Are we smarter than Mother Nature?

     The arrival of dental implants has revolutionized the field of dentistry the same way that industrial revolution changed our daily life and made us efficient & productive beyond our wildest imaginations. I first became interested in dental implants in 1993. As I began my research, I soon realized that there were only a small handful of data available at the time. We finally have a real meaningful solution for replacing our lost teeth that closely resembles a natural tooth. Dental implants have been proven to be both durable and as comfortable as our natural teeth without the worries of getting cavity.  They make us look and feel good and confident. They can even improve our general systemic health.

     Needless to say with popularity comes gimmicky tag along(s). There is nothing wrong with new spin-offs that improve upon the original concept, so long as it is initiated and driven on real science not popular demand. Throughout the years I have seen these popular driven spin-offs come and go. There was once a dental implant type called “Blade implant” (Some very creative dentists even carved their names into these blades as their radiographic signature). Their design was driven from lack of required bone width for placement of dental implants so they decided to narrow the implants to fit thinned available bone. Another very imaginative spin-off actually inserted some long screws externally from under the chin to eliminate the need for bone to implant integration. Others include mini implants, short implants, etc. We now are able to re-grow the lost bone and remain true to natural tooth form and function.

     The latest Spin-off is called “All-on-4”. Its inventor, Dr Paulo Malo of Lisbon, Portugal decided to place the dental implants where it is convenient as opposed to where they should be placed for optimum force distribution. The back part of our jaw bone usually goes away faster than the front section. Dr. Malo decided to place two implants in the front area of each jaw where there is usually adequate bone and place the other two sideways at the end of front area while tilted sideway pointing toward the back of the jaw. These four dental implants are then connected together and supposed to replace fourteen of your natural teeth (hence the name “All on 4”). To top it off, he claims you can go ahead and chew on them that night.

    This concept is flawed for two major reasons. First, dental implants, like any other post, can tolerate compressive (vertical push) and tensile (pull) forces very well. But they should not be placed under sideways (Shear) forces, especially on the back of the jaw where jaw forces are at their highest. A vertical force over a tilted post (dental implant) translates the center of gravity away from the body of dental implant to surrounding bone. Bone cells simply can’t handle that kind of repeated force and will over the years resorbs the precious bone around the implant. Besides, no dental implant has been designed to be loaded sideways. It will eventually go away and leaves you worse off.

    Secondly, about placing them in today and chewing with them tonight or in an hour. To this date I have not seen any legitimate study that suggests applying load and pressure on the newly placed dental implant improves its success ratio. Bio-science suggests otherwise.  Bone cells go through several stages during the process of integration with dental implant including “Osteoclastic" (dying of the old bone cells) and Osteoblastic (growth of new bone cells) phases. Immobility and prevention of micro movement is crucial to the successful integration process. In my opinion there is no need for immediate loading of the dental implant. Transitional dental implants will achieve the same result by allowing you to chew immediately without compromising the integration process. They are relatively inexpensive and are well worth the investment. So before we all fly to Lisbon or Katy to get on all fours, let's ask ourselves if we would feel comfortable living in a house that is sitting on top of tilted “load bearing posts”? If the concept does not feel safe enough for your home then it can't be any different in your mouth.

Typical All-on-4 dental implant cas

my case, in function for over 5 years

 About the Author: Dr. Farid Noie  has been in private practice in the Bay Area since 1996. He is a Diplomate of International Congress of Oral Implantologists, Fellow of Academy ofGeneral Dentistry, and Assoc. Fellow of American Academy of Implant Dentistry. He has completed his surgical training at New York University as well as Medical University of South Carolina, Temple University and Wright State University School of Medicine. He completed his oral Anesthesiology training from University of Alabama at Birmingham. He is a member of the American Academy of Cosmetic Dentistry.