Deutsch Removable Bridge
Seattle cosmetic implant dentist Lance Timmerman in Tukwila has brought to Seattle the Deutsch Removable Bridge ZR® as a “new implant solution”, but really is an example of “Everything old is new again”. Let me explain.
As dental implant technology improved (and the need to replace an entire arch of teeth or to improve upon dentures that became loose over time) the solutions became more affordable. Rules of thumb were established, and the accepted standard of minimum number of implants per arch were determined.
Ideally 8-10 implants on the upper arch, 6-8 implants on the lower. More implants means more stability and less stress per implant while chewing. Truly, more IS better.
“More dental implants means predictability. There are many advantages to having an abundance of implants. Bite force distribution is a major factor as well as insurance that if one implant fails (bone loss, bacterial infection, etc) the other implants can make up for it. If one can afford this level of care, they really should give it strong consideration. The fee can add up, but if it lasts longer (forever? I would never promise that) and doesn’t need replacing, then the investment NOW means it is cheaper in the long run.”
—Dr. Lance Timmerman
Complications and Challenges with Dental Implants
Many times patients seek treatment with dental implants when it is almost too late. It never IS too late, but treatment becomes more expensive with each challenge and complication. Most commonly a complication is the size and location of the sinus cavities. Implants require bone. Dental implants require MORE bone than the size of the implant, to make sure that as the body heals AND in the future as the bone is turned over that there is enough blood supply to stay put. Too thin of bone means the implants will only be temporary. So bone needs to be thick and TALL. If the sinus is in the exact location where an implant would be ideally placed, the sinus must be “moved”. A sinus lift is very common and is the most successful and predictable bone graft procedure, but many people elect to avoid them. This often leaves only the space from eye tooth to eye tooth, and normally results in only 4 implants as an option.
All on 4 Dental Implant Solution
The All on 4 treatment takes advantage of angled implants and angled abutments to maximize use of the limited space of bone and increases the distance between implants. In general, implants need to be place in a vertical direction to bite forces, but can be angled when the restoration links the angled implant to other implants (straight or angled).
When the decision to proceed with the All on 4 is made, it is ONLY due to an effort to save money. The savings comes from using fewer implants, avoiding bone graft procedures, and (in the majority of cases) by using a converted acrylic denture. This is commonly called a hybrid denture.
Acrylic Dentures Smell Terrible Over Time
Even when everything is done perfectly, there is no denying that if acrylic is not removed from the mouth regularly (and not just in a dental office for cleaning) then the porosity will allow the restoration to take on a unique smell and taste. This renders this procedure nothing more than a long term provisional or temporary restoration. This can be considered a prototype for a better restoration in the future, but should not be considered the most permanent solution. The average case begins to smell in 8-10 years.
Replacing All on 4 Restorations
There are essentially 3 decisions to be made when the patient is bothered by the smell or taste or when the spouse, family, friends, and co-workers can no longer stand the smell.
- Create a brand new acrylic screw retained denture (hybrid denture)
- Create a new porcelain or porcelain fused to metal bridge (cemented or screwed in)
- Create a Deutsch Removable Bridge ZR®
A new hybrid is only a decision when trying to save money, as the definition of insanity is doing the same thing over and expecting a different result. As long as you know you are simply on a schedule to keep doing the same thing over and over, and paying full fee each time, then that is perfectly fine. A porcelain version of the same thing is perfectly acceptable, but significantly more expensive. It is a great investment and can be very beautiful and functional, but to be done this way requires a talented lab technician, not just “any lab”. Trying save money on bridges like this results in very fake looking and often uncomfortable restorations that do not last very long. You get what you pay for.
The best of both worlds
Most people desire an implant solution if they have dentures because they hate covering the roof of there mouth or the lower arch is unstable. The Deutsch Removable Bridge ZR® is removable, allowing better hygiene, yet does NOT cover the roof of the mouth.
This still requires a lab technician skilled as an artist as well, otherwise things will look incredibly fake. The investment is significant enough that the result should be as beautiful as possible, the kind of work delivered by Arian Deutsch, the developer of the Deutsch Removable Bridge.
Old design with Modern Materials
This is not a new invention. This style of treatment was developed in the 1950’s but fell out of favor because the available materials wore out too quickly. Telescopic abutments, the key to the treatment, were metal to metal interfaces.
Over time, the repeated insertion and removal led to the metal becoming smooth or polished, so the bridges would not stay in place. With the Deutsch Removable Bridge, the telescopic abutments are made of zirconium so the wear and tear is significantly reduced.
The interface is a gold liner attached to a metal frame.
The 5 micron space allows incredible and intimate fit, and the result is stability.
While nothing lasts forever, if the metal wears down, the gold can be replaced. This means that the restoration itself does NOT need to be replaced, just the interface. This is significantly less costly than an entirely new bridge.
Upgrade an All on 4 Restoration
The best news of all is that All on 4 restorations CAN be upgraded. The DENTAL IMPLANTS do not need to be replaced.
The same implants can be used, but new zirconium telescopic abutments will need to be created. Most of the cases do not require more implants, unless the original treatment was not designed properly.
We offer dental crowns as well.