Teeth are lost because of trauma or disease. Trauma may come in the form of an accident or excessive biting forces. Disease is generally tooth decay or periodontal disease [gum disease] but there are other categories such as cancer and various neoplasm’s of the jaw that may result in tooth loss. Studies show that more than 50% of the population have one or more missing teeth. Trauma commonly causes the loss of a single front tooth. The effect this has on a persons’ well being is obvious. Fortunately an experience dental implantologist can usually remove the remaining root, place a dental implant, and secure a new tooth to that implant in one visit of an hour or two. The loss of a single tooth in the back is usually caused by tooth decay or periodontal disease. Sometimes this can be treated just like front teeth but for various reasons it is often more time consuming.

 More often than not the treatment for a single missing back tooth is as follows:
1.    Extraction of the damaged tooth and grafting of the root sockets. Wait 4 months then
2.    Placement of a dental implant to replace the root of the single missing tooth. Wait 4 to 6 months then
3.    Placement of an abutment on the dental implant and record taking for the fabrication of a crown to replace the single missing tooth. Wait 3 weeks then
4.    Permanent attachment of the abutment to the implant and cementation of the crown to the abutment.  TREATMENT COMPLETE

The need for replacing a single missing tooth in the back is often times not as intuitively obvious as the need for replacing a single missing tooth in the front; but it is important. Teeth are very movable. We’ve all witnessed an Orthodontist putting tension on a tooth with a small rubber band and moving it where ever he wants. Each tooth in the mouth has a position and a purpose. When there is a single missing tooth the body’s natural reaction is to drift adjacent teeth into the void that is created. Over time a single missing tooth may actually cause a change in the position of every other tooth in the mouth. Malocclusion may then develop contributing to TMJ [tempromandibular  joint] dysfunction, headaches, muscle spasms in the neck and shoulders, food impaction between teeth, tooth decay, periodontal disease, and other problems. Because these problems don’t always develop and because they may occur years after the single tooth is lost, people often times don’t associate the loss of their tooth to the problems it caused. It is a shame that a single missing tooth is frequently ignored in light of the possible consequences but the development of dental implants for the replacement of a single missing tooth is encouraging many more people to seek early treatment.

Multiple missing teeth usually follows a single missing tooth. Each time a tooth is lost and not replaced it accelerates the process of losing more teeth. As multiple teeth are lost all of the problems associated with a single missing tooth are exaggerated. But there are additional concerns as well. Those would include but not be limited to:

1.    Collapse of vertical dimension- As multiple back teeth are lost the mouth loses their support when we close causing the chin to get closer to the nose. This has the effect of deep folds at the corner of the mouth and thinning of the lips. It can easily age a persons’ appearance by 10 to 20 years.
2.    Collapse of facial structure-As multiple back teeth are lost facial support of the cheeks is lost causing a sunken in look. Once again the result is premature aging.
3.    Bone loss- The bones of our upper and lower jaws have only one natural purpose; the support of our tooth roots. When the roots are lost the bone begins to melt away much as a muscle does that is not used. This results in further lose of facial support and can make the wearing of artificial prosthetics such as dentures impossible. It can also make the placement of dental implants more challenging.
4.    Inability to chew foods properly-The mouth is the first in a series of organs designed to assimilate and digest foods. The more thoroughly we can chew the food the better the whole system works. Mom wasn’t wrong when she admonished all of us to chew our food more slowly and thoroughly.
5.    Inability to eat a healthy diet-As more and more teeth are lost it becomes increasingly difficult to eat a balanced diet. Important staples such as raw vegetables and nuts become impossible to eat and we lose out on the many vitamins and minerals they provide.
6.    Inability to eat the foods we enjoy-Corn on the cob, ribs, steaks, fajitas, etc. become impossible to eat. Many people don’t know how much being able to eat what they want means to them until it’s too late.
7.    Embarrassment-There is a social stigma associated with missing teeth. Many people simply quit smiling or hide their smiles with their hands. That is unfortunate because we know of very few people who lost their teeth because they wanted to. Each person has their own story and all of them or sad.

