A faster approach to dental implants

Those who wear dentures may have new reason--and ability--to smile. In just two visits, patients can get a new set of teeth with minimal surgical intervention and pain, full chewing capacity and such precise implant placement that he or she can chew an apple the same day.

Called Teeth in an Hour, the procedure uses a surgical template created from a CT scan to help place implants precisely. The template, known as the Nobel Guide, was developed by Nobel Biocare of Sweden, which began training implant dentists at this time last year.

One of them was Dr. Daniel Marinic, an implant dentist in Evanston. "The CT scan eliminates the guesswork in determining what parts of the jawbone offer the best sites for implant placement," he said, explaining that oral surgeons previously had to estimate location of nerves, vessels and sinuses to avoid putting implants there.

Patients first have a CT scan of their jaw. Using Nobel Guide software, the CT scan is converted to a 3-D model of the patient's jaw. With this model, the dentist can determine the final position of the implants. The information is e-mailed to Nobel Biocare and a Nobel Guide, or drilling template, is crafted.

Within two weeks the Nobel Guide is returned to the dentist. Using this guide, a dental lab fabricates an exact replica of how the jaw will look after implant placement. Using this master model, Nobel Biocare fabricates the final titanium framework that will hold the teeth in place and allow the patient to put force on the implants the day they are placed.

In all, Teeth in an Hour actually require 12 weeks and two office visits. The name derives from the time required to place the implants. The conventional implant procedure can require multiple surgeries over several years.

"It's very precise," Marinic said. Conventional images taken in many dental offices are two-dimensional. Cross-sectional, or 3-D, images make the placement of implants safer, more predictable and accurate. "It's as though the patient's jaw is on a computer screen and you can get second opinions before you ever start."

The candidate for Teeth in an Hour is medically fit, has sufficient bone and a proper-fitting denture.

The day of surgery, the oral surgeon numbs the patient's mouth, places the Nobel Guide over the teeth and gums, drills holes for the implants, places the implants, removes the guide, screws in teeth to the implants and the patient walks out the door with teeth. The procedure is less painful because gum isn't being pulled off the bone, as in the conventional procedure, Marinic said. Most patients require only a mild painkiller.

The new procedure allows the use of wider, longer implants because the dentist knows where the vital structures are, according to Marinic. Wider, longer implants are firmer and more stable than smaller, narrower implants used by freehand dentists.

Joseph Kastenholz, 78, of Glenview recently had seven Teeth in an Hour implants placed in his lower jaw. "I had a partial plate, and one of the teeth anchoring it was starting to go," Kastenholz said. He opted for the procedure after other alternatives didn't work.

"After the teeth were implanted, obviously my gums were quite sore," Kastenholz said. "Once the Novocain wore off, I had minor pain for several hours. By the first evening I ate.

"I can't believe it," Kastenholz said. "I can eat anything I want." The procedure actually took nearly three hours, he said. Was it worth it? "Ask me in 10 years," he said. "Right now it is."

Teeth in an Hour costs about $25,000 per arch. A single tooth implant placed freehand costs around $1,800, according to local oral surgeons. Use of the Nobel Guide adds about $1,000 to the cost.

"Oral surgery is an art," said Dr. Neil B. Hagen, an implant dentist in Chicago who has performed Teeth in an Hour procedures. "It's not a science, and making it computer-based makes it more of a science. It certainly levels the playing field between experience and non-experience.

"With the Nobel Guide, a novice who doesn't do much surgery can do very well because technology has taken away a lot of the artwork of placing an implant correctly," Hagen said. "It's nothing more than a mechanical procedure."

Dr. Richard D. Isaacson, an oral and maxillofacial surgeon in the northern Chicago suburbs who has not trained in Teeth in an Hour, said he thinks the procedure probably will be fine with the right candidate but cautioned that he prefers that implants integrate, or adhere to the bone in the correct position, for several months before placing the final prosthesis.

"The jury is still out how that will work long term," Isaacson said. "Although integration takes place in well over 90 percent of cases, even if you have perfect bone and everything went well, you cannot guarantee that every implant will integrate as planned."

Less-expensive alternatives to Teeth in an Hour include mini-implants. Recently approved by the Food and Drug Administration, mini-implants are intended for longer-term use and are useful in patients who do not have enough bone to accommodate standard implants. Another alternative is to use just two standard implants to help support a lower denture that isn't stable.