Full Mouth Dental Implants

When you have all or most of your teeth missing and you want to replace them in the best possible way, then the treatment you need is a full mouth dental implant surgery.

The implants are placed in the jawbones and act as a root replacement, over which fixed bridges or permanent dentures are secured.

This is a large and expensive treatment. The goal of this page is to provide you as much information as a patient needs before choosing to get a full set of new teeth with dental implants.

• Reduced risk of bone loss: As the implants are placed in the jawbones, they get anchored firmly, preserving the integrity of the bone and maintaining bone height and volume, thus significantly reducing the risk of bone loss.
• Improved facial appearance: As mentioned, whole mouth dental implants prevent bone loss, the bone height and volume is maintained. The bony ridges give proper fullness in the cheek and lip region giving a better look. In case of bone loss, the lower third area of the face appears collapsed and sunken giving a wrinkled and older appearance.
• Improved speech: Quality of speech is greatly improved (more clear speech) as compared to other treatment options. Whistling sounds and lisping may be seen if missing teeth are not replaced or if replaced with ill-fitting / improper dentures.
• Improved chewing efficiency: Easier eating as chewing efficiency is more like normal.
• Comfortable and convenient: It eliminates the need for daily removal and maintenance of false teeth. No need for adhesives and no slipping off while eating, talking, smiling, etc.
• Durability: This is a permanent restoration, that lasts for many years and even a lifetime if maintained properly with good oral hygiene.
• Improved self-esteem and confidence: Positively affects the social life of the patient.

• Complete edentulism (toothlessness): Cases where all the natural teeth are missing and are to be replaced in an as natural way as possible.
• Several missing/bad teeth: Even if a patient has some or most of the teeth but they are severely damaged/decayed and large scale dental work would be needed (e.g. multiple root canals, bridges, crowns), restoring the entire mouth with tooth implants might be a better option.
• Health and hygiene: When a patient is healthy enough and is able to maintain long term proper oral hygiene after the procedure.

There are certain conditions where complete teeth reconstruction with implants is strictly not recommended, these are absolute contraindications. In some situations, the treatment can be opted for with some care and precautions but not as a priority treatment. These conditions are listed under relative contraindications.

Absolute Contraindications

• General health: Overall health of the patient which makes any surgery or anesthesia inadvisable.
• Malignancy: Active cancer, any procedure may act as a stimulus and may aggravate the growth of cancer cells tremendously.
• Bone diseases: Severe form of osteoporosis, osteomalacia, Paget's disease, brittle bone syndrome, fibrous dysplasia, etc. These are the abnormal bone conditions where the bone quality is very low and fibers that form the bone are also abnormal both in quality and quantity. This results in the poor anchorage of implants and implant failure.
• Cardiovascular problem: Heart problems like recent myocardial infarcts (within 6 months), acute rheumatic fever. Any type of procedure during this phase may greatly impair the health of the patient by causing generalized infection.
• Radiation therapy: Patients undergoing radiotherapy in the head, neck, or face area are strictly prohibited for any type of surgical procedure (even if minor) in the mouth and nearby regions because the blood supply is greatly reduced, resulting in very poor healing and very high risk of infection causing implant failure.
• Immunological causes: Immunological diseases, AIDS, patients who are in the process of organ transplantation, auto-immune diseases, etc.
• Medications: Certain medications like bisphosphonates (taken for osteoporosis, reduces the blood flow to the bones), Immunosuppressant drugs (given in organ transplantation to prevent the rejection of the organ transplanted)

Relative Contraindications

Those patients who come with the following conditions may be advised for a whole mouth restoration but only under proper consultation of the physician.

• Uncontrolled diabetes: Diabetes, if in a controlled state poses no problem, but if uncontrolled, causes rapid resorption of bone, and also healing is delayed.
• Hypertension: Very high shooting up of blood pressure results in severe bleeding during and after the surgery. So, it is mandatory to get the blood pressure in the normal range before undergoing any surgical procedure to reduce the risk of complications.
• Pregnancy: Any kind of stress during the initial months of the pregnancy may affect the development of the baby and in later stages may lead to preterm labor (early delivery).
• Mental illness: Patients with mental illness may be very uncooperative and show highly unpredictable behavior. It's better to wait until the psychiatric treatment gets completed and improvement is seen.
• Artificial prosthesis: Patients with artificial heart valves, artificial joints, bone plates, etc. are treated only under high antibiotic coverage as the risk of generalized infection is very high in them.