 These are but a few of the problems that people face because of single and multiple missing teeth. Now, dental implants offer amazingly simple and dependable solutions. Dental implants for single missing teeth or multiple missing teeth are artificial roots made of titanium that replace the roots of natural teeth. For a single missing tooth one implant is placed and a crown is attached to it. The result is a natural looking tooth that functions and works just like the natural tooth that was replaced. Many people think that with multiple missing teeth that one dental implant is required to replace each tooth; that is not usually the case. For example if three teeth in a row are missing it is often possible to replace them with only two dental implants and a fixed bridge between them. With the amazing All on 4 protocol and entire arch [16 teeth] can be replaced with only four implants and a fixed bridge.

 The placement of a dental implant is usually quick and almost painless for those who are candidates. One requirement is an adequate quantity and quality of bone. As mentioned previously when a tooth is extracted the bone that once secured its’ root begins to melt away. Some studies indicate that up to 40% of the bone volume in that area may be lost in the first twelve months. Modern dentist with an understanding of oral surgery and implants place materials in the sockets where the tooth roots were to prevent this from happening. The result is a healthy site for the future placement of a dental implant. Dentist with a more advanced understanding of dental implants may actually place an implant into the socket when the tooth is extracted. When this can be achieved it is the best and simplest solution for preventing bone loss. But because many dentist do not understand dental implants and the protocols necessary for preserving bone, and because many patients take a cavalier approach to the loss of a tooth, sometimes there is a need for an implant but not adequate bone to support it. Modern implant designs minimize this as do implant placement protocols such as those of the All on 4 technique but they cannot eliminate the occasional need for more bone.

When there simply must be more bone, bone regeneration procedures are required. This normally incorporates one of many different types of materials that replace the lost bone volume and encourage the formation of new bone. With the advent of stem cell and bone morphogenic enhanced materials this has become far simpler and more predictable. What once required a maxillofacial and an orthopedic surgeon in a hospital setting can now be predictably performed by a well trained dental surgeon in his office. Once this new bone has matured, usually 4 to 6 months, a single or multiple tooth replacement dental implant can be placed just as predictably as if the graft had not been required.

Single Dental Implant Procedure:-

Steps for placement of a single dental implant in the site of a single missing tooth
•    After conscious sedation is administered the placement site of the single missing tooth  is infiltrated with local anesthesia. 
•    A small incision is made in the soft tissue covering the bone in the single missing tooth site and an osteotomy is prepared. An osteotomy is the same thing as a pilot hole made prior to the placement of a screw in wood. Once the osteotomy is completed a single dental implant is threaded into it. Now we have a man made root where the natural root was. Just like a natural root this dental implant is beneath the gums and in the bone and cannot be seen in the mouth. A piece called an abutment is screwed into the single dental implant. The abutment provides the transition from the dental implant beneath the gums to a tooth above the gums. Impressions are taken of the abutment and they are sent to a dental laboratory  
•    In about three weeks a crown is returned from the laboratory and it is secured to the abutment with glue [cement]. You now have a new tooth that looks, functions, and feels just like a natural tooth.

Dental implants for the replacement of single missing teeth and multiple missing teeth have become as routine for dental implantologist as fillings are at your family dentist. For those with single missing teeth they offer an exceptional replacement solution that can help prevent future problems. For those who have lost multiple teeth or all of their teeth dental implants can give them back their smile, confidence, and self esteem. It can truly give them a second chance.

If you have lost your teeth then Dental Implants Houston can offrer a permanent and long lasting solution to teeth loss problem. Do you want to know more about Houston dental implants? Know more!

