Implant Success: What A Patient Can Do

Each patient has a role in the success of their dental implant. What can you do?

• proper nutrition is important because it is necessary for optimal wound healing.  Intake of vitamin A, C, D, and E and minerals (calcium, magnesium and boron) are recommended.
• stress management is important because in the short term it effects wound healing time.  In the long term, stress manifested in clenching or grinding can affect implant survival.
• smokers are at a higher risk of inflammation and bleeding around implants which can lead to bone loss.
• uncontrolled diabetes is associated with a higher risk of implant failure on placement and on greater inflammatory risk over the long term.
• satisfactory hygiene--control of bacterial contamination of tooth/implant surfaces is important. This biofilm combination of microorganisms can be removed on a daily basis through thorough oral hygiene and regular maintenance visits for professional cleaning.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

17-year Implant Bridge Success

Today I had the privilege of seeing a 63 year old patient I treated 17 years ago.  She had her teeth removed when she was 20 years old, and for the last 30 years before I treated her had been unable to wear a lower denture.  She was very thin, had digestive problems due to a poor diet and had become a recluse because she was reluctant to leave the house and be out in public with a collapsed face. We placed four lower implants and, according to the original Branemark protocol, fabricated a mandibular fixed implant supported bridge.  Now she dances three nights per week and has a healthy glow about her.  She joked that she has to watch her weight because she can eat anything on the menu.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

When Retreatment Is Necessary

For a healthy individual with good oral hygiene, dental implants are predictably successful and survival rates above 90-95% are reported.  This patient reported he was not comfortable wearing an upper denture, so he had four dental implants placed with a screw-retained prosthesis.  Unfortunately, he was not in good health, being a diabetic, having untreated hepatitis-C, and chronic sinusitis.  On a temporary basis, he now wears a temporary denture that holds onto the remaining single implant as his health status improves.  After that, we will examine and discuss his treatment options and alternatives.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Healthy Implants, Healthy Smiles

This healthy young (40 years old) man, with a difficult dental history, finally found himself in the position to fix his mouth.  The one thing he knew for sure--he didn't want to have a denture.  His upper remaining teeth were failing, and the upper back teeth had been gone for such a long time that the bone had shrunk also. The idea of sinus lifts and bone grafts, a more serious surgical procedure, did not appeal to him.  Fortunately, the bone in the front of his upper jaw, examined by means of a CT Scan,  was more than ample for us to place six dental implants.  

Position of Implants

The positions of the implants, their distribution, and the "tilted" angulation of the most posterior implants, allow fabrication of a computer-designed, milled titanium framework to support a full complement of upper teeth and be screw retained.  The end result will be a permanent upperfixed bridge.  We have had great success for many years treating both upper and lower jaws with the All-on-4 technique.  More information is available on our website, with patient reports on their experiences. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

All-on-4 Success in Bakersfield

Parel and Phillips, in the Journal of Prosthetic Dentistry report on a study of implant survival rates for 558 jaws treated with 4 implants per jaw in a patient population between 2008 and 2010.  A total of 2,132 implants were placed, with only 48 failures, giving a 97.8% success rate.  Of the few failures, they were 5 times more likely in the upper jaw and more often associated with male patients, poor bone density, opposing natural teeth and the location of the most posterior implant.  Smoking, bone volume, systemic factors, addictive drug use and pathology, including the existence of periapical infections did not appear to be related to failure in this population.  When patients with greater risk had additional implants placed, there were no failures.  Dr. Tupac, Bakersfield's only full time Board Certified Prosthodontist,  specializes in taking patients from failing teeth to implant supported fixed bridges and has been successfully treating patients in this manner for many years.  All treatment, from diagnosis and treatment planning, to extractions and implant insertion, to fabrication and placement of the fixed bridges is accomplished in his office.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

How Prosthodontics and the NobelGuide Go Together

Today's 3D Techonology

NobelGuide Implant Surgery Planning software allows us to take the 

information from I -CAT scan of a patient's mouth and perform virtual 

surgery on the computer before taking a patient into the actual surgery.

