A single-tooth implant or a full-mouth solution?

Most patients work it out by counting gaps: one tooth missing, one implant; three teeth missing, three implants. That arithmetic sees only the mouth as it is today. In implant treatment the question that shapes the plan takes a longer view: will the teeth you have left still be there in the years ahead? The answer to that question is the whole difference between a single tooth and a full mouth.

The situation in which a single-tooth implant is right is clear. There is a single gap, the neighbouring teeth are sound, the gums are healthy and there is enough bone in the area. Here the implant is placed in the gap itself, a single crown is made on top of it and the neighbouring teeth are left untouched. That is also where its advantage over a bridge lies: a bridge calls for the sound teeth on either side of the gap to be filed down irreversibly, an implant does not. With a conventional implant you wait for it to fuse with the bone; that wait is measured in months and causes no trouble with a single gap, because you carry on chewing with the rest of your teeth.

But tooth loss rarely comes on its own. Whatever caused one tooth to be lost is usually at work throughout the mouth: gum disease built up over years, the bone that holds the teeth reducing across a wide area, repeated root canal treatments, broken bridge supports. In a mouth like that, closing one gap does not change the picture. Your new crown settles in, then a year later another tooth starts to loosen, and two years later one more is taken out. New gaps open up next to the one you closed.

This is where the price of going ahead piece by piece shows itself. Every stage means separate surgery, a separate healing period and separate bridgework. Worse, each new extraction makes the work done at the previous stage unusable: when the support of a bridge made two years ago is taken out, the bridge goes too, and the bite has to be set up again. The total time stretches over years and the amount you pay includes the same items several times over. What would be paid for once if it were all done in one go, the laboratory work, the bridgework and the clinical process, you end up paying for three times.

The logic of a full-mouth decision is the opposite. The implants are planned not to fill the gaps one by one but to sit at the load-bearing points of the jaw. Teeth that are close to extraction are taken out within the same plan, the jaw is built in one go and the bite is set up once, correctly. You are not left with years of uncertainty hanging over you; you are not waiting to see when the next tooth will go.

This is exactly the situation the Implant72 protocol is for. A strategic implant locks mechanically into the hard outer layer of the jawbone, the cortical bone. A conventional implant anchors in the softer spongy bone inside, and fusion has to be waited for; that is where the difference comes from. This is why a bone graft and months of waiting do not come into it, and the fixed teeth are fitted over three clinic days. For the same reason, this approach was not devised for a single gap. If you are missing one tooth, we tell you so.

Which list you are in is shown by the CBCT scan and the gum examination together. Seeing yourself in the second list does not mean there is no treatment for you; it means the treatment that suits you is a different one.

This sequence is for the decision, not for the treatment. At the end of it you have in writing which tooth will stay, which will go, and what that is based on.

1. 1

   Send us your scan

   If you have a panoramic X-ray or a CBCT scan, send it through the form. The scan is read by the dentist who will carry out the treatment; the first reply is written by the dentist, not an assistant. You do not need to come in; we get back to you within one working day.

2. 2

   We assess the remaining teeth one by one

   For each tooth we look for the answer to a single question: will this tooth carry the load in the years ahead? Mobility, root fracture, past root canal treatment and the bone loss around it are looked at together. We give you this assessment in writing, tooth by tooth.

3. 3

   The gums and the supporting bone

   Pocket depths, bleeding and the level of the bone that holds the teeth are at the centre of the decision. When there is disease spread through the mouth, a plan that focuses on one gap is an incomplete plan.

4. 4

   A three-dimensional CBCT scan

   A panoramic X-ray is two-dimensional; it gives an idea of the height of the bone but not of its thickness or the condition of the hard outer layer. Because the decision about a strategic implant rests directly on the cortical layer, we make no promises before we have seen a CBCT scan.

5. 5

   The bite and the opposite jaw

   It is not possible to plan one jaw independently of the other. What is in the opposite jaw, where the bite settles and how the chewing force is spread are all part of a full-mouth decision.

6. 6

   You get the plan in writing

   We set out in writing why we have chosen a regional solution or a full-mouth one, how many implants we will use and what bridgework we will go ahead with. If a full mouth is not needed in your case, we write that just as plainly.

There are five routes, and none of them is superior to the others in every case. Which is right for you is decided by the number of gaps and the condition of the remaining teeth together.

We write these not to frighten you but so that you can ask the right questions at whichever clinic you go to.

The course below applies to patients who have a full-mouth fixed solution. In a plan where a conventional implant is used for a single tooth, fusion is waited for and the timetable is measured in months.

1. Three clinic days

   Once the examination and planning are complete, the extractions, the surgery and the fitting of the fixed teeth are spread over these days. You do not leave the clinic without teeth. Some swelling and tenderness over these days is normal.

2. The first week

   The swelling goes down. We ask you to eat soft food, to stay away from hard and hot food and to brush the area gently. If there are stitches, they are removed during this period.

3. The first weeks

   We increase the chewing load step by step. Habits such as hard-shelled foods and chewing ice are put off during this period. Getting used to the new bite is also completed over these weeks.

4. Check-ups and the long term

   We give you the check-up schedule and the care routine for the bridgework in writing. Interdental cleaning, regular professional cleaning and yearly imaging are the very things that make this treatment last.

We give no figures on this page, because the right figure can only be given after a CBCT scan and an examination. Send us your scan and we will set out the scope in writing, item by item. These are the items that set the total:

Scope: regional or full mouth

A single gap, one part of the mouth and a whole jaw are entirely different in scope. This item affects the total more than all the others; we tell you which is right for you after we have looked at your scan.

The number of implants and which jaw

One jaw or both, how many implants are planned and in which areas they will be placed set the total directly.

Preparing the mouth

If there are teeth that have to be taken out, gum inflammation that has to be treated or roots that have to be removed, these are added to the plan and affect the timetable too.

Bridgework

The material of the fixed teeth and the laboratory work affect the total directly. We tell you the brand of the material we use in writing from the start.

How many times it will be repeated

In a plan that goes ahead piece by piece, the clinical process, the laboratory work and the bridgework come into play several times. The total spread over the years can end up higher than the total for a solution built with a single plan.