Full-Arch Rehabilitation on Implants

Yes, when the implants have measured stable — and that’s most cases. The bridge you leave with is provisional but fixed: screwed to the implants, not removable, and you can’t take it out at home. It’s reinforced acrylic in the shade you chose, it looks good, and nobody who doesn’t know can tell. You eat soft food with it and don’t bite into hard things. It’s meant for the healing months, and once the implants have fused with the bone (3–6 months) we replace it with the permanent bridge, in zirconia or hybrid. One caveat we always give: the decision is made during surgery, with the stability gauge in hand. If an implant hasn’t gripped firmly enough, we don’t load it that day and you get a different temporary solution. That happens in a minority of cases, and we tell you about the possibility in advance.

The first evening — soft and cold: yoghurt, pudding, mash, a smoothie. From day two, soft pasta, eggs, fish, cooked vegetables, soups, rice. Within a week most people are eating almost everything, except what needs a hard bite. And that’s the rule for all the healing months: no biting into hard things — nuts, crusty bread, steak, a whole apple, ice — until the dentist clears it, usually once the permanent bridge is in. The reason isn’t the provisional bridge, it’s the implants: during these months they’re fusing with the bone, and a hard bite could shift them. You can cut an apple into slices and eat it, just don’t bite into it. If you’re unsure about a particular food, ask at the check-up — that’s exactly what it’s for.

Then we don’t load that day. The implants stay in the bone and heal quietly for 3–6 months, as in the “standard” protocol, and you get a different temporary solution for the period — usually a temporary denture adjusted so it doesn’t press on the implants. After healing we go on to the permanent bridge as planned. We always keep that decision open, because loading an implant that hasn’t gripped firmly enough is the surest way to lose it. It happens in a minority of cases — more often in an upper jaw with soft bone — and we tell you about the possibility back at the consultation, so you don’t hear of it for the first time in the chair. The price doesn’t change because of it; what’s changed is the order, not the treatment.

Between two and four hours for one jaw. That includes the anaesthesia, extractions if you still have teeth, placing the implants through the guide, measuring stability, and fitting and adjusting the provisional bridge. The implant part itself is relatively short; what takes time is the extractions and getting the bridge right in the bite. There are breaks along the way. Two jaws — usually on two dates about a week apart, and only people coming from far away do both in one long day, six or seven hours. Plan on a full day: come after a meal, with someone to accompany you, and don’t go back to work that day. If you’ve chosen sedation with an anaesthetist, add time to come round — and then you certainly don’t drive home.

During the surgery — usually not. The anaesthesia is local, and what you feel is pressure and vibration, not pain. If you’re anxious you can choose sedation with an anaesthetist, and then you remember almost nothing. Afterwards — yes, there are two or three days of swelling and discomfort, sometimes a bruise on the cheek too. It’s controlled with ordinary painkillers on prescription, with cold on the first day. The swelling peaks on day two or three and comes down after that. Most patients tell us at the one-week check-up that it was less than they’d feared; the extractions, if there were any, are felt more than the implants. Pain that gets worse after day four, or a temperature, is something you call about rather than wait.

The provisional is reinforced acrylic. It’s light, a little thicker on the inside, easy to repair if something breaks, and meant for the healing months — to absorb the period while the implants fuse. It’s also a trial version: with it we check chewing, speech, bite height and tooth shape, and whatever we change on it carries over to the permanent one. The permanent bridge comes after 3–6 months, from a digital scan of the implants. It’s either zirconia — strong, thinner, doesn’t stain, colour-stable — or hybrid (a titanium frame with acrylic or composite teeth), which suits grinders and especially long bridges. Zirconia lasts 15 years and more; on a hybrid the teeth are renewed after 7–10 years and the frame stays.

When the stability on the day allows loading — which is most cases — zero. The extractions, the implants and the provisional bridge are done in the same chair, on the same day; you come in with the old teeth and leave with the provisionals. In the minority of cases where the implants haven’t gripped firmly enough, we don’t load, and then you get a different temporary solution — usually a fitted temporary denture — until the implants fuse and the bridge can be attached. Even then you don’t go home without teeth; we tell you about that possibility back at the consultation. Anyone telling you about “two weeks without teeth while the gums settle” is describing a different protocol, where the teeth are extracted first and the implants placed later. With us that isn’t the default, and if there’s a reason to do it that way in your case, you’ll hear it in advance.

Yes, but not like the permanent one. It’s acrylic, in the shade we chose together before surgery, with a tooth shape designed for your face, and anyone who doesn’t know sees no difference. People go to weddings in it. There are two things you do notice: it’s a bit thicker on the inside, and the tongue feels that for a day or two and then stops; and your speech is a little different for the first couple of days, mainly the S and SH sounds. It passes. The permanent zirconia, which comes after healing, is thinner, less shiny, and looks more like a “tooth”. And the provisional is also a trial run — whatever you don’t like about it (shape, shade, length) you say at the check-up, and it’s corrected in the permanent. That’s what it’s there for.

You can, and we do it — but it’s a long day: six or seven hours with a break in the middle, and at the end of it you have swelling in both jaws at once. Most people prefer two sessions about a week apart, and recover from the first before the second. The bite for both jaws is planned together either way, so there’s no difference in the result. Who a single day does suit: anyone coming from far away or from abroad, anyone who’s chosen sedation and doesn’t want to go through it twice, and anyone who simply wants to get it over with. If you live ten minutes from the clinic — why rush? We decide at the consultation, by the extent of the extractions, your health, and what suits you.

We take it out — it’s quick, under local anaesthesia — let the bone heal for two or three months, and place a new one. What happens with the bridge in the meantime depends on how many implants there are: with six, the bridge usually keeps working on the five that are left, and you barely notice the difference. With four — sometimes it has to come off temporarily, or you switch to another temporary solution until the new implant has taken. That’s why we plan more support points than you’d need “on paper”, and why we suggest six in the upper jaw. It happens to us rarely, mainly in smokers and in soft bone. The replacement is covered by the warranty under the terms of the agreement — check-ups and hygiene. If the bridge starts to feel loose, call; don’t wait.