Dental Implants in Houston and Other Teeth Replacement Solutions
Periodontal disease, severe or mild, or tooth decay has become a common problem for people. Due to this, we are loosing one or several teeth. However, the solutions available for teeth replacement are traditional in nature and are generally uncomfortable to wear. Moreover, these solutions are temporary solution. Some of these traditional teeth replacement solutions are bridges, dentures, etc.

However, there is another teeth replacement solution, which is considered among the best solutions available till date and that is “dental Implants Houston”. A person who has lost teeth can get back permanent teeth through dental implants in Houston. In this process, an artificial tooth root is inserted in the jawbone. This self-sustaining tooth root acts as an anchor and supports the replacement teeth. According to a survey, it has been found out that the rate of success of Houston dental implants is more or less 95%. In fact these implants can last for lifetime, if some points are maintained carefully:
1.    Maintenance of dental hygiene in a proper manner
2.    Visit dental clinics in a regular and scheduled manner

One of the best parts of dental implants in Houston is that it induces growth in its adjacent teeth. The reason behind this is that it is self sustaining in nature and doesn’t need support from the adjacent teeth. In fact, these dental implants help in maintaining the structure of the jawbone.

Different Parts of Houston Dental Implants

These implants have essentially 3 parts:
1st Part: A base implant - This is essentially made up of titanium and replaces the tooth root. It is joined with the jawbone.

2nd Part: Abutment – This abutment is connected with the titanium-made base implant. This is the part that remains protruded from the gum-line.

3rd Part: Crown – A crown, which resembles natural teeth, is placed over the abutment and forms an artificial tooth. This tooth is self-sustaining and looks as well as feels absolutely normal.

Benefits of Dental Implants

1.    They are permanent in nature and offer long term solution. If proper dental hygiene is maintained, accompanied by dental clinic visit in a scheduled and regular manner then it can last a lifetime.
2.    The resulting look and feeling of these implants are absolutely natural.
3.    They are not required to be attached with the bone, with the help of artificial gum lines or adhesives.
4.    They are not required to be removed.
5.    They are self-sustaining and thus don’t require support from adjacent teeth. That’s why dental implants in Houston help the bones of adjacent teeth to grow.

Can this procedure replace one missing tooth? Can it replace several or all of the missing teeth?

Yes, one missing tooth can be replaced with this method. Firstly, an implant is placed in the missing tooth area, having a base implant that is made up of titanium. Then an abutment is posted over the base, followed by a crown that looks absolutely like a natural tooth.

The same procedure is done for many or all missing teeth. Thus, teeth loss is not a problem anymore. You can get back your shiny smile back with Dental Implants in Houston.
The all on four dental implants method is the latest phenomenon in cosmetic dentistry world, where you can get back your youthful smile in a single day. Read this unique case study on full mouth all on four implants.

This has been a very typical week at The Brueggen Dental Implant Center – Houston.  My primary case load centers around the All on 4 Dental Implant protocol and the ancillary procedures sometimes required to complete that type of case.

