How many dental implants can I do at one time?

Recently, a long time patient of mine finally decided to bite the bullet and proceed with total teeth replacement. He is an extreme dental phobic who trembles the moment he comes into the clinic. In fact, he often tells me that he loses sleep for a few nights before each appointment. He has severe gum disease and I have referred him to a periodontist (gum specialist) for management. However, the gum disease has progressed too far and all that could be done over the last ten years was to simply delay in the inevitable. Every few years, he loses a tooth and eventually, he was left with just a few very loose teeth, so loose that they move when he speaks. He knew that all the teeth has to be replaced with dental implants. Naturally, being fearful, he wanted to proceed with slowly, doing one implant at a time. That would be the worst thing to do for a dental phobic.

Conventional wisdom (if there is such a thing) tells us to approach the unknown with caution. You dip one toe into the water before jumping in. Can we apply that logic to implant dentistry? Most certainly. Most people do not lose their all at once. In today's context, when you lose a tooth, a dental implant can be placed immediately after the extraction. If you have already lost several teeth in various parts of the mouth, you can chose to have implant replacements done individually, in groups, or all together. There is no limit to the number of implants you can have in one go. There are several considerations when deciding which approach to take.

1: Cost of dental implant treatment

Dental implant treatment is possibly the most expensive dental treatment today. If multiple implants are needed, the cost can be rather formidable. Medisave can be used to cover part of the surgery cost but the prosthesis ie the crown, is completely out of pocket. As such, many patients choose to do the implants in stages to spread out the cost. However, is certain situations, such as when all the remaining teeth have bad prognosis and are due to be removed eventually, doing the implants in stages actually increases the overall cost. This is because each surgery will involve use of certain sterile surgical consumables which are the same regardless of whether you do one implant or ten implants. The cost of the prosthesis will also increase as multiple temporary prosthesis will be needed at each stage leading to the final prosthesis. As such, for this category of patients, I usually would advise doing all at once and if cost is a problem, we can work out an installment plan. 

2: Pain

Many patients think that dental implant surgery is painful. They imagine that if one implant already hurts, having ten implants will hurt ten times more. Interestingly, very few of my dental implant patients complain of pain. The amount of local anesthesia required is also very little. It is true that having multiple implants will probably hurt more than having a single implant. However, having a single implant placed over multiple sessions would have more cumulative pain than getting it over and done with in one session. It all depends on how you chose to perceive pain. 

3: Fear

Fear of the dentistry is very common. Implant dentistry, to the uninitiated, can be quite daunting. For patients who have dental phobia, it is better to undergo the stress once than multiple times. Many phobic patients tell me that it is the anticipation of the surgery that creates the worst fear. While there are techiques one can use to manage such fear, it is best to minimize the number of stressful occasions than to have to deal with it many times. For the phobic patients, doing everything in one go improves the experience of the surgery.

4: Time

Each surgery requires a period of preparation and follow up in addition to the procedure itself. It is not just a matter of showing up once to get one implant done. Before each surgery, we have to update the patient's medical history and status as well as the oral condition. Postoperatively, there are followup visits to ensure the implant heals uneventfully and to pick up any potential problems before they pose a danger to the success of the implant. In addition, each implant requires a period of 6 weeks for integration with the bone before the final prosthesis can be placed. Doing them together reduces overall treatment duration.

Overall, if the plan is to replace all the teeth, it is best to do all the implants in one go. If plan is to keep existing teeth and just replace the already missing teeth, implants can be done individually or all together without any difference in outcome.