Hybrid Prosthesis – “All-on-Four”

A hybrid procedure involves removing all remaining teeth from the maxillary (upper) or mandibular (lower) arch, placing four to six dental implants per arch to support the appropriate prosthesis. The prosthesis is then screwed onto the implants and is not removable. This allows for excellent distribution of forces and makes it possible for temporary teeth to be placed in one day. The surgery takes on average 3-4 hours per arch to fully complete, and you will be sedated throughout the procedure. Depending on involvement, some cases require the aid of an anesthesiologist (that is a separate fee).

Pre-Operative

At your initial consultation visit we will obtain a CBCT (3D image of your jaws) to determine candidacy and begin the initial planning steps for an implant retained prosthesis. Once your treatment plan has been made, a tentative cost will be discussed with you. This does not include cost for your final restoration which will be fabricated by a dentist or prosthodontist.

2-3 weeks before your scheduled surgery date, you will return for a pre-operative diagnostic appointment that will include new imaging (CBCT with X-clip, Intraoral Scanning), reviewing the procedural steps and addressing all questions or concerns. Post operative prescriptions and instructions will also be reviewed.

Post-Operative

FIRST 72 HOURS: Do not disturb the surgical area during this time. Do not rinse vigorously or probe the surgical sites with any objects. Please do not smoke for a minimum of 96 hours, as this can delay healing and increase chances of implant failure. You will feel like you are speaking with a lisp after the temporary teeth are installed and this typically lasts a duration of two weeks after the prosthesis is placed but goes away with time. Speech is not permanently affected.

SWELLING: Swelling is expected to increase over the first 2-4 days but may last longer. It is not abnormal to experience swelling of the face (jawline, eye region) as well during this first week. Swelling can be minimized by applying a cold pack wrapped in a towel applied firmly to the surgical or swollen region. It is recommended to sleep elevated with an extra pillow and keep the head elevated to reduce swelling.

BLEEDING: It is not typical to experience excessive bleeding after your surgery but oozing and a minimal amount of bleeding is expected during the first 24 hours.

PAIN: Longer lasting local anesthetic (Exparel) will be used to help minimize post operative discomfort. You will also be given a prescription for pain medication. Exparel can provide up to 48-72 hours of numbness after the procedure. If you do not achieve adequate relief at first, you may supplement with Ibuprofen. It is recommended to begin taking pain medication prior to local anesthetic wearing off to best manage post operative discomfort.

NAUSEA: Nausea is not uncommon after surgery. Typically, the primary cause is pain medication. Nausea can be reduced by eating prior to taking pain medication. If you were prescribed antibiotics, it is recommended to take probiotics as well to reduce intestinal upset. If you have a known history of nausea following sedation or with narcotics, an anti-nausea medication can be prescribed. Please call our office if symptoms persist.

DIET: Nutrition and staying hydrated is very important after your surgery. A non-chew or very soft-chew diet is required for the first six months. The temporary prosthesis will look and feel like it could be a final product, but it is made of acrylic materials and the implants anchoring it are in the process of healing, therefore significant chewing is not advised. Soft food recommendations include pancakes, protein shakes, soft cheese (cottage cheese), yogurts, scrambled eggs, soups, mashed potatoes, steamed fish or anything that is easily cut with a plastic fork.

MOUTH RINSES: The temporary prosthesis will be screwed into the implants and you will not be able to remove it for cleaning. Keeping your mouth clean after surgery is essential. Starting the day after surgery, use the prescribed oral rinse as directed. If you are unable to tolerate the prescribed mouth rinse, you may rinse with warm salt water as an alternative. Please avoid using any over the counter mouth rinses, such as Listerine, while the implant site is healing. It is recommended to purchase a Waterpik or other water flosser to help aid in cleaning under your prosthesis; use on the lowest setting. During this time the patient may see their dentist but is not required to have any specific cleaning.

BRUSHING: To maintain hygiene rinsing and utilizing a soft bristle toothbrush to gently cleanse the prosthesis is recommended.

BONE GRAFTING: If you have had additional bone grafting you might notice some of the bone grafting material expelled from the surgical site. The bone graft material looks like small grains of sand. This is completely normal and not of concern. If you have had bone grafting, please do not use a straw during the first week of healing to limit suction motion.

FOLLOW UP APPOINTMENTS: If you have chosen to do each arch separately typically the final device will be fabricated once the last arch has been completed and had time to heal, to allow for optimizing your bite and occlusion the final prosthesis.

After the healing time of about six months, you will return for a final implant check before being released to your dentist/prosthodontist to begin fabrication of the final prosthesis. The dentist will continue working with you to customize the device based on things such as materials, sizing, colors, shape etc. until you are completely satisfied with the final prosthesis.

Hybrid Prosthesis Appointment Timeline

1. Initial Consultation	To evaluate if you are a candidate for a hybrid prosthesis, financial information.
2. Pre-Operative Appointment	Three-four weeks prior to surgery date, diagnostic appointment with imaging and reviewing prescriptions.
3. Surgery	Implant placement and temporary prosthesis procedure under IV sedation.
4. Post-Operative Appointment	Two weeks after your procedure date.
5. Final Post-Operative Appointment	Six months, to check implants before releasing care to your dentist/prosthodontist.
6. Final Prosthesis	After your final implant check post op appointment, you may see your dentist at any time to begin customizations for the final prosthesis.