Month: March, 2010

Removing Failing Subperiosteal Dental Implants & Replacing with All-On-4 Dental Implants

This morning, at the Brueggen Dental Implant Center, we did a lower All-on-4 dental implants case for a 60 yr old gentleman from Colorado. 

He was in town on personal business and learned about us from a T.V. ad. His medical history was non-contributory. Dentally, he was wearing an upper and lower denture. There was a mobile and failing unilateral subperiosteal implant on the lower left, and one had previously been removed on the lower right. Subperiosteal implants are placed beneath the “gums” and rest on, but not in, the bone.

Subperiosteal implants are used when there is inadequate bone volume to place a dental implant into the bone, and the treating doctor is not aware or trained in other options. They experience a very high failure rate. I have removed a number of subperiosteal implants but have never placed one. 

These implants were placed in Colorado about 15 years ago when the upper and lower dentures were made. It was the doctor’s hope to attach the lower denture to the subperiosteal implants, but unfortunately, that was never possible. 

This patient was displeased with the fit of his false teeth. Even with thick denture adhesives, he was unable to eat, and the lower was unstable even in speech. He was a very active gentleman and very frustrated with his situation because his previous dentist had told him that he did not have enough bone for dental implants.

We took a cat scan (a very sophisticated x-ray designed to allow precise measurements of bone in all dimensions) and determined that he did have enough bone for dental implants if the All-on-4 dental implants (a full set of upper or lower teeth fixed to 4 dental implants) technique was used.

Consultation revealed that financially doing this on the upper and lower was not feasible, so we elected to do a new denture on the upper and the All-on-4 dental implant procedure on the lower.  Our in-house lab pre-made the upper denture, so when he arrived this morning, we were able to deliver that before I began the surgery.

Using conscious oral sedation, I began the surgery at 9:30 A.M. The failing subperiostel implant was removed, 4 endosseous dental implants were placed, and the surgery was completed at 10:55 A.M.

Impressions were taken for the lab and at 4:30 P.M., the patient was ready to leave with his new upper denture and new lower non-removable teeth attached to 4 implants.

His healing and recovery should be uneventful, and I anticipate making his final set of teeth in 6 months.

Dr. Brueggen

Houston Dental Implant Dentist

Ridge Expansion in Preparation for Upper All-on-Four Procedure

My last two blogs were about Mr. A, the gentleman that we did an upper All-on-Four on about 2 weeks ago and who is waiting for hyperbaric oxygen treatment, so I can proceed with the same on the lower. I saw him Monday and he is continuing to do well with the upper.  I’ll keep you informed as Mr. A’s treatment continues. 

I began another interesting case last week. As this is our second case report we will, with great originality, call this Mrs. B. Mrs. B is a 75 year old woman in good health who came to me with missing back teeth and a fixed bridge on the upper and lower that went from the eye tooth on one side to the eye tooth on the other; 6 unit bridges.  Decay had gotten under all 4 crowns on the eye teeth and the bridges or teeth could not be saved. 

To make a long story short, it turned out that Mrs. B wanted her remaining teeth removed and wished to have the All-on-Four procedure on the upper and lower, i.e. full sets of upper and lower non-removable teeth made of 4 upper and 4 lower implants. The problem here was that the front teeth that were replaced by the upper fixed bridge had been extracted many years ago and the bone in that area had dissolved, leaving a ridge of only 4 millimeters in width.  Mrs. B’s previous dentist told her that there was not adequate bone volume for implants and that she would either need extensive bone grafting, using her hip as a donor site or just give up and wear dentures.  These were not attractive alternatives to Mrs. B so she came to me for a consult.

