Dr. Josh Muir and Dr. Tanner Townsend discuss the benefits of sedation 😌 for patients with dental anxiety 😨, sharing a story of a patient who needed sedation for a routine procedure 🦷. They also highlight the success of all-on-four implants 🎯, recounting a patient's positive experience and subsequent decision to upgrade to all-on-four for the upper jaw 😁. The conversation covers the transition process from dentures to All-On-4 implants, emphasizing reduced pain and improved patient satisfaction 🌟. They also touch on the advancements in dentistry 🦷🔬, including the ability to provide temporary solutions ⏳ and multiple try-ins, and the overall impact of these treatments on patients' lives, enabling them to eat 🍽️, play musical instruments 🎶, and regain confidence in their smiles 😊.

Dr. Josh Muir 0:01
Welcome everyone to our dental implant podcast called Smile Reconstructed. My name is Josh Muir, and we’re here with,

Dr. Tanner Townsend 0:08
Dr Tanner Townsend as well. Nice to be back with you, Josh.

Dr. Josh Muir 0:11
Yeah, I’m excited. We have some fun things to talk about today, kind of some cool events that have taken place in the office. So Dr. Townsend, why don’t you start us off with some of your experiences that you’ve had lately.

Dr. Tanner Townsend 0:22
Okay, well, I just wanted to share a quick story, because I think it’s really applicable to other patients that have dental anxiety. So today, we had a patient previously that we had placed some implants on. We had placed four implants in the lower jaw, and the same time we took some teeth out, and they were sedated for that, they were totally asleep. And most of the time when we do an overdenture, we have to go back and uncover those implants, meaning we have to unscrew the little healing screw and put on a healing cap. So the healing cap is going to sit outside the gums. And 99% of the time, I’d say I have done that when patients are awake, we just do a quick little incision, unscrew the healing cover, screws, what we call-

Dr. Josh Muir 1:04
Be more like doing a filling where someone’s just getting numb, and it’s something that’s quicker, more routine, that most people are able to just tolerate their mouth and tolerate well. So what, so what happened today?

Dr. Tanner Townsend 1:16
I’m glad you made that point. So today we were doing that, and we got this patient numb, and they were not tolerating it well. They were having a really hard time just with the idea of it. I think more than anything, it was the dental anxiety was setting in. And so what happened was we had three we had to do, and we got through one and started getting through a second one, and we said, let’s have another day that we come back and let’s put you to sleep to finish this.

Dr. Josh Muir 1:44
Gotcha.

Dr. Tanner Townsend 1:45
And what a blessing that is to be able to put a patient to sleep that’s really struggling with something like that.

Dr. Josh Muir 1:50
So I was in the office working on the computer, and I could hear some sounds coming from that room, and it sounds like you guys really didn’t do much at all. You really hadn’t even started, but just approaching the patient, she got so nervous that she would let out some yelps. That’s what it sound like from where I was sitting. So I don’t know. I think the take home message is, what a blessing that we have sedation as an option for patients that need it.

Dr. Tanner Townsend 2:17
Yeah, it’s really quite a blessing, because I don’t know how you would work on those patients. Like you said, there are different levels of dental anxiety, and that was this routine is doing a filling, and somepeople need the sedation for that.

Dr. Josh Muir 2:31
People need it. Yeah, exactly, great.

Dr. Tanner Townsend 2:33
Well, you’ve had a lot of interesting things happen recently as well. Tell us about your day and kind of some different things that have happened recently for you.

Dr. Josh Muir 2:41
Yes, I wanted to tell you something funny. And I don’t know if I’ve told you this story or not, this happened a while ago, but I just thought it was hilarious, and it kind of blew my mind. So we were finishing a case with a lady who was getting her All-On-4, her teeth would be permanently fixed to implants up on the top. She got her smile back, and she held the mirror. She loved it. She stood up, and right as I went to say something, she said, “Thank you so much.” And she grabbed me and hugged me. I was just opening my mouth to say something, and her ear went all the way inside my mouth to the point that I licked it.

Dr. Tanner Townsend 3:23
You really got her ear then.

Dr. Josh Muir 3:25
She had no idea, but and I patted her back and rubbed her back a little bit. And then our hug was done. And then we went on talking together, and that was that. But,

Dr. Tanner Townsend 3:36
She didn’t notice a little wet spot on her.

