An End to Patching Teeth One at a Time

The Patient's Journey

This patient arrived with periodontal disease that was still advancing. She had been treated for it before, and she had had crowns placed on teeth the disease had already compromised. Her dentition was failing anyway. What she said she was tired of was patchwork dentistry that had never made her look better, and what she wanted was a solution with some finality to it, where she could smile and eat without thinking about either.

Periodontitis does not destroy teeth. It destroys the alveolar bone and the periodontal attachment that hold them, and the teeth are lost as a consequence of that. The distinction explains why the previous work had not helped her. A crown restores the portion of a tooth visible above the gingival margin, and it does nothing whatever about the support disappearing beneath it. Restoring the visible part of a tooth whose attachment is being consumed treats the appearance and leaves the disease undisturbed.

Understanding the Challenge

The decision in this case concerned timing rather than technique. Dental implants require alveolar bone to integrate with, and periodontal resorption is progressive. Every month spent retaining teeth that will be lost regardless is a month spent consuming the bone their replacements will need, which converts a straightforward reconstruction into a grafting case.

That produces a conclusion patients rarely expect. The appropriate moment to remove a periodontally failing dentition is generally earlier than the teeth themselves force the issue, because the ridge is still intact enough to receive implants. Waiting until the teeth are genuinely hopeless usually means augmenting the bone before implants can be placed at all, which adds months and considerable expense to the treatment and still does not reproduce the original ridge volume.

Her remaining bone was assessed in both arches before anything was extracted. Each arch retained sufficient volume to receive four implants without augmentation, and that finding is what made the sequence below possible on the timescale it ran.

How We Approached Treatment

Twenty-five failing teeth were extracted, twelve upper and thirteen lower, and four implants were placed in each arch.

Four implants per arch is not a reduction from eight. Distribution governs the outcome more than quantity does, because a fixed prosthesis transfers occlusal load along its length to the implants supporting each end. Four implants distributed correctly in sound bone carry a full arch reliably. The number is determined by the bone available at assessment rather than by preference, and in this patient the assessment supported four.

Both arches were restored with fixed bridges in PMMA on bars milled from titanium. The titanium bar gives each bridge its rigidity and carries it on the four implants; the PMMA, a dense acrylic, forms the teeth and the gum. PMMA is lighter than ceramic and is straightforward to repair or remake. It wears and can take on stain over the years, so the teeth are expected to need refurbishment at some point, while the titanium bar and the implants beneath it stay in place.

The Result After Seven Months

She has a fixed prosthesis in each arch, carried on four implants apiece, and nothing that comes out. The occlusion was rebuilt across both arches simultaneously, which is the only way to establish a bite when every tooth in the mouth is being replaced at once.

Maintenance differs from maintaining natural teeth, and it is not lighter. The tissue surrounding the implants is cleaned professionally on a set recall with instruments intended for implant surfaces, the retaining screws and connections are assessed annually, and home care runs through a water flosser and interdental brushes rather than conventional floss. Implants do not decay, but the tissue around them can still become inflamed, and detecting that early is what the recall interval exists for.