 This week we did 2 full mouth All on 4 cases and 1 upper arch only case with individual implants to replace a few lower missing teeth and crowns to restore the remaining lower teeth. The rest of my time was filled with typical implant cases, ridge augmentations, and sinus lifts. I just finished the surgery on my last full mouth All on 4 dental implant case of the week today. This patient had Class IV periodontal disease with no missing teeth.  There was Class IV mobility of the upper and lower central and lateral incisors, Class II mobility of all four cuspids, and Class III mobility of the bicuspids and molars. Pocket depth was 6 to 18 mm.  The upper and lower centrals and laterals had no bone remaining at all. I mention this because these are particularly interesting cases on the upper. The lower is almost always routine.  But when all of the upper teeth remain and especially when there is severe damage to the bone from periodontal disease, completing the uppers in one appointment can be challenging.  Depending on the size and position of the maxillary sinuses the All on 4 Dental Implant protocol places the most posterior upper implants somewhere between the second bicuspid and the mesial root of the first molar. They will be angled to the anterior at 35 to 45%. When all three of these teeth exist and must be extracted at the time of implant placement finding enough bone to engage the implants at 35 to 45 ncm can be impossible especially if the apex of the first and second bicuspid roots are right at the floor of the sinus.
The complexity is compounded by severe periodontal disease which leaves no cortical plate and often several mm of very vascular, soft, membranous bone.  Such was the case today.  This case began 2 weeks ago when our patient arrived at the Brueggen Dental implant Center for their first visit. A cat-scan, consultation, examination, and treatment plan was completed. It was determined that with periodontal surgery, 5 maxillary and 4 mandibular teeth could be kept.  After discussing these options it was clear that the All on 4 Dental Implant protocol was this patient’s best option. The possibility that I might not be able to place the upper posterior implants with enough torque was discussed. If that happened I would place 2 to 4 mini transitional dental implants and the patient would need to wear an upper denture for 6 months before I uncovered the dental implants and attached the provisional fixed hybrid prosthesis. I actually warn every patient of that possibility.  But on cases such as this I stress it.  RX’s were written and an appointed was reserved for this morning.  Augmentin  500 mg bid, Metronidazole 250 mg qid were to be begun 3 dys before the appointment and continued for 7 dys after. A medrol dose pak was to be begun the morning after the surgery and 30# 600mg Ibuprofren were given for pain q6h prn. 10mgs of diazepam was given to take hrs the night before the appointment.
This patient arrived at 8 am this morning. Paper work was completed, post op instructions were reviewed with the patient and her spouse, the post op appointment was scheduled in 21 dys, and conscious sedation was begun with 10mg diazepam and .25 mg of triazolam.  Approximately 1 hr later, 9:15 am, 50 – 50 N20 was begun as I scrubbed. At 9:30 I administered local anesthesia with 2% lidocaine and 1:100 epi and .5% bupivicaine HCL with 1:200 epi. All of the upper teeth were extracted, granulation tissues were removed, alveloplasty was completed, and implants were placed. Everything was uneventful until I placed the “last” implant. It was the upper right most posterior implant. I noted that the end of the osteotomy, which was prepared for a 4.0 X 18 Nobel Bio Care Speedy Goovey Dental Implant, was in a void. This is evidenced as an obvious lack of resistance and is never a good sign. If you are placing a 13 or 15 mm dental implant you can always go longer if there is room but once you have committed to an 18 mm dental implant you can only go larger which in the Speedy Groovey Dental Implant System is all the way to a 5mm wide platform dental implant. That implant has gotten me out of many “jams” in the past. When you lose resistance at the end of the osteotomy there are three possibilities. 1. You have penetrated a vacuole in the bone. 2. You have inadvertently entered the sinus, nasal cavity, or penetrated through one of the borders of the mandible or maxilla or 3. You have entered the socket of a tooth you have just extracted.  In this case it was the later.
The Speedy Groovey Dental Implant is a straight wall design as opposed to a tapered implant so you have torque from the beginning to the end. In typical type II bone for a 4.0 X 18 dental implant I will prepare the last 3 mm to 2.8, the middle 9 mm to 3.0, and the first 6 mm to 3.2.  This will usually give me 25 to 35 ncm of torque until I reach the terminal 3 mm where it rises to 45 ncm. As I placed this implant I noticed that the initial torque was only 15 to 20 ncm and as I approached the terminal 3 mm it was only 30 ncm but it was getting tighter. I screwed it in 2 mm deeper to reach 35 ncm and then did a little more alveloplasy to correct the ridge discrepancy.  I considered removing the implant and placing a 5.0 diameter but this would have left me with less than 1mm of buccal bone and though I sometimes violate the 1 ½ mm rule I prefer not to. I was thinking how good I was until I placed the angled abutement on this implant and the implant turned slightly indicating that I had less than 35 ncm on the implant. 35 ncm is my absolute minimum for an immediate load fixed hybrid on 4 implants so something had to be done. I’ll stretch a lot of things but not this. Fortunately there was room for a fifth implant so we placed it, achieved the desired torque, closed the case and where through with the first stage surgery at 10:40. Open tray impression pins were placed and luted together with spent surgical burs and Duralay and an impression was taken.
At 12:30 our lab had a screw down bite rim prepared, we took a bite registration, marked midline and other land marks, and began the surgical phase of the lower arch.  As on the upper local anesthesia was administered, teeth were extracted, alveloplasty was performed, granulation tissue was removed, implants placed, tissues closed, and impressions taken. At 2:00 P.M. our lab picked up the impression. It is now 3:30 and I am seeing hygiene exams and catching up on my paper work while I wait on the lab to complete the fixed hybrids.  Lab work is the most unpredictable part of the All on 4 dental implant protocol for me.  Monday I was at home by 5:30 after completing an upper and lower case but sometimes its’ almost 8:00. Accurate bite registrations can be a problem with sedated patients, I have never found manipulated retruded centric to be a good position, and we are very particular about the cosmetics. Thus it is not uncommon for us to do a bite registration and remount after the lower appliance is finished and we sometimes have to make an appliance over if we really don’t like it.
Hopefully Alex will deliver these appliances in another hour or two, they will be perfect, and we’ll get out early.  But regardless, by 7 or 8 we will have provided a service for a 45 yr old woman that brings an excitement and joy to me that I wish every dentist could experience.  In one day, only the second time this young lady has ever been in The Brueggen Dental Implant Center – Houston, we removed 32 terribly diseased teeth, placed 9 dental implants, and she will leave with upper and lower fixed teeth that she can eat with this evening and smile again with pride. She will require no analgesics stronger than Ibuprofren and will be able to return to work tomorrow if she wishes.
The All on 4 Dental Implant protocol is the closest thing to a miracle that I have ever been blessed to witness and I will be eternally grateful to Dr. Paulo Malo for his genius, wisdom, courage, and willingness to share this with me.
FAQ 1: How effective are All-On-Four Dental Implants compared to Traditional Implants?