We now have a couple of bone grafting materials that work just about as well as natural bone, possibly better, that require no secondary surgery to harvest material for a graft. But as it turned out, Mrs. B could be treated adequately without bone grafting of any nature, so I’ll talk about the new bone grafting materials in another blog.  When teeth are removed, the bone remaining that once held the roots of the teeth is called a ridge. To place a large enough implant to secure a non-removable set of teeth, the ridge needs to be a least 7 millimeters wide. As I mentioned, Mrs. B‘s ridge was only 4 mm wide. Keep in mind that bone has a consistency more like wood than concrete, so it is possible in certain circumstances to “stretch” or expand it.  In this case, by making a very thin incision in the center of the bone ridge and then placing a small tapered screw into the bone, I was able to expand it to 7mm and place the implants. This saved Mrs. B two additional surgeries, months of healing time and a lot of expense.   Though the success rate for this procedure is very high, it is not without possible complications, so I’ll let you know how it goes.

Visit to learn more about the All-on-Four Dental Implants procedure.

More on Dr. Wayne Brueggen

Completed All-on-Four Dental Implant Case

Good morning everyone. I promised a report this week on the case I mentioned last week. That was the patient requiring full mouth reconstruction with the All-on-Four technique because of rampant and uncontrollable tooth decay as a result of head and neck radiation therapy for oral cancer.  We’ll call this gentleman Mr. A as he is the first of our case reports.  As you may recall, I decided to do the upper only and proceed with the lowers later after appropriate hyperbaric therapy.  Mr. A arrived at 8AM Monday morning to begin his sedation.  At 9AM, the surgery had begun. Under conscious sedation, 8 upper teeth were extracted and 4 dental implants were placed. The surgery was completed at 11:15 AM and we began making a new set of teeth. Mr. A rested comfortably and at 4PM we let him see his new smile. Mr. A loved it and reported the following day that he was pain free and working in his garden. I expect a continued uneventful recovery. Regarding the need for hyperbaric oxygen treatment before I proceed with the lower, there is an interesting side note. This has often been a major inconvenience for my patients because of the expense – often in excess of $10,000.00. Mr. A found that Medicare will cover the cost. That’s a welcome development.  As this case moves to completion, I’ll keep you up to date. Mr. A’s next visit will be in about two weeks. We’ll check on healing and give him oral hygiene instruction. I’ll let you know how he is. Visit to learn more about the All-on-4 procedure.

Dr. Wayne Brueggen

Former Cancer Patient to Receive All-on-4 Dental Implants

I encountered an interesting challenge a few days ago and did the follow up consultation yesterday. This patient was a healthy active 72 yr. old gentleman missing only a couple of teeth that had been replaced with fixed bridges and his remaining teeth were all crowned. Most of this work had been completed about 7 yrs ago and was beautifully conceived, planned and crafted. Unfortunately, there was recurrent tooth decay under almost every crown and several teeth were actually broken off.

The medical history revealed that this gentleman had been treated for cancer on the border of his tongue about 15 years ago with radiation and chemo. Dry mouth and other factors related to this treatment regimen lead to his rampant tooth decay. Neither he nor I had any confidence that if we removed and replaced all of his existing crowns and bridges that the result would be lasting. That combined with the need for surgery and dental implants, even if we did attempt a crown and bridge solution, led us to favor an approach that would ultimately involve removing all of his existing teeth and replacing them with implants and a non-removable set of teeth that would attach to them. This would require hyperbaric oxygen for the lower arch but not the upper.

We decided to do the upper arch this Monday with the classic All-on-Four procedure and work with the lower in a few weeks. Monday, I will extract all of his upper teeth, place four implants, and construct and deliver a full set of non-removable teeth.  It will take most of the day, primarily to make the new teeth, but he will be sedated, so the day will go quickly and easily for him. 

The primary risk for this patient is the possibility that I will not be able to attach his new teeth to the implants the same day and he may have to wear an upper denture for six months first.  This risk is greatest when most of the upper teeth remain and require extraction on the day of implant placement. The tooth sockets leave little bone to engage the implants and sometimes, approximately 3% of the time, the implant cannot be placed sufficiently tight and I must wait before attaching anything to it. I’ll try to give you a report next week on how this goes.

Visit to learn more about the All-on-Four Dental Implants procedure.

Dr. Brueggen

Houston Dental Implant Dentist