The most common steps are mentioned below. There may be variations as no two cases are the same. It depends largely on the overall health and oral health of the patient.

1. Initial consultation, where the oral cavity is thoroughly examined clinically and medical evaluation is done.
2. Initial impressions of both upper and lower jaws are taken to know the relationship between them.
3. Possible X-Rays, CT scan in order to know the quality of the bones and to rule out the nearby structures like maxillary sinus, nasal floor (in the upper jaw), and inferior alveolar nerve (which runs below/close to the root ends of lower back teeth). Along with it, Computer-Aided Design (CAD) is made to exactly know where the implants are going to be placed.
4. Bite registration of the patient is taken. This is to know the relationship when the mouth is closed and how much space is there in between the jaws for placement of the false teeth.
5. The bite taken is held by mounting it and mock of how you will look after getting the new teeth.
6. A surgical stent is created from the mock up. This is like a stencil, which helps to guide and orient the implant in the proper position and direction.
7. Dental implant placement surgery is done. This surgery may slightly vary depending upon the type of implant used like a one-stage or two-stage implant (discussed later).
8. Implants are then allowed to heal by fusing with the adjacent bone (osseointegration) for a period of 4- 6 months.
9. The mockup which was prepared earlier (step 5) is re-checked and ensured that everything is fine. Any changes if required can be done.
10. Final denture construction. The duration required may vary according to the complexity. There may be visits in between to check for accuracy of the manufacturing process before proceeding to the next step.
11. Final placement of the denture and necessary instructions are given to the patients.
12. Follow up to ensure everything is going okay, followed by regular dental checkups.

Your dentist will examine and check if the conditions are favorable or not for implant placement. If they are not, they might be made favorable by the appropriate treatments.

This may include:

Bone grafting: Bone grafting is required where there is severe bone loss. It can be due to prolonged period of edentulism (missing teeth) without replacement of implant, ill-fitting dentures which accelerates bone resorption, aggressive gum problems etc. In such cases, implants does not get anchored firmly due to insufficient bone around them hence, there are higher chances of failure.

Bone grafting is a procedure when graft is placed, secured and allowed to heal. Once adequate volume is obtained, the procedure is carried on.

Bone graft can be taken from the oral cavity or any extra-oral site of the same person (Autograft). This shows excellent results. Other types of bone grafts, for example, allograft, xenograft and alloplasts are also available.

Sinus lifting: When there is insufficient bone height present in the rear part of upper jaw, which is above upper molar and premolar teeth, sinus lifting is required.

In this case the membrane of the sinus floor is lifted and graft is placed. After the healing is completed and adequate bone height is achieved, implant is placed.

Extraction: Any root ends, infectious root pieces etc. found during clinical or radiographic evaluation are extracted as they may interfere with the implant placement.

Two- stage implant surgery is a procedure where a cut is given, bone is drilled according to the implant size and the implant is placed. After the placement, it is immediately sutured and covered with the flap (overlying gums) and allowed to heal.

After 5-6 weeks, when the healing is completed, again the implant is exposed by giving a cut and then the abutment (which connects implant and crown/bridge) is placed.

Clinically after the first surgery,nothing is seen in the oral cavity. After second surgery, when the abutments are attached, metallic extensions from the gums are visible in the mouth.

One-stage implant surgery is the placement of implant and abutment in a single step. This simplifies the procedure, but there is a danger of accidental biting over the healing implants . It may even cause the implant to slip off slightly. So care must be taken to avoid such incidence.

Materials used in dental implants are:

• Metals:
  Titanium and its alloys
  Stainless steel
  Cobalt, chromium, molybdenum alloys
  Tantalum
  Gold
• Ceramics:
  Hydroxyapatite
  Bio- glass
  Aluminum oxide
  Polymers and composites
• Others:
  Carbon

Out of the materials available so far, titanium and its alloys are widely used as they are very much compatible with human biological system and shows very good fusion with the bone.

