Full mouth rehabilitation does not necessarily mean removal of all teeth and rehabilitate them with the help of dentures or other modes of fixed replacement like Implants.
It is a complete comprehensive care to confront a wide range of issues such as gum health, teeth bite, Smile designing which when dealt with in the initial stages definitely reduces the procedure time, Cost of the treatment and also prevents the progression of the problem thereby help evade Full mouth replacement procedures.
Teeth do not come with an expiry or a set period of life, which when maintained properly by following everyday regimes like brushing twice a day, flossing, using mouth rinses and with regular periodic visits to a dental professional will make them last for a person’s lifetime.
Cost of Full Mouth Rehabilitation
It is very difficult to ascertain the cost of full mouth rehabilitation when it involves multiple treatments like Root canals, Crowns, Bridges, and other treatment modalities. In instances where there are multiple missing teeth or when there is mobility with the teeth or are damaged beyond repair, it requires Full mouth reconstruction of teeth
It can be
- Removable
- Semi-fixed
- Fixed
1) Traditional removable dentures (Removable option)
Procedure
Removal of the remaining standing teeth under local anaesthesia, followed by proper debridement and bone smoothing technique called Alveoloplasty to prepare a uniform base for the Denture. The patient is then made to wait for approximately 4 weeks for the tissue to settle down as dentures are gum supported. It will take approximately a week for the fabrication of the denture following the healing period.
2) Semi-fixed
This option was introduced to overcome the problems associated with removal dentures that keep moving around while talking and chewing, leading to embarrassing moments, which is more evident with the lower denture. With the help of 2 to 4 implants depending on the requirement, these dentures though have to be removed every day at bedtime can be stabilized using Implants.
3) Fixed teeth on Implants
This can be achieved using:
1) Basal implants
(or)
2) Conventional implants
BASAL IMPLANTS
Also called as Single piece Implants, as the name suggests is a single entity where the Implant body and the Abutment that supports the crown are fused to form a single entity. Basal implants support cement retained prosthesis and can be opted in patients with any bone type, can be loaded immediately as the Implants will be engaged in the dense cortical bone. These can be used to replace a single tooth to a complete set of teeth.
UPPER ARCH
Eight to ten Basal Implants based on the bone volume, density and the preferred prosthesis will be placed in the upper arch, These include the Pterygoid implants which are placed in the distal most region behind the third molars in the upper arch, the benefits of this implant being
- It will help avoid cantilevers.
- Help place full set of teeth.
LOWER ARCH
Around 8 to 10 Implants will be placed to rehabilitate the lower arch completely, the number of Implants will vary based on the prosthesis, as zirconia bridges requires more Implants when compared to Porcelain Fused to Ceramic (PFM).
Implants thus placed will be scanned and sent to the lab for the fabrication of the required prosthesis.
BENEFITS:
- Immediate loading of teeth, permanent teeth in five days
- A single visit technique.
- Affordable.
DISADVANTAGES :
- They are not US FDA approved, therefore not suggested for International patients.
- They support cement retained prosthesis, therefore retreivability is a major cause of concern, it is a very laborious process and precarious for the implants.
- Placement of more number of Implants is required owing to the narrow diameter and the strength of the Implants.
CONVENTIONAL IMPLANTS – FACILITATE SCREW RETAINED RESTORATION
Tilted implants are a judicious alternative to additional invasive surgeries like Sinus lift procedures and Bone grafting in highly resorbed jaws as, the Implants are positioned at an inclination of 30° or more with regard to vertically or axially placed implants.
The rationale for using inclination in the implants is to bring down the cantilever span of the prosthesis, there by providing favorable grinding force load distribution on the prosthesis and also maximize the anterior posterior span of implants thereby improving cortical anchorage and primary stability.
Benefits of TILTED Implants
- Longer implants are used which increases Bone : Implant, contact ratio there by promoting primary stability and additional anchorage.
- They avoid long span cantilevers as implants are placed distally.
- Superior load distribution on the arch.
- Help avoid Bone grafts and Sinus lift procedures there by resulting in decreased morbidity.
- Quick recovery.
