Novum Same Day Teeth (Click here to view a demonstration)

This new modality is appropriate for patients whose lower teeth are "in their last chapter".

Loose infected lower teeth that traditionally we may have heroically attempted to save can now be removed and replaced with a fixed arch of teeth in a one day procedure.

My personal observation of the procedure is that it is better done over 2 days to allow streamlined scheduling for the clinical and laboratory stages of the constructed arch and an empathetic patient return the following day after a good night's sleep, rather than having to return that same afternoon, somewhat numb and swollen.

The surgical procedure is difficult to execute given the access between the tongue and lips, especially under a general anaesthetic whilst some of the landmark positions of the face length and horizontal plane are more easily recorded on an awake patient sitting upright.

Although the chance of an implant failing to integrate with the bone is less, the possibility of one of the three supports becoming loose is real and must be factored into the emotion and finances of the procedure. A loose implant must be removed, the arch of teeth must be minimised by reducing the biting table at both sides which may result in a compromised stability of the upper denture for the 2 month healing period at which time the healed bone site is reprepared using special positioning jigs.

The salvage of the failed implant involves a repeat of the surgical stage, albeit a more minor and easier access and many more hours of operator and laboratory time and expense.

Patient satisfaction has been excellent, most boasting that they can eat bones and nuts and apples. The space below the arch structure does not pose a problem as food which enters that space between the gum and metal 'passes through'.

The advantages of Novum are:

1. 1/3 cost of conventional customised gold/platinum milled bar or supporting a porcelain lower screw retained bridge ie $11,000 v's $35,000
2. Conventional denture type construction with plastic teeth/gum units, which are easily repaired. The glass/metal bridge with a small fracture of glass would need to be returned to a high temperature furnace which could alter its fit - more time and money to maintain. Novum is cheaper to maintain.
3. Prefabricated bars with minimal maintenance and stock replacement of components in the event of a fracture or damaged screw in say a MV Accident.
4. Early loading and connection means no painful transitional denture and multiple adjustments for sore spots and relines. The patient/dentist emotion when moving from teeth to a new full lower denture resting on the healing gum is a nightmare for both the patient and the practice as the denture shape mismatches the new healing shape, causing exquisitely painful sorespots which alternate and move around the bearing areas. This nightmare is avoided by electing for Novum.
5. Single stage procedure with minimal discomfort and interruption of work and social schedule.
6. Nobel Biocare practitioners available world-wide .
7. Excellent Corporate innovation and research allows improvement in components - all screw on and off compared to cemented type dentistry.

The reason for caution in the recommendation for Novum is standard procedure so that should the quality or density or even the actual position of the anatomical structures preclude the Novum election, then we would need to have explored a fall-back or alternative option, rather than having to wake you from the anaesthetic asking for your preference. So, these matters need to be mapped, costed and explained even though we may be confident of sufficient bone geometry.

Our measurements from computer generated images do tell us exactly where the nerves supplying your lip reside, yet the 3-D realisation and placement of the 3 fixtures in the predetermined position - exactly parallel and exactly the correct distance apart - these factors can vary so the alternative classical implant approach may be chosen at some point during the procedure as it allows flexibility in the distance between implants and alteration of their angulation away from certain areas

The Novum technique involves using a pre-machined curved titanium bar whereas the customised classical technique would later involve making a sub-frame to suit your particular shape. The cost of constructing such a milled precision bar can exceed US$ 1000! The Novum works because those 3 fixtures are parallel only because of a sequence of guiding jigs thus distributing the biting loads without undue stress. Additionally, the Novum fixture collar has a mouldable face contacting the bar, which is compressed into the shape of the bar to customise the fit more accurately. These factors plus the larger diameter ( 5mm compared to 3.75 mm) permit immediate - same day or the next day loading.

The classical approach - what we did before Novum - requires or allows individual alteration of angulation because of bone density, shape or anatomy. The ideal arrangement would be similar to a chair: 2 supports at the front, 2 at the rear. Because of the excellent jaw bone character at the front near the chin, the percentage failure is lower than anywhere else in the mouth, the upper jaw often exhibiting very soft bone. So, sometime we can place 4 implants at the front, none at the rear as a cantilever can provide sufficient biting area over the bone, which is more fickle at the rear of the mouth. So, because of the additional risk, we have often recommend more implants at the rear than may actually be necessary, just to cover the possibility of an implant failing to osseointegrate firmly into the bone.

So the options are:

1. Novum,
2. 2 at the front, 2 at the rear
3. 2 and 2 or more should you want to be safe,
4. 4 or 5 or 6 at the front with a cantilever.

Academic article on the complexities of treating the lower jaw

http://www.worlddent.com/2001/05/articles/marinello.xml?page=1


Summary of Novum advantages:

• Second cheapest option
• Quick one stage
• Minimum intervention for maximum occlusal table
• Preferred fallback position to maximum dental "alamo" - last ditch battle to save damaged teeth.
• Solves halitosis
• Solves heroic periodontal appointments in one day
• Cheaper than customised implant structures
• Simple: 3 supports with a bar and easily maintained superstructure
• Minimal encroachment into the sturdiest bone region or
• Minor entry into the vibrant curve of jaw
  

Want to know how the procedure is carried out?  Press here for a demonstration (you will need Flash to view the files).