Same Day Teeth on Implants
Milling Immediate Implant Teeth
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 service and technology. 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 German made Amann Girrbach mill, where the tooth is milled out of PMMA (a highly esthetic acrylic). This is all done on-site This tooth then is basically screwed into your implant. Patients either wait around 70-90 minutes for the tooth, or come back later that day or the next day for delivery. 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.
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
- 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.
- 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.
- 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.
- 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.
A word About the Temporary (Provisional) Prosthesis and Final Prosthesis
The Provisional Bridge (Prosthesis) delivered at the time of surgery is called a “Surgical Prosthesis”. It is possible to deliver the final prosthesis within 2-3 days – avoiding the Surgical Prosthesis. However, during the next 8-12 weeks, the soft tissue (gums) surrounding your implants will remodel, and shrink to within 3 mm of the bone. By giving your body (gums) time to remodel after the surgery, when your dentist makes the “Final Prosthesis” he can better contour it to the remodeled tissue. By doing this, your “Final Prosthesis” typically will end up with better esthetics and cleansibility.
Therefore, 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”. Typically these utilize a titanium or zirconia framework supporting porcelain or cubic zirconia teeth, with the red/pink gingiva typically made out of highly esthetic composite resin.