- Avoid anatomical structures and provide immediate replacement of teeth.
Implant placement is followed by placement of Multi unit abutments (MUA/TMA)
Multi-unit abutments (MUA) are metal connects that help to join a dental implant with the prosthesis, these are available for all implant platforms and in different angles and sizes.
The benefits of these being
- To adjust the height disparities, the jaw bone will not be at the same level nor the available bone should be adjusted to make the bone even (loss of precious bone). Implants, placed in the uneven bone will be brought to the same level with the help of Multi unit abutments. This brings balance in the restoration for even distribution of grinding forces.
- Multi-unit abutments will allow different implant systems to be used in coordination with each other in a single arch.
- Implants, as discussed before placed at an angle to the vertical axis can be straightened at the gum level using MUAs.
- MUAs maintain a 2 to 3 mm distance between the implant body and the prosthesis that is present at the gum level, this arrests the infection, if any, that arises at the gum level from reaching the implant body.
- Helps overcome the restorative challenges.
Teeth can be fixed on Conventional implants using All on 4, All on 6 or All on 8 techniques.
ALL ON 4:
This is an affordable graftless solution for people who are looking for a fixed solution at low cost.
As the name suggests 4 implants are strategically placed in each of the upper and lower jaws at an angulation (Tilted implants) in the anterior segment of the jaws.
PROCEDURE:
Upper Arch
Damaged teeth, if any will be removed under local anaesthesia and 4 implants will be placed in the same sitting, 2 anteriorly on either side of the midline, 2 in the midsection of the upper jaw, just before where the sinus starts on either side.
These implants will be placed at an angle or tilted to increase the Antero posterior distance and reduce the cantilever span of the prosthesis (since there are no implants being placed in the posterior most segment of the jaw but teeth have to be extended up to the rear end to aid in grinding, unsupported teeth are called as cantilevers)
Lower Arch
Damaged standing teeth, if any will be removed and 4 implants placed in the lower jaw, Two implants on either side of the midline and two in the mid segment of the jaw in an angulation to increase the antero posterior spread and to reduce the cantilever span.
The Implants thus placed are attached with the required multi unit abutments as it is a significant step in the full arch replacement cases, followed by scanning of the implants to prepare the final prosthesis.
The prosthesis will be an acrylic denture on a Cobalt chromium frame work, which will be tightened on the implants.
BENEFITS:
- Affordable.
- Immediate loading of prosthesis.
- Maintenance free.
- No grafting or additional surgeries required.
CONS:
- Cantilevers cannot be avoided
- Few cases cannot be loaded immediately,in such cases interim dentures will be provided for immediate use.
- Dentures and not Ceramic bridges are fixed in the “All on 4” concept which are prone to wear and tear and teeth may have to be replaced every 4 to 5 years depending on the usage without disturbing the implants.
ALL ON 6
All on 6 is a revolutionary concept designed to overcome the problems associated with All on 4 Concept. It is a permanent solution that looks feels and functions like natural teeth.
As the Name suggests 6 implants are placed in the upper and lower jaw each and PFM, DMLS or zirconia prosthesis anchored on these implants
PROCEDURE
UPPER ARCH:
Upper damaged teeth, if any existing, removed under local anaesthesia and 6 implants will be placed in the upper arch, two on either side of the midline, two in the mid-segment of the jaw and two in the pterygoid bone present behind the upper third molars on either side, the difference between All on 4 & All on 6 concepts is the placement of pterygoid implants which help avoid Sinus lifts, Cantilevers and provides support till the distal most tooth thereby creating a balance and improving the life of the implants due to even load distribution of the grinding forces.
LOWER ARCH:
Existing damaged teeth removed under local anaesthesia and 6 implants placed, 2 in the anterior segment on either side of the midline, two in the middle segment and two in the posterior most region of the lower jaw, in case of low bone quality in the posterior region, implants will be placed using the nerve bypass technique which is safe and effective.
This is followed by the placement of Multi unit abutments on the implants and scanning for the preparation of the final prosthesis, which can either be PFM, DMLS or Zirconia, which will be fixed on the implants with the help of screws (screw retained prosthesis) in less than a week’s time.
