properly positioned in the dental arch, therefore distributing the bite forces.   Another big advantage is normally when a person loses all their teeth in a whole dental arch, the gums and bone have very irregular contours, due to years of periodontal bone and gum loss.   The hybrid prosthesis makes up for this esthetically by replacing lost gums and bone via the superstructure and gingival replacement.   When designed properly, with enough implants to distrubute the bite forces the long-term success with these is high, usually 98-99% or higher after 20 years.   In addition, they are highly functional and esthetic when designed properly.

 

Crown and Bridge Prosthesis:

This refers to a situation where the implants are placed precisely where the teeth used to be, and the subsequent teeth on top of them are made up of bridge work, just like dental work on teeth.   It usually requires more implants per arch and may be more costly.   The higher cost comes from more implants, and the fact that the prosthesis is typically all porcelain.   The advantages of this type of prosthesis are as follows. 

They are very similar to your original teeth in how they emerge from the gingiva (gums), which mentally and esthetically can be very nice.  The prosthesis is broken up in several different components, which may make it easier for the dentist to deliver, and if a tooth ever chips or breaks, just that section needs to be replaced.  Another advantage is the skills required for your dentist to fabricate this are similar to what they do for placement of tooth supported crowns and bridges.    This prosthesis cannot be done when there has been excessive bone loss in the areas where the teeth used to exist.

 

Overdenture:

An overdenture refers to a “removable” prosthesis that snaps onto implants.   In the lower jaw – usually 2 or 4 implants are used to stabilze the denture.  In the upper jaw either 2, 4 or 6 implants are used to stabilize the denture.   With only 2 implants in the upper jaw – the palatal portion of your denture must remain.   If placing 4 or 6 implants – the palatal portion of the denture can be removed.   This improves the quality of eating significantly – via better taste and tactile sensitivity. 

It not only keeps your denture much more stable, the implants themselves help prevent vertical bone loss of the jawbone – which prematurely ages people with dentures.

The advantage of a “removable” overdenture  over a “fixed” hybrid prosthesis is a lower cost for prosthesis fabrication, and a decreased surgical fee because of the need for less implants.  A significant advantage of the overdenture is oral hygiene is may be easier, since it can be removed, the implant attachments and underside of the prosthesis are then very easy to brush and clean.  In the upper jaw, when there has been significant bone loss, often the overdenture is the most ideal prosthesis to replace missing teeth, because it can have a flange to provide lip support and improve the esthetics around your mouth, while at the same time be easy to clean.  When made properly, they fit very tightly, do not budge during eating, and provide high patient satisfaction. 

Maxillary Hybrid (Upper Jaw): 

When you lose all your upper teeth, or are about to lose them, this usually is the prosthesis (set of teeth) of choice.   The teeth can be removed in stages so you always have a fixed bridge during treatment, often supported by a combination of teeth and implants.  We have also developed techniques so that even if we remove all your teeth at once, we often can place implants, register their positition with a laser digital scanner, and from that design and mill a beautiful provisional prosthesis delivered that day, or the next morning. 

The final prosthesis typically will have 6-8 implants.   There are two key engineering principals.  One is the number of implants is more than 4.  The upper jaw has softer bone than the mandible, therefore 6-8 implants are ideal to provide wide arch support, and longevity.  The other is you place the majority of the implants in the molar and premolar area with only 2-4 in the incisor and or canine area.  By placing the implants posteriorly, this puts the large bite forces of the molars on top of the implants, preventing prosthesis fracture, or implant overload.   Often sinus lift bone grafts are done for the posterior molar implants so large (13-16 mm long) implants can be placed, with large surface area to handle these bite forces.   It also keeps the implants away from the 4 front upper teeth, so they can be positioned on the prosthesis for maximum esthetics, speech, and cleansibility.

One other advantage of a hybrid prosthesis on 6-8 implants -is longevity -in the face of changing oral hygiene.  As patients get older, their dexterity and ability to clean may become compromised.  If a patient develops gum disease (peri-implantitis) around one of these implants years later, it can be cut out from the prosthesis, and the remaining implants can typically support it.

