Complications With Temporary Teeth in All-on-4 and All-on-6 Procedures
When discussing All-on-4 and All-on-6 (full arch dental implant restorations) it’s important to keep in mind that during the course of the treatment a patient typically wears two types of prosthesis or teeth that are anchored by the dental implants. These two types of teeth are temporary or provisional teeth and final/permanent teeth.
Temporary teeth are given to the patient during the initial healing phase of the treatment (first 3 months after surgery) and anywhere from 1-3 months thereafter as the doctor optimizes the patient’s bite, esthetics and overall look and feel of the teeth in preparation for the final or permanent teeth.
Both temporary and final teeth can have a number of potential complications associated with them. As a rule of thumb, temporary teeth are more likely to have complications because they are typically made from less durable material. The purpose of today’s discussion is to address in detail potential complications associated with temporary teeth in particular.
What are complications with temporary teeth?
You may be wondering about what can go wrong with a temporary crown and what are the disadvantages of temporary teeth. While there’s no need to worry, but it’s helpful to understand a few potential complications:
- Teeth fracture
- Teeth loosening
- Teeth discoloration
- Bite misalignment
- Sealant plug coming out
- Esthetic concerns
- Speech difficulties
- Air escaping under the teeth
Lets look at all of these potential issues in more detail.
Teeth fracture
One of the most common potential issues with temporary teeth is fracture of the temporary prosthesis. This can happen at any time point from initial placement of the teeth to the point of when the final/permanent teeth are delivered. However, what I have noticed is that if the teeth are going to fracture, this is not very likely to happen during the initial healing process (first 3 months after the surgery). During this time the patient is on a very soft, mushy diet, so it is very unlikely that the teeth will break. However, when the patient begins to eat regular foods after the implant healing has been confirmed, that’s when the prosthesis fracture can occur.
It is important to think back to the concept of cantilever, which I spoke about in the previous blog post. To recap, a cantilever is the part of the prosthesis without support (the teeth extending past the last implant in an arch). Typically, that’s the weakest part of the temporary prosthesis because it’s the part that can flex the most during chewing and can therefore break. It also happens to be the part where molar teeth usually are (main chewing teeth). When you add that together with the fact that temporary teeth are made from a type of strong plastic material without any further reinforcement, it’s not very surprising that they do break occasionally.
It should be noted that in an All on 6 setup as opposed to All on 4 setup, cantilevers are virtually non-existent. Unsurprisingly, therefore, the risk of temporary teeth fracture in an All-on-6 setup is minimal. Indeed, in my practice, I see cantilevers fracturing off temporary teeth a lot more often compared to molars in an all on 6 setup.
If you discover your All-on-4 dentures broke, there’s no need to worry—it can be resolved quickly and painlessly by placing another temporary prosthesis. This can be done the same day, assuming that the doctor has access and ability to 3D print the prosthesis from a digital file in the office. So, by and large, even though it’s a minor inconvenience for the patient, temporary prosthesis fracture is a fairly easy complication to manage
Teeth loosening
Temporary teeth are anchored to the dental implants using very small prosthetic screws that thread through the teeth and engage the implants underneath. Depending on the number of implants in the arch, these prosthetic screws can range in number from four to six per arch or jaw. Because the prosthetic is made from the plastic material and the prosthetic screws are made from metal material, there is a bit of mechanical movement/flexing in this setup. Over time, typically if the patient chews with a lot of force this flexing motion of the prosthesis can loosen up the prosthetic screws and they will cause the teeth to loosen. Fixing this problem is very easy—the screws just need to be re-tightened. It is also worth noting that this particular issue is very unlikely to happen with the final teeth since there is a titanium metal bar that engages both the prosthetic screws and the implants. Therefore there is not nearly as much flexion and screw loosening with the final prosthesis. In any case, loosening of the prosthetic screws is problematic because it can lead to screw fracture that can complicate things. Therefore, it is important to see your doctor at the first sign of prosthesis loosening. Normally one can tell that the prosthesis is starting to loosen up if the teeth begin to move or “click” when chewing.
Teeth discoloration
This is a fairly common issue, especially with temporary teeth. Since temporary teeth are made from a porous plastic material, they tend to trap stains within the porosities. Coffee, red wine, and smoking can cause the temporary teeth to discolor rather quickly. In addition, aggressive tooth brushing with abrasive toothpastes can wear out the glazing compound of the temporary teeth, further opening up the porosities within the material.
It is not recommended to change out the temporary teeth due to discoloration in the first 3 months after the surgery. If at all possible, this type of procedure should be avoided so as not to disturb the healing of the implants in the initial healing phase. However, at any point thereafter, the stained prosthesis can be replaced for a fresh one within one short appointment, provided the doctor has the ability to 3D print and process the replacement prosthesis in the office.
