Those who wear dentures may have reason to smile. In just two visits, edentulous 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.

Teeth in an Hour is a procedure that uses the Nobel Guide, a surgical template created from a CT scan to help place implants precisely. In June, Nobel Biocare of Sweden began training implant dentists in use of the Nobel Guide to replace all teeth, a few teeth or a single tooth.

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 laboratory fabricates a master model, or 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 require 12 weeks from start to finish and two office visits. The conventional implant procedure required multiple surgeries over several years.

The CT scan eliminates the guess work in determining what parts of the jaw bone offer the best sites for implant placement, said Dr. Daniel Marinic, an implant dentist in Evanston who trained in the procedure last summer. Before, oral surgeons had to estimate the location of nerves, vessels and sinuses to avoid placing implants there.

It’s very precise, said Marinic. 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 what you are doing.

The candidate for Teeth in an Hour is edentulous, medically fit, has sufficient bone and a proper fitting denture. Age has nothing to do with it, said Marinic. Those in their 30s and 40s who may have advanced periodontal disease are calling like crazy, he said. Their bone has receded and they can no longer wear dentures comfortably.

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 not painful because you aren’t pulling gums off the bone, as is done in the conventional procedure, said Marinic. Most patients require only a mild painkiller.

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

Joseph Kastenholz, 78, of Glenview recently had 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.

There was no pain, Kastenholz said. After the teeth were implanted, obviously my gums were quite sore. Once the Novocaine 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 took nearly three hours, he said, since he had seven implants placed. 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. Technology tries to make surgery easier and more predictable.

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, said Hagen. It’s nothing more than a mechanical procedure.

Dr. Richard D. Isaacson, an oral and maxillofacial surgeon in the Chicago suburbs who has not trained in Teeth in an Hour, said he thinks the procedure will probably 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, he 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.

The greatest thing about Teeth in an Hour is the ability for the patient to walk out and start functioning, said Dr. Gregory Doerfler, an oral surgeon in Glen Ellyn who has trained in the procedure. They are not compromised from an aesthetics standpoint.

Less expensive alternatives to Teeth in an Hour include mini implants, recently approved by the FDA for longer-term use and useful in patients who do not have enough bone to accommodate standard implants, and the use of just two implants to help support a lower denture that isn’t stable.

By Terri Yablonsky Stat

Special to the Tribune

 -30-