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Focus - Germany

2007 March

Article in German

Q & A --- “TEETH IN A DAY” & “TEETH IN AN HOUR”
(Questions asked in an interview with Focus Magazine, March 2007)

1. WHICH KINDS OF PATIENTS CAN UNDERGO THE TWO “FAST” PROCEDURES (TIAH AND TIAD)?

The primary requirement for both procedures is simply that the patient needs to be in stable general health, with systemic conditions like hypertension and diabetes medically under control.  Generally speaking, “Teeth In A Day” is an excellent procedure for any patient, with or without teeth, but is most commonly used with individuals who have advanced bone loss around their natural teeth and may have severe periodontal disease that affects their gum and bone.  “Teeth In An Hour” is computer guided and works well for patients who are missing some or all teeth.  These patients are more than likely wearing a removable denture, or have tried unsuccessfully to wear a removable appliance.

Some specific conditions in which an immediate solution is particularly good are trauma cases in which patients have suffered lost teeth in accidents, and congenital situations like Ectodermal Dysplasia in which patients are born with missing adult teeth.  Trauma cases are excellent candidates for “Teeth In A Day,” as soon as they are released from emergency medical treatment, while either “Teeth In A Day” or “Teeth In An Hour” is appropriate for patients congenitally missing teeth.

As far as age goes there is no real upper limit.  Our oldest “Teeth In A Day” patient was 99 years old.  We do look more selectively at younger patients.  Depending on their specific needs and the degree of growth of the bones of their faces – their “cranial anatomy” – we might opt instead for a temporary solution until the facial bones are fully grown.

2. THE DIFFERENT STEPS OF THE PROCEDURES.

“Teeth In An Hour” requires four specific technology steps before the actual surgery.  The patient needs to attend only one short visit for a 20-second CT Scan:  1) CAT Scans; 2) the Reformatting of the Scan Images; 3) Transmission of the 3-D computer plan; 4) Steriolithography and Rapid Prototyping; then the patient’s Surgical Visit takes place.  Let me take a few minutes to explain each step:

The CAT Scan must be of a specific quality that separates the slices by 0.4 mm, and can be done by either of two devices:  the traditional spiral scanner that requires the patient to lay flat on a movable table for 20-25 minutes, or the I-Cat cone beam scanner that allows the patient to sit upright while the wings of the machine circle once around the head for less than a minute.  In either case, the patient must wear a removable denture containing radiographic markers.  These markers enable the software to combine various data files, which enhance the planning process.  Following the patient scan, a second scan is made of the denture itself, with the patient away from the scanner.  We made the decision to install an I-Cat cone beam scanner at our facility; we feel there is real value in the quality control it gives us and the convenience it offers our patients.

Following the scans, we use Procera software from Nobel Biocare to reformat the data files into three-dimensional images that help us plan the size and placement of implants, both in the jaw and in relationship to the prosthetic teeth that will be created.  Dental implants vary in length and diameter to meet specific needs; one of the most important parts of the procedure is ensuring that each implant is of the correct size and in the correct position.  This is a critical aspect of the biomedical engineering that takes into account loading forces on the bone and the implants, position of the prosthetic substructure and the function and esthetics of the teeth.

The completed surgical files are transmitted to one of two Nobel Biocare manufacturing facilities such as Gothenburg, Sweden, where laser steriolithography and rapid prototyping technology are used to quickly create a precision appliance called the “Surgical Template”.   This template is placed in protective packaging and sent to the surgical team.  Our own specially trained dental technicians use the surgical guide to retroengineer and create a precise model of the patient’s jawbone and gum tissue with replicas of the implants installed.  Laboratory technicians use this precise “Master Cast” to design and construct the screw-retained set of teeth that will be installed at the time of actual surgery. 

The final step of the “Teeth In An Hour” process is the actual surgical visit, in most cases the first and last surgical event the patient will undergo as part of the “Teeth In An Hour” process.  At the Pi Implant Center, the Surgical Template is fastened into the patient’s mouth with specially designed anchor pins.  The surgeon uses the stabilized template to precisely locate and prepare the receptor sites in the bone into which the implants will be carefully delivered.  When all of the implants have been precisely positioned according to the original computer generated plan, the anchor pins and Surgical Template are removed from the mouth.  Finally, the newly constructed teeth are positioned over the implants and small retaining screws are used to securely fasten the teeth to the implants. No surgical incisions and no sutures are required.  The entire procedure usually takes less than an hour from the time the surgical template is positioned to when the patient can bite on their new set of teeth.

The procedure for “Teeth In A Day” is somewhat different, but similarly efficient.  In the first step, impressions are taken of the patient’s existing teeth and are used to create stone models of the patient’s mouth.  Dental technicians use the stone models to create removable prosthetic dentures which will become the initial implant-supported “Teeth In A Day” prosthesis.  In the case of the Pi Dental Implant Center, having a dental

lab on-site allows us in some cases to execute this step while “Teeth In A Day” surgery is underway, accelerating the patient’s timetable to a new smile.

At the next visit, which generally is the first and most likely the only surgical visit, the patient will have the remaining loose or decayed teeth removed.  After the gums and bone are thoroughly cleansed, the titanium implants are placed in the bone.  A special exterior surface called TiUnite on the Nobel Biocare Branemark implants we use lends itself to some biomedical and genetic engineering.  We coat the TiUnite surface with special proteins called growth factors, which are known to accelerate the healing process. 