Bite misalignment
This is a fairly common potential issue that can occur with temporary prosthesis but the good news is that it is fairly easy to fix. What is meant by bite misalignment is that the teeth of the upper and lower jaw do not come together ideally (patient is only biting on the right or left side for example) or that not all the teeth are coming together (back teeth are touching on both sides but the front teeth are not). This is most likely to happen immediately after the surgery for a couple of different reasons. Some patients have been missing teeth for a very long time and have simply forgotten what their “correct bite” is. They are not sure how the teeth need to come together. In most cases, they can “retrain” themselves to guide the lower jaw into a correct bite by simply practicing their bite in front of the mirror for a few minutes each day for the first few weeks after the surgery. In some cases however, forgetting the correct bite is not the issue. It may be simply the fact that the teeth were designed to be in the less that ideal position during the “design” phase of the treatment or perhaps the teeth were simply “misprinted” on the printer. There is a fairly simple fix to that issue though. A new digital scan of the temporary teeth is taken, and the lab technician typically makes very small adjustments to the teeth on the computer and sends a redesigned file to print. New teeth typically fit way better and result in an improved bite and improved satisfaction for the patient.
Sealant plug coming out
As we discussed before, there is a certain set of small prosthetic screws that hold the teeth to the dental implants. These screws are threaded through the prosthetic temporary teeth within a channel called “access hole channel”. Think of it as a tube of varying height, ranging from an eighth to a quarter inch in height. This access hole channel is sealed with a soft, easily removable, plastic material called VPS, in order to prevent food impaction in the channel and to make the surface smooth. It is somewhat common for this VPS seal or plug to come out occasionally. Although this is not common with final teeth (a different, harder, stickier material is used there), VPS seal coming out is pretty common with temporary teeth. As you can imagine, the fix is fairly simple—it’s just a matter of replacing the sealant plug.
Esthetic concerns
Simply put, this happens when the patient is not entirely satisfied with how the temporary teeth look after the surgery. Whether the smile is “too gummy” or teeth are “too big” or “too small” or “too narrow” or “too wide” or they simply do not like how the smile looks, this issue can definitely be fixed. Making aesthetic changes to the temporary prosthesis is simply a matter of redesigning the teeth in digital format once a patient’s needs and wants are taken into consideration, and then simply printing a new set of teeth and placing them in the patient’s mouth. The patient can then evaluate the new set of teeth over the next few weeks to see if they like them or if further changes need to be made. This process can take two or three tries, until the patient is completely satisfied with the esthetic outcome. It is important to note that it is not recommended to make these changes during the initial healing period (first 3 months). The less manipulation is applied to the implants during that time period, the better. Every prosthetic change during that time can negatively affect implant healing and should therefore be avoided. On the other hand, once the implants heal (3 months have elapsed from the surgery date), these changes can definitely be made and the work of achieving an ideal smile can be carried out.
Speech difficulties
Getting used to the new teeth is not simply an esthetic issue, but also a functional one. It means getting used to the new bite and oftentimes adjusting to speaking with the new teeth. A typical full arch prosthesis includes the teeth and the artificial gums. Therefore, temporary All-on-4 prosthesis is a little bit “bulkier” compared to the natural teeth. This bulkiness, especially in the upper anterior area, can occasionally cause speech problems. Over time, patients can get used to that and retrain their tongue to this new prosthesis, so that speech is not affected.
Another thing that can cause interference with speech is that the tongue feels “constricted” by the new teeth. Patients who have been missing the majority of their teeth for a long time, have a tongue that is used to having all that extra space in the mouth. Having a full set of teeth placed back in one day can make the tongue feel like there is a lot less space in the mouth all of a sudden. I often compare this to moving from a spacious 3 bedroom house into a studio. Over time, the tongue will get used to its new surroundings and won’t feel as “cramped”, but it will take some time.
Air escaping under the teeth
As I mentioned above, the prosthesis consists of teeth and artificial gums. The artificial gums rest or sit on the implants and the patient’s natural gum. Temporary teeth are made on the day of the initial surgical procedure when the implants are placed. At that time, the natural gum of the patient is swollen from the surgery and the fit between the natural gum and the artificial gum of the prosthesis is very tight. However, as healing progresses, the natural gum tends to shrink. This leads to a small gap developing between artificial and natural gums. This gap can cause air escaping especially with speech as well as food impaction. Overall, this is a fairly easy issue to manage. After 3 months of healing, once the natural gums have resettled into their new position, a new digital scan of the gums is taken and the temporary teeth are redesigned taking into account the new position of the natural gum. The gap is sealed and the air escape and food impaction are virtually eliminated.
Who to turn to for quality All-on-4 or All-on-6 dental implants?
Curious about all-on-4 temporary vs permanent teeth? Wondering what are the side effects of temporary teeth, if any? You’re in the right place! Dr. Tsvetov is here to answer all your questions, from the aftercare steps and tips to details about the procedure. Feel free to get in touch, no matter where you are in Temecula!
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