3 on 6 Dental Implants: What They Are and Why Most Providers Choose All-on-4® Restoration Instead

So when it comes to fixed solutions, we are looking at a couple of different options. One of the options that's not pictured here, but I do have an example of, is called three on six. So I'll walk you through kind of the levels of restorative options. Okay? So this is what I would call an f p, fixed partial, one. Okay? Three on six. So that means three bridges on six implants. Okay. Okay? This option only replaces white tooth structure, not gum. So case selection is super important. You need to have enough gum tissue and enough bone height to be able to mimic what natural tooth size is going to look like in your mouth. What do I mean by that? If your bone level is up here and you've had a lot of resorption over the years, these teeth are not gonna look like that. Yeah. They are going to look like horse teeth. Okay? And also, the timeline for a three on six is very different than from an all on four or all on six. Because if you have an experienced provider who actually wants to help make this look like a natural restoration, they're gonna take the time to shape the gum tissue. That means several rounds of temporaries that expand the gum tissue to house all of these pontics. Remember we talked about the pontics? To house all of these pontics and scallop around them in the way that normal normal gum tissue would. A pro is if this is done correctly, case selection, both the patient and the doctor are willing to put in the time to properly shape the gums and the bone is stable enough to hold this setup, it can look very natural. It does, however, pose an interesting situation when it comes to cleaning because you think about the gum tissue, let's say it's right around all of these. You need to clean around all of these individual anatomies. Right? So when you are flossing, you are going up and down over them and in between all of these implants in order to make sure that you're not accumulating any plaque or bacteria underneath there that can cause inflammation to the gums. Additionally, over time, your gums starts to pull back if it's not properly stimulated. So another thing that these patients may or may not notice, depending on the design of the actual teeth, is the black triangle. So when the gum pulls back and you have kind of a hole in between Right. You may or may not have seen that, like, with, you know, in in your own life or with someone in your life. So you'll be able to kinda see through, and then it'll stop looking natural in the long term. Okay? So case selection is super important for an f p one. An f p two, fixed partial two, is similar to an f p one, except that it also replaces some of the gum level. So let's say we've got our teeth here. An FP two is going to replace some of the gum level. Okay? The amount of implants in an FP two can vary dramatically. Like, you can have some of setup like this or you can have more of an all on x type setup. I don't know many people who would be a great candidate for this because when you smile, if you show any level of gum, your smile is going to show where that transition line is between the the fake gum and your natural gum. And so, I guess if you have a smile that's like this, you could consider something like that. But again, it can pose difficulty for cleaning because you're still dealing with a lot of anatomy there. Okay. Okay? An FP three, fixed partials three, is going to be something like an all on four or all on x restoration. Okay? So this here shows all on four. Meaning, all of the teeth are anchored to four implants in the bone. Okay? Sometimes you'll see all on six or all on five. It really depends on the patient's anatomy and bone structure. So if someone has a really large arch, you may see more implants placed there because the goal is from the front to the back, like the front most implants to the back most implants, you wanna have good spread. What that's going to offer is great stability when the patient is chewing. Great stability for the implants because implants are wonderful devices for withstanding vertical forces. But once you start applying shearing forces to them where they're having to put pressure against that, you know, bone that's been integrated into them, in the long term, they might fail. So, yeah, that's kind of a little bit of theory behind that. But again, one of the big advantages here is when you're looking at the surfaces that you're cleaning, we go we start with f p one, all of this anatomy. We get all the way to f p three. It's flat surfaces that you're cleaning in between the implants. So in my opinion, the hygiene is a lot easier to maintain. Okay. Okay. So in talking about FP threes, let's look at the different options that are available to us. So let's talk about this that you have here. This is a temporary full arch. Okay? So when you hear things like teeth in a day or same day teeth or, you know, full arch options like that, this is usually what they're referring to. So once the surgery occurs and the implants are placed into the bone, they will put cylinders onto those abutments, right? Abutments. Okay. And then they'll take a denture like this that has been hollowed out in the middle, and they will attach this set of teeth to that using flowable acrylic. Okay? So that's why you see these different colors here. Remember that spread I was talking to you about from front to back? This particular case is a tough one because this spread is not not ideal. But but yeah. So so a patient will be sent home with something like this. Pros, it's done the same day in the chair. Cons, This technique was created in the nineties and was revolutionary when it was. One of the big problems with this is this acrylic and all of these margins that are in between the new acrylic and the, you know, the acrylic that's native to the denture, they are bacteria traps, food traps. And so it becomes really difficult to keep this area clean. It absorbs and attracts bacteria and plaque into its pores. So even if you have the ability to brush it out of your mouth, it's still going to be a trap for for bacteria. Now the implant survival rate for a temporary solution like this is not bad. I mean, it's somewhere between ninety to ninety five percent. But things that can complicate it are the microflexure that exists in something that's acrylic. Like we talked about, over the healing period, implants are integrating with your body. That process is called osseointegration. It is a delicate process. Your body's creating this new bone cell by cell. If anything interrupts that process, implant won't integrate, it will fail. What I had seen personally in my practice prior to my Nubia days is these can fracture at a pretty high rate. I was repairing things often in order for the patient to be able to just get through the healing period. After they're done with the healing period and these temporaries, then we start taking impressions and doing a wax try in, and it's several visits for the patient, and several months, it can be anywhere between six to eight, ten months even, depending on the kind of procedure that needs to be done for the patient, until you get your final teeth. Okay. Okay? And in between, between this very old method and the, I would say, most cutting edge method, is it'll still be same day, but as soon as the