Mandibular Hybrid (lower jaw):

The same principles apply as with the upper jaw- a superstructure sits on the implants and the teeth and artificial gums (gingiva) are put on the prosthesis. 

However, the lower jawbone is anatomically much different.  It is very dense, and therefore 4-5 implants will support a whole arch of teeth.  5 implants has been the standard for 40 years, however people with smaller bite forces, and if the teeth are not planned to extend to the molars, often 4 will suffice.   Bone grafting is rarely needed in the lower jaw to place 4 or 5 implants for a fixed hybrid prosthesis.   This is because the implants are placed in the anterior one half of the lower jaw, from the1st premolar forward, staying anterior to the inferior alveolar nerve.   Because of this nerve, the 5 implants used in the lower hybrid are placed in front of this nerve – basically from the 1st premolar forward.  The molar teeth are cantilevered off of the 5 implants.   The strong superstructure prevents fracture. 

Also, hygiene with the lower hybrid is very easy.   Since the lower lip covers up the lower jawbone and part of the gums, a space can be left between the lower gingiva and the underside of the prosthesis.   This makes cleaning this relatively easy.

The lower fixed hybrid was the very original implant prosthesis developed in Sweden by Branemark in the mid 1960’s.  It has the most data on longevity, and basically is the most maintenance free implant supported prosthesis in existence – when properly designed. 

Guided Surgery:

The advent of in-office CT scanners and intra-oral laser digital scanners to record the dentition has made pre-planning your extractions and implant placement extremely precise and accurate.  The scans are combined in planning software, combined with a new design of your new set of teeth.  2 surgical guides are made for your surgery.  They are attached to your bone, one guide establishes how much contouring of your bone is needed and done, the second guide has guide tubes for extremely accurate implant positioning.  Our full time lab technician does this design and guide fabrication from a pre-op intra-oral digital scan (Trios 3-shape Scanner)

This allows for Implant placement exactly where they were planned, and subsequently screwing in your new prosthesis immediately.  These immediate prosthesis have been pre-designed for esthetics and function.  The set of teeth delivered the day of surgery is called a “Surgical Prosthesis”, and is made out of highly esthetic PMMA acrylic.  After 2-4 months of time – allowing for your implants to fully integrate to your bone, your dentist then makes a more esthetic and durable “Final Prosthesis”, out of the materials discussed above.

Same Day Conversions:

Guided Surgery

In last 2 years there have been significant technological advances allowing us to extract all your teeth in a dental arch (or both arches), place dental implants, and deliver a beautiful custom made set of teeth, screwed solidly onto your implants. 

The technique is as follows

  1. A pre-operative CT scan is done in our office. This is combined with a pre-operative Trios intra-oral digital video scan – this records your dentition and bite in 3 dimensions.
  2. The radiographic scan (CT) is combined with the Trios video scan, and from there a new set of teeth are designed to fit your smile and face. Layered surgical guides are premade – one determining any bone modification and trimming.  The second guide is for extremely accurate implant guided surgery. 
  3. A plan is made for your set of new teeth, called the “Surgical Prosthesis”, because it is delivered at the time of surgery. It is made out of very esthetic and strong PMMA (Polymethylmethacrylate Acrylic).  It can be done two ways.  The least expensive is at the time of implant surgery, we scan your implant positions using digital scan bodies attached to your implants. Our lab technician then combines this digital scan with the pre-op design of your teeth, and mills the new bridge –a complete set of teeth.  This can take 3-5 hours, so we deliver it later that day, or first thing the next day.  This one piece milled prosthesis is extremely esthetic and durable.
  4. Alternatively, to save the 3-5 hours of wait time, the “Surgical Prosthesis” is milled ahead of time, and retro-fitted onto the implants.  With new software, this prosthesis is now delivered and secured within 20 minutes after implant placement.  This technique requires custom pre-made abutments, and special mulit-unit abutments, and therefore costs couple of thousand dollars extra.