When all of the implants are securely anchored in the jawbone, individual titanium abutments are connected to the top of each implant.  Each abutment supports a prosthetic cylinder that becomes an integral part of the new set of teeth.  To ensure a precise fit, this connection between the implants and the prosthetic teeth happens directly in the mouth.  A thin rubber dressing temporarily covers the surgical incisions, but allows the abutments to show through.  Once the rubber barrier is in position, a liquid resin is applied to the prosthetic cylinders and the teeth are positioned over the abutments by the surgeon.   Then the patient is asked to close their teeth together into their natural position while the liquid resin solidifies. When these teeth are solidly connected to the abutments, the screws are removed and the teeth are taken from the mouth to the laboratory where additional reinforcement is applied and the entire set of teeth is shaped and polished.

While the dental technicians are refining the teeth in the laboratory, the surgeon works with the patient, closing the incisions and suturing the gum tissue tight to the titanium abutments.  When the gum tissues are properly closed, the teeth are firmly fastened to the implants with the small titanium screws.

3. THE CAT SCAN APPOINTMENT

Yes, the CAT scan is usually accomplished at the very first visit.  Our experience is that patients who have made the decision to prioritize their teeth are looking to get the procedure underway as soon as possible.  They usually leave our office with a diagnosis, and a treatment plan the offers various options and  recommendations for “Teeth In A Day” or “Teeth In An Hour.”

4. VIRTUAL SURGICAL PLANNING

Planning the operation on the computer is a very exacting and precise science which weighs heavily on the surgeon’s understanding of the biomechanical loading forces that will be applied to the overall rehabilitation.  Human jaw closure is powerful, exerting forces in the range of 500 PSI in the molar areas.   Assuming that the surgeon chooses the number and location of implants properly, the patient can have a set of teeth that can last a lifetime. 

5. “BONE THAT HAS TO BE REBUILT”

With the ability to look at the bone in three dimensions, our ability to place implants in difficult clinical situations has been significantly improved.  The Procera software for implant surgical planning has been particularly helpful in eliminating the need to build bone up or to perform additional bone grafting surgery.

6. STUDIES ON TEETH IN A DAY AND TEETH IN AN HOUR

The scientific basis for both of these protocols is found in the research generally referred to as “Immediate Loading.”  Our web site has many scientific articles that have been published in refereed professional journals that discuss the protocols and the success rates.  The very best

study was one conducted by the IFFE Director of Research, Stephen F. Balshi, II, BEE, MBE.  His Masters thesis at Drexel University in Philadelphia was on the immediate loading of Branemark implants with the “Teeth In A Day” protocol. 

7. WHAT ARE THE SUCCESS RATES:

This is easy.  We’ve achieved 100% success in providing patients with permanent teeth.
With individual implants, we have achieved a clinical success rate of 98.6%.  This is true of both the “Teeth In A Day” and “Teeth In An Hour” protocols.

8. PATIENT REACTIONS AND ACCEPTANCE OF TREATMENT

Yes, patients are eager to have this treatment because they no longer have the fear and functional limitations of using removable dentures.  We have many patients who would be willing to discuss their treatment experience in our Center.

The TEETH IN A DAY treatment has grown by over 200% in the past two years and the TEETH IN AN HOUR has grown by 400%.  This trend is a very strong indicator as to the future of patient care globally.

Also, one of our research team is doing a scientific study on the self-esteem associated with these treatments. Preliminary results are exactly what we would logically expect – patients feel so much better about themselves after they have a beautiful and functional set of teeth.  

9. PRACTICE DYNAMICS

The PI Dental Implant Center has for decades sought to provide our patients with state of the art treatment methods.  The evolution over the past 16 years from two stage implant rehabilitation to immediate loading with one stage surgery has significantly changed the way we deliver patient treatment.  As “Teeth In A Day” and “Teeth In An Hour” have become the standard of care for the Pi Dental Center, the most apparent change has been the abbreviated treatment time.  We are much more efficient, which means we need to be highly prepared for each treatment visit.  We’ve ensured that our entire staff understands computers and the special software that is used throughout the day in patient care. We put a premium on accurate communication between the clinical staff and the laboratory so that the teeth are prepared with optimal aesthetics in advance of the surgery.

Following completion of their dental rehabilitation, all patients are continually followed through a professional oral hygiene program with our certified dental hygienists.

DISCLAIMER
In 2007, the doctors at Pi Dental Center were asked to be part of an article on high tech dentistry for a German Magazine titled "Focus".  Since the doctors at Pi Dental Center do not speak German, they were asked a series of questions in English.  These questions and our answers can be seen in English Q&A below.  The doctors at Pi Dental Center stand by this information.

As with any magazine article, the writer accumulated technical facts and information based on the series of questions and answers that we provided.  From what we were told, it appears that other dental professionals were interviewed as well.  The writer used this information to craft an article that would be interesting to the non-professional general public.  The editor may have further altered facts and information in the process.  Pi Dental Center cannot endorse the information that is written in this German article, since we don't speak that language.  The German language article is simply on our website for the reading pleasure of our German language patients.

 

 

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