I need dentures. I really want implant-supported dentures but I have been told I don’t have enough bone in my upper jaw to secure a dental implant, what can I do?
We see this situation all the time. A patient presents with severe periodontal disease or trauma but still has her natural teeth or has had a denture for a long time and it’s just not working for her anymore. She has substantial bone loss as a result. She has already been to dentist that offers dentures but dentures are uncomfortable and don’t feel like real teeth and the patient is tired of not being able to eat what she wants. Her mouth hurts all the time. The dentist has told her that dental supported dentures (All-on-four dentures) are not an option due to the severe bone loss. The patient is frustrated and about to give up and is almost resigned to living with a sub-par smile, a sub-par denture, sub-par dental function and a sub-par overall experience. She just doesn’t know where to turn. Read on……we have a solution.
Are there solutions if I have severe bone loss?
There is something called a zygomatic implant or zygomal implant or zygoma implant. It is an extra-long implant that doesn’t screw into the maxilla bone (upper jaw bone), but instead, passes through that bone and attaches to the Zygoma (the cheek bone in laymen’s terms). The advantage of this is the surgeon who places the implants, does not rely on weak or deteriorated maxillary bone but instead uses the strong Zygoma bone to secure the implant and in return secure the denture in place. These zygoma implants work in conjunction with 3 to 5 other implants placed in the upper jaw to support the denture, which can be permanently fixed in place. The result is a strong structure that allows implant supported dentures to be worn, when otherwise they would not be an option.
See pictures of zygoma implants
What should I look for in a dental practice that does Zygoma implant-supported dentures?
The challenge with this procedure is finding a dental team that can perform this procedure. Remember, every dentist in the State of Maryland is legally allowed to place implants. This does not mean they do, will or should. Even fewer dentists are able to place zygomatic implants. That’s because very few dentist, or even oral surgeons, have the training and experience to confidently place these unique dental implants. When choosing a doctor to place these implants here are a few things you should ask.
1) How many of this type of implants has the doctor placed. Not how many regular implants has he or she placed but how many zygoma implants has he/she placed.
2) Do they have an onsite CBCT system to accurately map the bone structure in 3D? This is important because guiding the implant screw to the proper spot is measured in millimeters and placement is critical
3) Who is going to design, secure and build the denture (also called the hybrid or implant-supported prosthesis)? Is that person a board-certified prosthodontist or just a general dentist? Be careful here, again, all dentists in Maryland can legally make and insert a denture, but prosthodontists go to school for years and years, even after their 4 years of undergraduate university and 4 years of dental school to learn the art and science about dentures, even fewer prosthodontists are well versed in implant supported dentures and even fewer with Zygomatic implants. So make sure you ask, how many zygomatic implant supported dentures have you done Doc?
Choosing your materials:
So now you have your team of surgeons and prosthodontists who are going to do the zygomatic implant-supported denture. You’re not done. Now you need to understand the materials that the denture is going to be made out of. There are a lot of choices from acrylic to zirconia, to dental ceramics. They all come with a different price tag. Make sure you ask, who is going to fabricate my denture and are they using the best material? Is the lab tech going to be on site when we do the procedure, in case there are modifications that need to be done?
The actual procedure:
Ok, you have made it this far and you’re ready to have the work done. It's going to cost you about what a nice foreign sports car costs so be prepared and don’t get sticker shock, somewhere between $20K to $40K per arch (you have two arches, upper and lower) is what you should expect. The practice schedules you for almost an entire day and makes the arrangements.
First comes the oral surgeon. The surgeon will do a few things depending on your situation. Most patients want to be sedated during the surgical part of the “all-on-four” process. This is usually done with IV sedation, this will bring the patient to a level of sedation that will allow the procedures to be done comfortably and most patients have no memory of the surgery. Most cases involve extracting any teeth that are still in the way, from just a few stragglers to a full mouth extraction including wisdom teeth. The surgeon will then use a special bone saw to “table the bone” also called alveoloplasty. This is done to make sure the denture has a good level surface to adhere to once the implants are placed. When the bone is nice and level, the surgeon will begin placing the implants. Using tools that resemble a miniature ratchet and drill set the dental implants are placed in the bone. Some implants are placed with a guide and other can be done free hand, depending on the judgement of the surgeon. Most implants penetrate somewhere between 8 and 14mm into the bone, Zygoma implants are a lot longer, they will range somewhere between 35 and 60 mm depending on the patient’s facial structure. The entire surgical process can take a few hours. Once it is done its time for the prosthodontist or the prosthodontist and lab technician to do their thing.
The prosthodontist. The prosthodontist is the quarterback who will do most of the planning, selection of materials, and communication with the patient. And, now that the implants are secured in the patient’s jaw, the prosthodontist will begin the custom work of securing the temporary denture to the implants. The temporary denture was fabricated previously in anticipation of the patient walking out with a “same day denture”, which is kind of a misnomer, because getting to this point took more than one day. Working carefully the prosthodontist and dental lab tech adjust the denture so it fits properly onto the implants and the gum, using something called an abutment. Abutments are devices that secure the denture to the implant. Abutments often will be angled in this type of scenario because the zygoma implants will likely be at such an angle to ensure it properly penetrate the zygoma bone and ends up in the right location so it meets the denture exactly. The angle of the abutment corrects for this angulation so the denture fits squarely on the newly tabled bone. The prosthodontist will make a few more modifications to ensure a comfortable fit and tightens the denture to the implants.
High 5s. At this point, the prosthodontist holds up a mirror to the patient so they can see their new teeth. It’s a pretty special moment. Here is a patient who for years has been embarrassed by their teeth. The teeth have been barely functional. The patient has been in pain due to periodontal disease and in the course of 6-8 hours, their life has been changed. The patient, who is still in a bit of discomfort due primary to the extractions and bone reduction work, still manages a big toothy smile, high 5s the dental team and is scheduled for a follow up in a few weeks to make sure everything is healing properly. But right now, the patient walks out of the practice with a brand-new set of teeth and a new outlook on life.
A few months later, after the swelling is down and the implants have integrated better and the gums have healed, the permanent denture is placed. This denture is made out of more permanent materials and if all goes well, will last years, even decades.
Who can do this type of work?
There are very few dental practices with the type of expertise to do “All on 4, implant supported dentures”. And even fewer that can do Zygoma implants for patients with severe bone loss. There is however a team of dentists, oral surgeons and prosthodontists called the” PearlFection Team” in Frederick Maryland, about an hour drive from Baltimore or Washington DC that is a world leader in this type of procedure. The doctors who do these procedures have perfected their technique at Walter Reed Hospital, yep, the same hospital that takes care of the President of the United States. They either did their rotations through Walter Reed, or were the leaders of the dental clinic, achieving notable distinction and perfecting their art. They have taken these skills and joined forces to provide the patients at PearlFection Dentistry in Frederick Maryland a quality of care that is second to none.
Who can get a consultation? Do I need to be famous or rich?
PearlFection Dentistry in Frederick Maryland, offers free consultation for anyone who wants to learn more about dentures, implant supported dentures, implants and zygoma implants. PearlFection doctors will even consult by phone for patients who live in other states or other countries. The team speaks English, Korean, Spanish, Hindi, Farsi, Tagalog and American Sign. If you or someone you know is frustrated with the level of care you have received, or have been told you are not a candidate for implant-supported dentures due to bone loss, or simply want options regarding dentures, give the PearlFection Team a call and get a consultation. They can make you smile.
The office phone number is 301-663-5550. The office is open 6 days per week and patients’ first appointment is usually a one on one screening appointment with a doctor, to better understand the patient’s goals and usually lasts about an hour.