This option for replacing a full set of teeth is fast becoming one of the most popular options to replace a full set of missing/failing teeth. The name ‘teeth in a day’ or ‘same day implants‘ refers to the outcome of the treatment – that being a brand new set of teeth on the same day as having the failing teeth removed. This treatment is also known as all on 4 however this refers to the implant bridges being supported by only 4 teeth, the reason why we have used the term teeth in a day as a title to this section of the book is that not all dentists or surgeons limit themselves to placing only 4 implants in one jaw, many (myself and Dr. Nigel included) will place more than 4 implants in one jaw to support the implant bridge if the amount of bone present allows, to provide even more support and stability to the implant bridge.
It’s worth noting that the teeth-in-a-day treatment is not always needed for both the upper and lower teeth, in many cases one set of teeth can be restored by less invasive treatment such as fillings, hygiene treatment, and other restorative work such as ceramic crowns. The teeth in the other jaw, however, may be too far gone and in need of removing completely, in this case, the teeth in a day treatment would only be needed for one jaw and not both. The general idea of this treatment is to extract the patient’s failing teeth that cannot be saved (upper teeth, lower teeth, or both) in one lengthy appointment (a full day for dual arch and half a day for single arch) and immediately after removing the failing teeth place the necessary implants (between 4-10 in most cases) into the jaw. The dentist then works with the on-site lab technician to fix a temporary set of teeth over the implants on the day of the surgery. The patient then leaves and returns weeks later to begin the process of having the final porcelain bridges made which make up the patient’s definitive teeth.
Teeth in a day step 1 – Consultation and Assessment
At the teeth in a day consultation the dentist, first of all, examines the patient’s mouth to confirm if the patient’s teeth are in fact unsalvageable. Once the dentist and patient have both agreed the remaining teeth in the mouth need to be extracted, the extent of the treatment is confirmed (upper arch, lower arch or both) and the patient has accepted the treatment plan, the preparation phase for the surgery begins.
To prepare for the day of the surgery the dentist will carry out the following:
3D scans (CBCT) to measure bone levels and virtually plan the placement of each implant
Clinical pre-op photos
Take a full medical history
Take scans or impressions of the patient’s teeth to send to the dental lab who will make the temporary bridges before the day of the surgery which are used to give the patient teeth at the end of the surgery appointment
Presedation assessment – in the event of sedation being carried out for the appointment which is usually the case. More on sedation later on in this book
Teeth in a day step 2 – Surgery day
The team on the day of the surgery usually consists of the dentist or surgeon carrying out the treatment, the sedation nurse as well as an implant nurse, lab technician, and sedation clinician if sedation is being provided to the patient. In addition to this with patients that have complex tooth extractions as part of their treatment, it is not uncommon to have an oral surgeon present who is specialises in extracting teeth although in most cases the treating dentist can also carry out the extractions.
If sedation is involved the patient is sedated and the treatment begins. The remaining teeth are extracted (or not if the patient is already without teeth and wearing removable dentures) and the implants area placed in their planned locations, the number of implants placed ranged from 4-10 although this can be different depending on the clinical scenario. Once the implants have been placed an impression is taken of the implants which is then passed over to the lab technician who will now make the temporary set of teeth that will be screwed in over the implants before the patient leaves. At this point, once the pre-made temporary teeth are being adapted and modified to fit over the implants in the patient’s mouth the patient can relax as there is nothing else to be done at this point by the dentist. Some time later once the bridge is ready, the dentist will fit the bridge over the implants and screw it in which gives the patient a brand new fixed set of teeth which is a life-changing moment for the patient.
Teeth in a day step 3 – Records and Impressions
Once the teeth have been removed, the implants placed and the temporary denture fixed into place the patient returns roughly 10 weeks later to allow time for the implants to integrate into the bone and the soft tissues to heal and take shape. The dentist reviews the mouth to ensure healing is on track and takes impressions of the mouth to send to the lab for them to fabricate a teeth try in. This is made once the dentist has assessed the different aesthetics of the patient’s temporary teeth such as how much tooth the patient shows when they smile, the midline of the smile, if the temporary teeth appear too wide or short, it also gives the dentist a chance to review the temporary teeth from a functional perspective and assess if the bridges bite properly and feel comfortable for the patient.
The impressions and feedback from the dentist are sent to the lab who fabricate the teeth try in which is needed for the patient’s fourth appointment.
Teeth in a day step 3 – Teeth Try In
Roughly a week later, based on the dentist and patients’ feedback on the temporary bridges, the lab send the patient’s teeth try in to the clinic. This is the proposed implant bridge in wax format to allow the dentist to make any changes in situ should there need to be any. In the majority of cases, the wax try-in is a true reflection of the changes made by the dentist and patient to the temporary bridge and so this appointment merely serves as a verification to tell the lab technician ‘ perfect – this is exactly how we want the final implant bridges to be, please make it happen ‘ and the technician will act on this feedback when making the final bridge work in porcelain. At this appointment the patient also confirms what shade they would like their teeth to be, some patients prefer a natural white shade and other prefer a bright white shade giving a ‘Hollywood smile’ effect. Before the bridges are made the patient can also request certain characteristics on the bridge such as translucency on the edges of the teeth or slightly misaligned teeth to give an even more natural appearance.
Teeth in a day step 4 – Porcelain Bridge Fit
A few weeks later, the lab produce the final porcelain bridges made of aesthetic ceramic called porcelain. The porcelain is usually layered on top of a zirconia core which gives the bridge strength and stability. The bridges are tried in and the dentist checks to ensure the fit is as it should be and the aesthetics are perfect. The patient is also shown the bridges in the mirror to ensure they are fully happy with the overall outcome. At this point should the dentist or patient want to make any changes they can be highlighted to the lab and the bridges are sent back to be perfected which would mean an additional appointment is required to refit the bridge however this happens in a minority of cases. This concludes the teeth-in-a-day treatment and it truly is a life-changing moment for the patient.