Dr. Josh Muir 3:40
So I did ask her about it later, and she laughed and laughed and laughed and she said, I had no idea. So anyway, kind of a funny story, but really, the one you were probably referring to was we had a patient that came in today, also who we had previously done an All-On-4 on her lower and just a regular denture on the top. And part of the reason for that was she thought she could do okay with a denture. And part of the reason for that was finances.

Dr. Tanner Townsend 4:10
Yeah.

Dr. Josh Muir 4:11
And she said, “You know, I just don’t know that. I want to spend that much on getting them both done with All-On-4‘s.” So when we first did it, she said, “Oh, everything fits great. The denture is good. I use a little bit of adhesive. It’s working really well.” And now she’s come back three weeks later and she said, “basically, no, it’s it’s working well. But I’ll be honest with you, I like the All-On-4’s so much that I’ve talked with my daughter. She’s going to help me with some finances.”

Dr. Tanner Townsend 4:40
Wow.

Dr. Josh Muir 4:40
And I’d like to do the top so I looked at the CT scan, I measured things. I said, Well, you’re still a candidate for that. Your bone hasn’t shrunk so much that you can’t do it. And when would you like to start this? And we talked about some things. She said, “I’d start right away.” So next week, she’s coming next week, and we’re, we’re doing that. So, I mean, pretty amazing. She said, “My lower, so my All-On-4 feels just like my natural teeth.” She said, “It’s just been amazing.”

Dr. Tanner Townsend 5:10
So that’s really awesome.

Dr. Josh Muir 5:11
So

Dr. Tanner Townsend 5:11
Let’s take that patient, for example. What, walk us through? What the steps are of what happens with that patient when you’re transitioning them from teeth or a denture to an All-On-4, what kind of goes all into that?

Dr. Josh Muir 5:24
So this is kind of a neat case, because we get to experience all of the different transitions.

Dr. Tanner Townsend 5:29
Yeah,

Dr. Josh Muir 5:30
And she’s experienced a lot of different things now too. So just to start out with, this is a patient who has put up with a lot of dental problems over the years and break down and destruction to the point that she didn’t have front teeth, and so she had gotten something on Amazon that it’s basically these veneers that just stick to your teeth. It comes in a strip. It fit over there nicely, and it allowed her to at least smile and speak. It’s not something that she could eat with. So for her, she was used to putting up with a lot, and to be honest, that’s kind of the ideal scenario where you have someone that is just looking for something more. So we had a records appointment where we made scans of her teeth and made a plan for her denture on the top and the All-On-4 on the bottom. And then she came to the appointment. She wasn’t asleep for it. And we took out her top teeth, her bottom teeth, we placed five implants on the bottom. We, even though we call it All-on-4, All-On-X, we did five implants. And then later that day, she had her lower teeth put in, and she had her upper denture put in, and right away, her smile was transformed, but she was numb and getting used to it. So we saw her a couple days later, and she did better and better. We saw her two weeks later, she did better and better, and we saw her three weeks later today, and that’s when she was really doing just loving it, and realized, holy smokes, I really got to consider doing the top. So what’s neat is, when we go through these protocols with the All-On-4, people tend to have less pain than they would just taking one tooth out, for example. And I think the reason why, and you’ve probably seen this too, where the new teeth, the denture, or All-On-4 it’s supported by implants, and so if you push on it, it doesn’t pinch the gums, and the gums are typically where the pain comes from. So if the gums are protected, then they’re not feeling that pain. Have you seen that in their cases?

Dr. Tanner Townsend 7:34
Totally, it pretty much acts as a band aid, but it’s a little bit more, because you know how, like, sometimes if you put a band aid on. It might still hurt underneath, but for some reason, like,

Dr. Josh Muir 7:43
Yeah

Dr. Tanner Townsend 7:44
It doesn’t hurt.

Dr. Josh Muir 7:44
It’s really protected. I have seen this in patients for years, but really what showed that to me was working with my father in law, who had the procedure done, and he stayed with us for a while after that, and so every day, I got to see him multiple times a day.

Dr. Tanner Townsend 8:00
Yeah

Dr. Josh Muir 8:00
And monitor that progress. And that was a just a huge educational experience for me to see, what do patients experience every day after surgery, after the procedure. So that was pretty neat. When someone has just a denture. What have you seen with that? Teeth come out, denture goes in.