Materials used for fixed bridges and dentures are:

• Metals and porcelain
• Acrylic
• Ceramics
• Fiber-reinforced composites

These are the latest modifications of full mouth dental implants.

It is not necessary to insert separate implants for replacement of each individual root. Even if fewer implants are placed properly with correct angulations (30 0 - 45 0 ), they can bear the load of several teeth.

They are available only in titanium and its alloys as zirconia implants and other materials are at risk of fracture at sharp angulation.

All-on-4 systems involves placement of 4 implants, 2 on each side and a full arch is fixed on it. Usually, it is carried out in the lower jaw where the bone is denser.

All-on-6 systems involves placement of 3 implants on each side, usually in the upper jaw where bone is lighter and less dense.

Since only a few implants are holding an entire arch, it is very important to use high quality implants for this procedure. All-on-4 is a trademark of Nobel Biocare and it is the best to use their implants for these procedures. Check out our article about Nobel Biocare implants!

The same day implants procedure is often carried out with All-on-4 systems. Implants are placed and immediately loaded on the same day.

The main purpose of this is esthetics, but it can be functional as well.

There is a higher chance of failure as there is no healing period. So, only healthy candidates with good bone quality and volume, with no systemic conditions and who does not smoke can go for it if your dentist feel so after examination.

For such large treatment as a full set of dental implants, it is usually recommended to wait the 4-6 months healing period of the implants, whenever possible.

The usual cost of full mouth dental implants iin the United States is around $50,000 - $60,000.

However, the cost largely varies depending on the location, dentist's experience, insurance coverage and probably many other factors. No two patients are same.

Prices vary greatly depending on the procedures required (bone grafting, sinus lift, teeth removal, root canal), general health of the patient, complexity of the case and many more factors.

In patients with high anxiety levels, intravenous (IV) sedation is required. Blood sugar tests and other tests if necessary may add on to the cost.

The values listed below are approximate. It is advised to get a written quotation from your dentist after the complete clinical examination and evaluation to know the exact cost of the treatment.

Full mouth dental implants (all inclusive, the entire treatment):

• United States: $50,000 - $60,000
• United Kingdom: £25,000 - £40,000
• Canada: Up to $55,000
• Australia: $40,000 - $60,000

X-Ray / CT scans:

• United States: $50 - $300
• United Kingdom: £50 - £200
• Canada: $50 - $300
• Australia: $50 - $300

Bone graft and sinus lift:

• United States: $800 - $1,100 and up to $3,000 for complicated procedures
• United Kingdom: £700- 900 and may increase up to £2,000
• Canada: $800 - $2,000
• Australia: $800 - $2,000

Extraction:

• United States: $75 - $350
• United Kingdom: £50 - £250
• Canada: $75 - $350
• Australia: $75 - $350

IV Sedation:

• United States: $700 - $900
• United Kingdom: £200 - £250
• Canada: $250 - $600
• Australia: $800 - $1,000

Can age be a problem for full mouth implants?
No, age is not a problem, if you are fit and healthy enough to receive an implant. General health is a more determining factor than age.

How long does the entire procedure take?
If you need no additional treatments, full mouth dental impants usually take around 3-6 months. Most of the time is needed for the implants to heal.

However if you need extractions, the procedure might take a few more months. Bone grafting might also add a few months.

Is it painful to get a complete set of dental implants?
There might be little pain and discomfort associated with soreness after the implant placement surgery for 2-3 days. After that, it usually subsides.

Moreover, you will be given pain relievers which will reduce your level of discomfort.

How to recover from full mouth surgery?
Practicing proper oral habits like proper brushing, flossing and rinsing, maintaining oral hygiene, proper diet and nutrition helps in quicker healing and faster recovery.

Can I smoke after the implant placement?
It is strictly prohibited for few days after the surgery. But it is better to avoid afterwards also as it is detrimental to the long term success of the implants.

What care should be taken on the day of surgery?
After the surgery, avoid any kind of physical activity and avoid going to your workplace. Relax at home. As for your diet, avoid spicy and hard solid food. You can take fruit juices and milkshakes. Even smoothies can be a great healthy option!