All-on-X full-arch implants

What we do at our office

Dr. Baruch Tetri, DDS, is a periodontist (a dentist with specialty training in gums, bone and implants). He earned his DDS at NYU College of Dentistry in 2006, completed his Certificate in Periodontics in 2009, and is a Diplomate of the American Board of Periodontology. For a full arch he designs the teeth and the surgery as one plan, so each implant goes where the bridge needs it.

The number of implants depends on your bone and your bite, not on the brand name. Before any tooth comes out we ask whether it can stay, and we compare keeping some teeth with a full-arch bridge, an overdenture and a conventional denture; they differ in surgery, cleaning, repairs, time and cost. You hear the alternatives before you agree to anything.

A photogrammetry camera records where each implant sits so the bridge can be made to match. The bridge is designed in our digital laboratory. Full-arch surgery is a long appointment, so sedation is discussed after a medical review, where our permits and team allow.

What happens at the visit

1. The first visit. We examine your mouth and look at a recent panoramic X-ray (one wide X-ray of both jaws) if you have one. We ask what you want to be able to eat, say and show.
2. Records and design. A CBCT scan (a 3D X-ray of the jaws) shows the bone and where the nerve and the sinus run. We design the teeth first and place the implants where that plan and the bone allow.
3. Surgery. Teeth that cannot be kept are removed and the implants placed in one appointment. A fixed temporary bridge the same day is possible when the implants are firm enough once placed; if not, you leave with a denture while they heal, a backup plan we agree on with you beforehand.
4. Healing. The temporary bridge lets us check how the teeth look, how you speak and whether you can clean under it, and we adjust it over the following months.
5. The final bridge. After healing we take new records (a digital scan and a bite record) and make the final bridge, with a try-in (the bridge seated for you to check before it is finished). The final bridge is a new piece, not the temporary renamed.
6. Checkups. The bridge comes off for professional cleaning on a schedule set by your gums.

Risks and limits

• Placing several implants at once is a bigger surgery than one implant: more swelling, more bruising, more days off.
• In the lower jaw the nerve, and in the upper jaw the sinus, sit near where full-arch implants go; the scan is how we plan around them.
• Same-day teeth are conditional. Thin bone, a graft placed at the same time or an implant that is not firm enough changes the plan on the day.
• If one implant of four fails, the whole bridge may have to come off while the site heals.
• A fixed bridge is not for life on its own: plan on repairs, and on cleaning it like teeth.
• Speech and lip support take weeks to settle.

Questions patients ask

How many visits, over how long?

Several visits around the surgery, then checkups through healing. The final bridge comes months later, not weeks; we tell you the timeline before you start.

Is a denture clipped onto implants the same thing?

No. An overdenture comes out to clean and sits on two to four implants; a full-arch bridge stays in and is cleaned in place.

Can you tell from an X-ray whether I am a candidate?

A panoramic X-ray lets us say whether a visit is worth your time. Whether and how depend on the exam and the CBCT scan.

Sources

• ITI consensus: Number of implants for complete-arch fixed prostheses (full-arch bridges)
• ITI consensus: Loading protocols for fixed prostheses in edentulous jaws (jaws with no teeth)
• American Academy of Periodontology: Dental implant procedures
• EFP S3 guideline: Prevention and treatment of peri-implant diseases

Related: Dental implants · Full-mouth rehabilitation · Our digital laboratory · The Viso G7 3D scan

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