Dr. Tanner Townsend 8:21
Yeah, a little bit more discomfort. I would say it’s better because the denture acts as a band aid, but we’re not able to close the gums up, oftentimes all the way, unless we’re kind of leveling off the bone all the way. It’s the exposed root sockets that kind of cause some pain. But with that All-On-4 procedure where we’re kind of making a nice, smooth transition line. We’re adding implants, and we’re able to close the gums all the way up. It tends to heal a lot nicer in terms of discomfort.

Dr. Josh Muir 8:50
Yeah.

Dr. Tanner Townsend 8:50
What have you seen? Have you seen the same?

Dr. Josh Muir 8:52
I agree, yeah. And when we think of a denture, a denture rests on the gums,

Dr. Tanner Townsend 8:56
Yeah.

Dr. Josh Muir 8:57
Now for a top denture, it’ll also rest on the roof of the mouth. And so because we’re not taking teeth out off the roof of the mouth, we can rest it on there pretty nicely, and that’ll stabilize it. So the top dentures tend to be a little less discomfort. The bottom denture, it only rests on the gums right where the teeth came out. And so that tends to be a little more discomfort. But in both cases, when we do the all on floor, All-On-4, All-On-X, it tends to be a lot less discomfort than than otherwise. So.

Dr. Tanner Townsend 9:27
After we go through that surgical procedure, we we’re going to make them a prosthetic or a screwed in denture the same day or the next day. What’s the process of healing after that? And how do you get to that final zirconia?

Dr. Josh Muir 9:42
Okay, so we like to see patients once we put that temporary or healing All-On-4 in those healing teeth, we like to see them again after a couple of days, just to make sure that bites coming together correctly, make sure everything is is right and truly, just making sure they’re comfortable with things they don’t need adjustments and so on. Then we’ve seen back in three weeks, if there are stitches, we’ll take those stitches out. We’ll just talk to them, see if we need more adjustments, and just just listen really, and then act on whatever discomfort or situation they’re in need of. I’m gonna restate that that was weird. We really just listen to what their needs are, and then we do what we can to meet those needs. We like patients for these procedures to heal for about four months. At that four month time frame, we see them again. We do X rays, we make sure the implants have healed, and at that point, we get records and scans for their what we call their aesthetic try in so we don’t go straight to the final even from there we can, but we like to give an opportunity for them to make changes. So we say, all right, you’ve had this temporary one in for three or four months. What do you think is it meeting every need? Is there something we need to change? Are the teeth too wide or too short? You know, do we need to bring them back a little bit, or do you want to see them more? Are they hidden behind your lips? And we can make them a little longer if we need to. So we go through all of those questions, and then we get our records, we talk to the lab and designer, and we say, hey, here are the changes we need. And then we make a new one for them to try in. They can wear it for a couple of weeks, and if they need to make any more modifications, we can. Or at that point, we go to the final zirconium option. And with that, they come in. We take one out, we put the other one on, we check the bite, make sure it’s make sure it’s all good. And then they’re finished. It’s really a good procedure, because you have one surgical appointment.

Dr. Tanner Townsend 11:38
And then you’re done.

Dr. Josh Muir 11:38
And you’re done with the surgery. You don’t in most cases, you don’t even need to be numb after that for the whole rest of the process. So.

Dr. Tanner Townsend 11:46
I think that really goes to show how far we’ve been able to come in dentistry, to be able to get it down to one surgical appointment. And it’s not that case for every single patient. There’s a lot of different factors that go into that, but a lot of cases, we’re able to get it down to one surgical appointment. And then you’ve got teeth from there.

Dr. Josh Muir 12:05
Yeah. Now a couple weeks ago is when I was teaching that class in Cleveland, Ohio on Overdentures, the snap-in dentures. And as part of that, we talked about, you know, here are the pros and cons to each option. Some patients really do benefit from the ones that snap in, and so we talked a lot about that, and did a lot of teaching on that. But in 2024 we have the technology to do so much better than a denture that is removable, and so it’s just been amazing to see that transition.

Dr. Tanner Townsend 12:35
Was it you that told me when you got back from your trip that can’t remember if it was you or not? You’ll have to correct me if I’m wrong. But someone said that overdentures in 2024 are very underwhelming. Was that you that told me that?