All on 4 is a process or technique rather than a type of implant. This technique incorporates 4 dental implants in each arch to which a complete set of new teeth can be attached and it can happen in a single easy appointment, all in one day.

Traditional techniques using dental implants begin with the extraction of any remaining teeth and then a 4 month healing period. During that 4 months and until the case is finally completed at roughly a year and a half patients must wear full false teeth. After the extraction sites are healed the maxillary sinuses must be grafted. Sinus lift surgery is usually accomplished bilaterally. After is it completed 6 to 9 months are required before the dental implants are placed. Finally somewhere between 8 and 12 months after the initial extractions dental implants are placed. This usually requires 8 to 10 dental implants on the upper and 8 to 10 dental implants on the lower. Once the dental implants are placed another 6 months pass and they are uncovered and healing abutments are placed to develop the soft tissue around the dental implants. The dental implants that were until now completely beneath the gums now exit through the tissue much as a natural tooth does. Two more months are required and then impressions for the fixed bridges can be taken. After another 3 weeks the fixed bridges are ready for placement and if all has gone well the case is finished. All told cases treated in the traditional manner require roughly 18 months, 4 surgeries, and 16 to 20 dental implants. To make matters worse favorable results are not as predictable as they are with the All on 4 technique. Four of these dental implants will have been placed into grafted sinuses. The failure rate for implants placed into sinuses is approximately 12 % as compared to 2 % or less for those placed in the premaxilla which is the area used for the All on 4 technique. Thus one can easily see that complications occur at least 6 times more frequently with traditional techniques and that with the number of implants and surgeries the cost for the traditional approach is much higher. The only negative with the All on 4 technique is that it requires a master implantologist with  a large body of experience and a highly trained team including an in house laboratory dedicated to All on 4 cases. Thus there are very few offices capable of offering this service.

