SPONSORED CONTENT: What the bone allows
SPONSORED CONTENT: A reader information feature brought to you by JP Dental and The Daily Sentinel
Teeth can fail for a variety of reasons, and it can be devastating for people when they do, especially when multiple teeth begin to fail, loosen or fall out of the mouth entirely. Eating becomes a challenge. Smiling becomes less frequent, and self-confidence plummets. While traditional dentures offer a cosmetic and somewhat utilitarian fix for those who have a mouthful of failing teeth, sometimes dentures continue to move, bone in the jaw continues to deteriorate and patients can’t get used to the feel of dentures.
And sometimes, patients may simply feel like they’re too young to wear dentures.
Nobel Biocare, the Swiss company that pioneered dental implants, introduced a procedure in 1998 that offers a solution for patients who need a full set of teeth called the All-on-4, which gives patients fully functioning teeth immediately, using only four implants. The implants are angulated to utilize available bone, which may eliminate the need for an expensive bone graft surgery.
During the initial surgery, a dentist who is thoroughly trained in the procedure will remove all the existing teeth, place the implants and fit the patient for a temporary, screwed-in denture that allows the mouth and jaw to heal from the surgery.
Although some dentists choose to place the temporary denture on the day of the surgery, Dr. John Poovey at J.P. Dental and Implant Center prefers to have patients come back the next day to get the temporary denture placed.
“A good surgery can take five to six hours,” Poovey said. “This is such a technically sensitive procedure and it is a tad too overwhelming for patients to sit in the chair with no food and no pain medications.”
When patients return the next day, Dr. Poovey can assess how they’re healing from the surgery and make sure the pain medication is working. It’s a quick procedure to place the temporary denture, and patients walk out with a set of teeth that look and feel like real teeth.
While the patient’s mouth and jaw heal, the lab is making the permanent prosthesis that will be placed four to five months later, after the jaw is completely healed.
The All-on-6 procedure is similar to the All-on-4, and is used when patients want the most stable and longest-lasting type of procedure. It can be used when patients don’t have adequate bone structure and need a sinus lift surgery. The material for the abutment, which connects the implants placed in the jaw to the crown, as well as the crown itself, is all zirconium, which is what makes it stronger and longerlasting. It’s also more expensive than the All-on-4 procedure due to the zirconium and the additional implants. During an office visit, Dr. Poovey explains the pros and cons of both procedures, as well as his recommendations.
“I do it based off what the patient desires and what the bone allows,” he said, “and what the end goal allows.”
According to Poovey, the Allon- 4 procedure is a less intensive surgical procedure, but doesn’t allow patients to chew as hard. While the All-on-6 procedure is more expensive, it may save younger patients more money over a lifetime as the zirconium teeth don’t wear down or need to be replaced.
Both procedures have a significant impact on patients’ quality of life. Patients can go back to eating food they like, rather than food that’s soft and easy to chew. That can lead to improved nutritional status, since soft and mushy food often doesn’t have the nutritional benefits of food with more texture.
Jawbone deterioration is greatly reduced, and patients are able to smile and laugh without thinking about their teeth. The teeth are permanently screwed in, which keeps them from moving while chewing and gets rid of sore spots in the mouth from dentures. They behave more like real teeth. Because of the cost of the implants, many patients develop better dental hygiene practices simply because they want to take care of their investment.
Since the introduction of the Nobel Biocare All-on-4 procedure, more than 100,000 patients worldwide have been treated, and there have been 34 clinical studies to back up the manufacturer’s claims.
PATIENT PROFILE: SHELLIE HORN
While living in California, Shellie Horn was in a bad horse accident, which smashed her face and fractured her teeth. She went to her regular dentist for help, and because she had been going to him for almost 20 years, she had a high degree of trust in him.
“My dentist was trying to fix what was going bad,” she said, “but I needed a specialist. He was doing things that he wasn’t necessarily qualified to do.”
Her dentist placed four implants in her mouth, but they became infected. She lived with the infection and the subsequent pain for about four years. When she finally consulted an oral surgeon in California, one of his first questions was whether or not she had seen a specialist. That’s when she realized that her decision to use her general practice dentist may not have been the wisest.
At the time, Horn was already planning a move to Nucla, so she asked the California surgeon for a recommendation for a dentist on the Western Slope. He recommended J.P. Dental and Implant Center. Horn went to her first consultation in January, 2016, and was impressed with the office.
“It was totally state-of-the-art, especially compared to the specialist who had sent me to him,” Horn said. “I’m so shocked about the care I got there; they care about you every step of the way. When you’re in pain and everything hurts so bad, they are trying to make you feel the best.”
Because the existing implants weren’t placed correctly and the infection had begun to spread to the bone, Dr. Poovey had to remove the old implants and help the infection to heal before he could do an All-on-6 procedure.
The first surgery took about seven hours and Horn’s lower lip developed sores as a result of being in surgery for so long. When she mentioned it later to Dr. Poovey, he first wanted to know why she didn’t call to let the staff know so they could have tried to alleviate when it happened, and then made sure that it didn’t happen again, even though she had several more hourslong stints in the surgical chair.
“I live so far away,” Horn said. “If I was going to town, I would call and they’d rearrange their schedule; they were so willing to work with my schedule.”
Because of the injury, Horn’s jaw wasn’t in proper alignment, which gave her frequent headaches. After the surgeries and the subsequent fittings to make sure the All-on-6 prosthetic fit as perfectly as possible, Horn noticed that her jaw no longer hurt and her headaches had disappeared.
“I can eat celery!” she said. While celery may not represent everyone’s dream food, it’s a definite no-no when it hurts to bite and crunch.
“It was worth every penny,” Horn said about the procedure. “You need teeth to have good health and live a long life. It’s not about beauty, it’s about health.”
PATIENT PROFILE: ELIZABETH PALMER
Elizabeth Palmer knew her teeth were causing her trouble. She could feel them moving, she couldn’t eat certain foods and was in pain, but hesitated to go to a dentist because her mother had lost all of her teeth by the time she was 58, and and at 60, Palmer didn’t want to hear that she would share the same fate.
“A friend recommended Dr. Poovey,” said Palmer, who went for her first consultation with J.P. Dental in the summer of 2016.
“I had terrible bone loss in my jaw,” Palmer said. “My teeth were shifting, and I was going to lose them. Dr. Poovey said I would need bone grafts, and the window for the graft wasn’t long due to the bone loss.”
About a month after that initial consultation, Palmer, who lives in Delta County, went back to J.P. Dental for the All-on-6 procedure.
“He did everything at once; he pulled the teeth and did the grafting at the same time,” Palmer said. “I had no discomfort and no pain. He and his assistant, Heather, made me feel so safe and comfortable.”
After the bone graft, Palmer said she had to wait an additional four months to allow her jaw to heal before she could get the implants, along with a semi-permanent crown. She was receiving the final, permanent screwed-retained set of teeth later on the day of the interview, but even with the semi-permanent set, she had noticed a huge difference.
“I can eat better than what I could with my real teeth,” Palmer said. “I can drink cold things.”
Palmer avoided dentists because of bad experiences with a few in her past, but her interaction with the staff at J.P. Dental has made her a believer in quality dental care.
“I can’t imagine that I would ever go anywhere else,” she said. “I tell everyone, ‘this is where you should go.’ He makes me feel like I’m a really special patient. The staff does, too; he runs a great office.”