Dr. Josh Muir 12:47
if I did, I was quoting someone else. Because that was really well said,

Dr. Tanner Townsend 12:51
Yeah, I was, like, really impressed by that, because it’s like, that’s so true, like, the All-On-4. And that goes back to what your patient said today. She’s like, I love this so much, I want to do it on the top. And I don’t know if I’ve ever heard a patient in an overdenture say I love this so much. You know what I mean? It’s very underwhelming, because, yes, you can still you function so much better than a denture, and the people that have been in dentures greatly appreciate it, but it is nothing compared to that All-On-4.

Dr. Josh Muir 13:21
Yeah

Dr. Tanner Townsend 13:21
And I’m seeing that more and more of like, man, the All-On-4 is an awesome option if it’s available,

Dr. Josh Muir 13:28
Yeah. And really, as we look at cost wise and time wise, it is more expensive, but it’s not hugely more expensive,

Dr. Tanner Townsend 13:36
Exactly.

Dr. Josh Muir 13:37
Most of the things are the same. You know, four implants and four implants. You know that part’s the same. You have some different components, the final, you know, the zirconium. That’s definitely going to be more a more expensive part, but it’s not a hugely more expensive thing. So, you know, when we bring patients in, or they schedule for a consult, that’s why we go over every option for them, and like this patient today, well, we call it upgradable treatment. Why don’t we start for with this? Yeah, denture on the top, All-On-4 on the bottom, and you can try it out if you decide you want to do something more on the top. Well, we’ve made teeth for it. Now we have a design and a smile that we can start with and work with and expand on. And so you have it upgradable as an option for later.

Dr. Tanner Townsend 14:23
Yeah, I think it’s an awesome option, because then if you’re in an overdenture or regular denture, you can upgrade. Just a beautiful thing.

Dr. Josh Muir 14:31
Well, I am just pleased that we’ve been able to provide dentistry in a time and year and season you know that offers so many options. It’s been quite an incredible journey to see this over the last 13 years.

Dr. Tanner Townsend 14:46
And I’ve come when it’s been a little bit more technology savvy, where you’ve seen more the how the advancements have developed. Yeah. I mean, do you feel like going into that a little bit? How much quicker Have you been able to deliver your, that product, as opposed to when you started doing this 13 years ago,

Dr. Josh Muir 15:01
Sure. I mean, for example, someone comes in for a front tooth, we can take their tooth out, put an implant in, put a temporary crown on, made out of porcelain, so it looks nice, feels nice, nice and smooth, pretty good color match, and all of that on a temporary basis. We can do all of that in one appointment. It was just amazing. And it’s not that we couldn’t do everything like that before, it’s that we would use different materials, and we were more limited. I mean the fact that we can 3d print a try-in denture now an All-On-4. That’s temporary, and then we can tweak it and then print another one. So a patient can have multiple try ins until they say, Yes, this is how I want it to look and feel. It’s amazing, yeah. Or the other thing is, ooh, this is too weak. I don’t like this design. This is going to cause problems later. Let’s bulk that out a little bit and and get something better for them. Pretty cool. Time to be involved in dentistry, though.

Dr. Tanner Townsend 15:57
That is really cool. Well, do you have any additional things you’d like to discuss in terms of this procedure, the All-On-4.

Dr. Josh Muir 16:04
Just that we often get caught up in. Oh, just, Hey, do this procedure because it’s great. Hey, you know, I’m glad you’re here. Let’s get you into the chair and we’ll start this procedure. It’s not just about procedures. It’s not about just getting someone in the chair, but these are changing people’s lives.

Dr. Tanner Townsend 16:22
Yeah.

Dr. Josh Muir 16:22
I mean, that’s what it does. And, you know, a denture can change someone’s smile. It can allow them to be more presentable in public and things like that. And it can allow them to eat some things. But we move from there to this, All-On-4 or All-On-X, and, my goodness, at that point they can eat, they can play the trumpet like we’ve had. One patient, his biggest concern was playing the trumpet still, and he struggled with that with a denture. And so we did the all on four. He can play the trumpet again. Another patient was a singer, and can sing again. And everyone wants to eat again and smile again and smooch again, you know, so, all of those things so but that’s really all I’ve got today. I’m grateful we were able to have a discussion and we’ll see you next time.