BENEFITS:
- Quick recovery.
- Avoids cantilevers.
- Immediate loading of teeth.
- Eliminate the requirement for Sinus lifts and bone grafts.
ALL ON 8 TECHNIQUE
As the name suggests 8 Implants will be placed in each of the jaws, this concept is very rarely used as 6 Implants when properly placed engaging the Basal bone, is more than adequate for FULL MOUTH REHABILITATION ON IMPLANTS.
FULL MOUTH RECONSTRUCTION USING ZYGOMATIC IMPLANTS
In very low bone cases (80% bone loss) where is no proper jaw bone left to engage the least available size of a 6mm Implant, owing to infection or pneumatization of sinus then, instead of subjecting the patient to invasive surgeries like Sinus lifts and Bone grafts and delay the loading of teeth by months together and troubling the patient with wobbling dentures in the mean time, till they can get their fixed permanent teeth attached on the Implants (In some cases there might not be a possibility to place the removable dentures) the hard and rigid cheek bone or the Zygoma bone can be engaged to place the Zygomatic Implants, these implants along with the Pterygoid Implants, placed behind the upper third molars and another Implant in the anterior region next to the mid line on either side will help in achieving 6 Implants in the upper jaw, paving way for immediate loading of teeth on Implants.
| Full mouth REHABILITATION | NUMBER OF IMPLANTS | TYPE OF IMPLANTS | LOADING OF TEETH | TYPE OF FIXATION | USA COST | COST AT LBR |
| Traditional Dentures | NO IMPLANTS | NO IMPLANTS | 10 DAYS | REMOVABLE PROSTHESIS | $3,000 | $ 500 |
| Basal Implants (Implants are not, US FDA approved) SOLID ZIRCONIA TEETH | 12 IN UPPER JAW, 10 IN LOWER JAW | SINGLE PIECE MONOLITHIC IMPLANTS INCLUDING 2 PTERYGOID IMPLANTS IN UPPER JAW | IMMEDIATE LOADING, 5 DAYS | CEMENT RETAINED TEETH (NOT APPROVED IN USA) | ———— | $ 10, 000 |
| ALL ON 4 WITH HYBRID PROSTHESIS (US FDA APPROVED CONVENTIONAL IMPLANTS) | 4 IMPLANTS IN UPPER & 4 IMPLANTS IN LOWER JAW | CONVENTIONAL IMPLANTS, NO PTERYGOID IMPLANTS | DELAYED LOADING, 4 MONTHS | SCREW RETAINED | $ 48,000 | $ 4,000 |
| ALL ON 6 WITH DMLS METAL CERAMIC TEETH (US FDA APPROVED CONVENTIONAL IMPLANTS) | 6 IMPLANTS IN UPPER JAW & 6 IMPLANTS IN LOWER JAW | CONVENTIONAL IMPLANTS WITH 2 PTERYGOID IMPLANTS | IMMEDIATE LOADING WITH CPBCCI PROTOCOL , 7 DAYS | SCREW RETAINED | $51,000 | $ 8,000 |
| ALL ON 6 WITH SOLID ZIRCONIA TEETH AND TITANIUM FRAME ( US FDA APPROVED CONVENTIONAL IMPLANTS ) | 6 IMPLANTS IN UPPER & 6 IMPLANTS IN LOWER JAW | CONVENTIONAL IMPLANTS WITH 2 PTERYGOID IMPLANTS | IMMEDIATE LOADING WITH CPBCCI PROTOCOL, 7 DAYS | SCREW RETAINED | $70,000 | $9,000 |
| ALL ON 6 WITH ZYGOMATIC IMPLANTS & SOLID ZIRCONIA TEETH ON TITANIUM FRAME | 6 CONVENTIONAL IMPLANTS IN UPPER JAW, 6 IMPLANTS IN LOWER JAW | 2 REGULAR, 2 PTERYGOID & 2 ZYGOMATOIC CONVENTIONAL IMPLANTS | IMMEDIATE LOADING WITH CPBCCI PROTOCOL, 7 DAYS | SCREW RETAINED | $90,000 | $11,000 |
