What is the cost of total teeth replacement with dental implants?

After my last blog post about total teeth replacement, we have many enquiries on its cost. So, I think it is most apt to followup with an article on that. As dental implants become the treatment of choice for missing teeth, many patients have had an implant or two before, or has had a friend or family member having it. It is thus common knowledge that the cost of dental implants in Singapore is quite high, though I must hasten to add, that it is the best replacement available. So, to some patients, the thought of replacing the whole set of dentition with dental implants seems rather daunting. In fact, I have a patient who described the cost as being equivalent to having a Toyota car stuffed into his mouth! Well, that was some years ago. The good news is that our understanding of how bone heals around titanium implants as well as the biomechanics of mastication has improved and total teeth replacement can be done at a lower cost. Today, it is possible to do total teeth replacement at "Hyundai" prices. However, they are not the same set of teeth. Functionally, they work just fine, just like your Hyundai will get you from point A to point B like a Toyota, but the details can be quite different. While technology can bring prices down, it can also drive up costs, when you do it with bells and whistles. For example, using CAD CAM surgical guides custom-made in Europe and couriered to Singapore to make an immediate restoration can drive the cost up to "BMW level". Let's take a look at how the costs adds up.

As mentioned in the previous blog post, total teeth replacement with dental implants is done when most of the teeth are beyond salvage and whatever remains that are salvageable have a questionable prognosis.

1. "Toyota" teeth

Traditionally, a toothless upper jaw will require a bone graft and 8 implants to support a set of fixed non-removable false teeth that is made of gold alloy and porcelain. A toothless lower jaw will usually need about 5 -6 implants to do the same thing though bone graft is usually not needed. The use of high gold content alloy is needed to ensure bonding of the porcelain and good fit of the prosthesis. This drives up the cost significantly. Porcelain teeth are individually built up by skill technicians, who will characterise the teeth with different shades and shapes to individualise the prosthesis for the patient. Fine craftsmanship naturally comes with a high price. The implants, ie the titanium screws that are implanted into the jaw bone are typically manufactured in Europe and America after years of research, and are priced to bring a tidy profit for the manufacturers. As a result, dental implant treatment usually run into the thousands of dollars. For patient undergoing total teeth replacement with dental implants in this traditional approach, the average bill size is about $120,000 and the duration of treatment will take about 12 to 20 months and multiple visits. 

2. "Hyundai" teeth

Not everybody can afford $120,000 for a set of teeth. Researchers experimented with different ways to achieve the same functional results at a lower cost. This is also made possible by the increasing number of implant manufacturers whose products have gotten FDA approval, making the competition more intense and hence driving the prices of implants down. As the technology of osseointegration (the process of bone cells bonding to a titanium surface), becomes better understood, more manufacturers are able to produce implants that can achieve 98% success, like the traditional European and American brands. Research also led to a better understanding of the biomechanics of chewing, which prove that under certain conditions, a full arch prosthesis can be supported by just four implants. In selected cases, the upper jaw, which is the more expensive jaw to treat than the lower jaw due to the need for bone grafting, can now be treated without grafting. To overcome the high cost of a custom-made porcelain bonded to gold prosthesis, stock denture teeth can be set up with acrylic onto a non-precious metal framework. Aesthetically and functionally, such a prosthesis is inferior to the traditional porcelain-gold prosthesis but it gets the job done nonetheless. The cost is also significantly less, at about $50,000 for upper and lower full arch prostheses compared with the traditional $120,000.

3. The "BMW"

While some researchers focussed on developing a more economical approach to total teeth replacement with dental implants, others made use of advances in technology to improve the delivery process. Using sophisticated treatment planning software, CT scan images are reformatted into 3D models onto which the final prosthesis is created virtually on the software. With the virtual teeth set up, implant placements are simulated on the computer in the best possible position. This plan is then uploaded to the implant manufacturer's server in Europe or America. A technician will create a surgical guide using 3D printing, which will translate the virtual plan into reality when placed inside the patient's mouth. This guide is couriered back to a laboratory in Singapore, whereby a provisional prosthesis is made based on the planned positioned of the implants. The guide and the prosthesis is then sent to the clinic. On the day of the surgery, the implant placement guide is placed in the patient's mouth and the implants are inserted through the guide. Once the implants are in place, the provisional prosthesis can be fitted directly onto the implants. This way, the implants are placed without opening up the gum to expose the bone and the patient can walk out of the clinic on the same day with a fixed set of teeth. The main benefit of this method is the significantly reduced pain and swelling due to the flapless approach, and the immediate function that can be given to the patient. The final prosthesis is usually made of either gold alloy and porcelain or milled zirconium, a couple of months later when the healing has taken place. This hi-tech approach may cost about $150,000- $180,000.

As you can see, the cost of total teeth replacement with dental implants can vary significantly depending on your preferences. Talk to your dentist to better understand the various options. While these are the three broad groups of treatment options available today, there can be different permutations of these. To get a proper fee estimation, your dentist will need to do a thorough physical examination. Even the "Hyundai" option entails a considerable amount of money and you should feel free to get a second or even a third opinion if you are not comfortable with the first dentist you see.