surgery is done, the restorative doctor will come in, take a series of impressions. Sometimes that will involve attaching something similar to this to the implants and then breaking it off. That can have a pretty negative impact on the survivability of the implants because when the surgeon places the implants into the bone, he or she is gonna be measuring how stable those implants are via torque value. It's important that we measure the individual torques of all of the implants as well as the cumulative torque in the whole arch. Okay? There's a minimum threshold that we wanna hit that will give us the green light to, you know, actually load it or screw the teeth in without compromising or risking the implants in the long term. And so if you're putting something on there and ripping it off or you're, really manipulating them a lot, it can compromise their survivability for sure. But in that model that I'm talking about, they'll take those teeth and then mill something out of a similar material, a temporary material that's not reinforced with metal, And then they'll screw that in later in the day. It is same day teeth but still a temporary version because several months later you're coming in and starting that whole process of a new prosthetic. Okay? With any prosthetic in the mouth, there's always a risk of a change in speech, difficulty chewing or closing your mouth in the proper bite, or just it feeling weird. I like to compare any of these to an amputee getting prosthetic legs. Right? That patient is relearning how to walk, sit, stand. These patients with these oral prosthetics are relearning how to speak, chew, swallow. If you're doing that with a temporary set and then several months later, you're starting from scratch with the final set. Right? So it it is it's multiple steps until you get to the place where you're like, okay. I feel good about this. Right. Okay? Now at Nuvia, we do something a little bit different. We actually deliver the final permanent restoration twenty four hours later from the surgery date. Like the final set? The final set. The set that is intentioned to actually last you a lifetime. Okay? So these teeth are often made from zirconia or a ceramic that's harder than metal. There are certain circumstances where we'll use a different material called g cam. The beauty of having these two options as final restorations is it gives us flexibility on what's best for the patient. Right? So if we're doing a single arch, like, let's say just the upper teeth and not the lower teeth, and the patient has natural teeth on the bottom, GCAM is oftentimes a great fit because it's more similar to the hardness of natural teeth. So we like placing like on like so nothing is damaging each other. Right? When you're doing the full mouth, so, you know, upper arch over lower arch, or if you're doing a single arch and you have crowns or other ceramic work on the bottom, 24Z might be a great fit for you because it's not at risk of grinding away or deteriorating anything that is softer than it, okay? The way this works is a patient will come in for their evaluation. We, as restorative doctors, will take a ton of measurements, we'll take digital imagery. We combine all of that into the design process, and then the next visit is surgery day. The patient will come in, be put comfortably to sleep, and we will be taking our measurements after the surgery to fine tune our design that we already started. The lab works tirelessly overnight, and the next day, the patient has their final permanent restoration. What does this mean? You don't have to get used to multiple different sets Right. And retrain your mouth, your tongue, your lips to to something new over and over and over again. The tongue is a muscle. As with any muscle in the body, if you wanna train to do something new, it doesn't happen overnight. But having the ability to start from start from zero and get to the finish line in one go is really valuable to the patients. The other thing that is really of note in the ability to deliver the final teeth the next day is the strength offered here. In my experience, it's actually really helpful to the healing of the implants, right? So we talked about that osseointegration, right? We're already experts there. We're already experts there, right? Osseointegration. What happens is when there is microflexure or breakage of a temporary, the implants get impacted, of course. When you have this super resilient cross arch stability from the beginning, they're not getting forces applied to them that could be negative in the long term, right? So that leads to my next point here, which is our success rate in comparison to the national average. At Nuvia, our success rate is actually over ninety nine percent when it comes to implants. Wow. And I attribute that to this super rigid cross arch stability that's given from the beginning. So, you know, everyone has different options, but from my experience, you know, in having treated literally thousands of these, I've seen really great success with this kind of option for patients who are wanting to get dental implants and find a solution that is going to presumably last a lifetime. Can I actually test those out, see how strong they are? Oh, absolutely, my dear. You know, we've run over them with a literal car before. Oh my gosh. Yeah. That's actually crazy. Yeah. So how much would something like this cost in comparison to some other stuff we talked about? That's a great question. So once you start getting into this range, the cost varies dramatically. I've seen studies that have said that an average person is going to spend somewhere around ninety seven thousand dollars on their teeth in their lifetime. Wow. Whether you choose any of these options. Okay. Replacing these over and over again, you know, getting individual crowns, like patchwork all over your mouth, or getting full mouth of dental implants. The cost of Nubia's in particular is certainly well below the national average, which is great. But for more details on the actual pricing, Nubia's created a cost guide that actually breaks everything down and answers so many questions that we've heard over the years of this treatment, and that is available in a link in the description. So hopefully that's really helpful for you. Awesome. So what you're saying is you could either be replacing stuff over time, or you could go ahead and go with a permanent solution and then Correct. This is certainly much more of a one and done type scenario, and so, you know, I see this often. Patients come to me and I look at their x rays, and I'm like, man, you've been living at the dentist your whole life. They're tired of going back and forth. They want something that is going to last them, and that they know, you know, the investment I'm putting in here, I'm not gonna be continuing to take care of like one fee here, one fee here, a single crown here. That's what I'm doing for myself, for my health, for my longevity, and my my functionality. And so it is a really, really great option for people who are candidates. Awesome. And as I mentioned before, not everyone is a candidate for dental implants, but an easy way to kind of take one step and find out if you could be a candidate is to take our sixty second quiz. We can also link that in the description, so if you're interested in finding out more, definitely check that out.