The All-On-Four dental implants don’t require additional surgeries or bone grafting, which has become a norm for traditional implants. It also proves to be more secure, comfortable & cost effective than traditional implants and is thus the treatment of choice for those who have already lost or are facing the loose of all of their teeth.

FAQ 2: What is so special about Dr. Brueggen’s All-On-Four Dental Methods?

Dr. Brueggen was professionally trained by Dr. Paulo Malo, the architect of the All-On-Four dental procedure. He has been performing dental implants for more than thirty years and specializes in providing successful implant solutions to patients with complex health problems and rare bone conditions.

Moreover, the Brueggen Dental Implant Center uses state-of-the art technology, including advanced imaging equipment and provides a lab facility, to provide patients outstanding and convenient dental solutions.But the greatest advantage to Dr. Brueggen’s All on 4 process is his team and their experience. Dr. Brueggen and his team have made the All on 4 dental implant reconstruction the focus of their practice. They do it every day and they’ve been doing it every day for many years. Equally important Dr. Brueggen has extensive training in general and cosmetic dentistry so he not only provides the surgery, he provides the new teeth as well. This makes the process seamless and is far superior to a surgeon and restorative dentist trying to work together on a case.

FAQ 4: How was Dr. Brueggen inspired to perform All-On-Four dental implants?

Dr. Brueggen has been handling dental implant cases since 1976 and is considered an expert in the field. He realized that the time and cost required to complete a full mouth reconstruction using  traditional dental implant procedures was far too great for it to be available to most of those who needed it. In 1994, he came to know about the unique All-On-Four dental implant procedure through papers published in dental journals. After reviewing the literature for over 10 years he was convinced that the results achieved with the All on 4 protocol were far superior to those achievable with traditional methods. Dr. Brueggen attended a lecture given by Dr. Malo and was further convinced. He asked Dr. Malo for his assistance in learning the technique. Dr. Malo agreed and arrangements were made for Dr. Brueggen to travel to Lisbon, Portugal to study with Dr. Malo.  His studies included both the prosthetic and surgical aspects of All-On-Four protocol. These days the All on 4 technique allows Dr. Brueggen to offer a lasting and predictable solution to people from all over the world.       

FAQ 4: What is the success rate with the All-On-Four Procedure?

Published data states that the success rate of All-On-Four dental implants in upper arches is approximately 97 to 98% and the success rate for lower arches is 98.2%. New data indicates perhaps even better numbers.    

Dr. Brueggen is firm in his conviction that the All on 4 process is the finest solution that dentistry has ever had and probably will have for the remainder of his career, for those who have lost all of their teeth or who are facing the loss of all of their teeth. There are three primary obstacles for people who need this procedure.
  1. Cost- A typical upper and lower case will cost around $50.000.00. About the cost of a high end new car. Not a daunting investment but certainly difficult for some. Our office has two treatment counselors available to assist patients in finding financing options. They can also help you explore other treatment options. For example, in some cases a lower denture can be secured with implants, also in just one day, for as little as $8,000.00. The treatment counselors responsibility is to treat you as an individual and make sure that a solution is found for you that makes you happy and provides you with the finest possible care.
  2. Fear-The second greatest obstacle for patients to overcome is fear. All most every patient who has lost all of their teeth or is in danger of doing so is a dental phobic. We solve that daily using safe oral conscious sedation.
  3. Inadequate Bone- The All on 4 procedure was specifically designed to allow a full arch of reconstruction without the need for sinus lifts or other forms of bone regeneration. That is possible on the lower virtually 100% of the time. The upper is not quite as predictable but it is still possible in over 70% of the cases presented to my office. When bone grafting is required we employee state of the art procedures  to cut down on time, discomfort and cost.   

Without a doubt the All on 4 method of dental implant placement and tooth replacement is the most remarkable dental advancement in the last 30 years. If you or anyone you know or love is suffering with false teeth or the prospect of having to wear false teeth there is no reason to put off help any longer.