In a presentation to his prosthodontic study group, Robert Tupac analyzed his experience with the long term results of his first 20 NobelGuide cases. The NobelGuide technique begins with the incorporation and assessment of 3D diagnostics, termed cone beam technology. This allows the ability to use a scan of a patient's jaw and apply a computer software program (NobelClinician Software) to create a three dimensional model of the jaw. The program involves virtual placement of dental implants in the image of the bone with clear visualization of selected anatomical structures, prosthetic requirements 
and implant positions. 

This prosthetic-driven planning ensures optimum implant support of the prosthetic restoration. The integrated diagnostics maximize treatment safety and predictability. The computer generated design is then used to fabricate a precise surgical template that is secured in the patient's mouth and through which the implants are placed with tailored surgical instruments. The technique means that implants and a screw retained implant bridge can be placed with minimal surgical exposure and that the patient can receive implants and a fixed prosthesis in one appointment. This technique has proven to be highly successful for those patients who are candidates for the procedure.

Robert G. Tupac, DDS, FACP, Inc., 
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309 (map)

Guidelines for Treatment Planning Therapy

Guidelines for Treatment Planning Therapy 

Cone-Beam

Dr. Lyndon Cooper's popular dental implant guidelines for treatment planning therapy in the edentulous mandible are designed to improve the success of both the implants and the prosthesis.  The "rules" govern the biology and amount of bone necessary for implants sufficient to support chewing forces.  The "rules" also specify the distribution of the implants to control the forces they must withstand and the amount of space necessary to fabricate a prosthesis with enough structural integrity to withstand these forces.

Implant tissue bar/overdenture and implant supported/fixed (hybrid) prostheses

The rules apply to both implant tissue bar/overdenture and implant supported/fixed (hybrid) prostheses.
The first rule is that the lower jaw must allow for implants at least 10mm in length--that the mandible's inferior/superior dimension be a minimum of 10mm.  Evidence in the literature supports the conclusion that 10mm implants in the anterior mandible have an equally high survival rate than longer implants.

Second Rule

The second rule is that the vertical (restorative) dimension must be at least 10mm from ridge crest to occlusal plane. Using a "top down" approach, the average height of mandibular anterior teeth is 10mm, and there must be room for acrylic attachment, a rigid framework, abutment height and biologic width.  This allows for a prosthesis with structural integrity and permits establishment of proper contours in support of comfort, mastication and speech.

Third Rule

The third rule is that the anterior/posterior distribution of implants be at least 10mm for the hybrid.  This allows the lever arm from the anterior implants to the posterior implants to be sufficient for the counter leverage necessary to support 15mm of cantilevered teeth back to the first molar.

Cone-Beam Technology Required

Applying these rules requires using cone-beam computed technology for a volumetric assessment of the mandible.  It means determining final anterior and posterior tooth position prior to planning and executing implant placement and presurgical correlation of the anatomy of the mandible with the location of the planned prosthetic teeth.

Robert G. Tupac, DDS, FACP, Inc., 
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Long term study results of 20 NobelGuide Cases by Robert G. Tupac, DDS, FACP

The NobelGuide Ensures Optimum Restoration

In a presentation to his prosthodontic study group, Robert Tupac analyzed his experience with the long term results of his first 20 NobelGuide cases. The NobelGuide technique begins with the incorporation and assessment of 3D diagnostics, termed cone beam technology. This allows the ability to use a scan of a patient's jaw and apply a computer software program (NobelClinician Software) to create a three dimensional model of the jaw. 

About the NobelGuide

The program involves virtual placement of dental implants in the image of the bone with clear visualization of selected anatomical structures, prosthetic requirements and implant positions. This prosthetic-driven planning ensures optimum implant support of the prosthetic restoration. The integrated diagnostics maximize treatment safety and predictability. The computer generated design is then used to fabricate a precise surgical template that is secured in the patient's mouth and through which the implants are placed with tailored surgical instruments. The technique means that implants and a screw retained implant bridge can be placed with minimal surgical exposure and that the patient can receive implants and a fixed prosthesis in one appointment. This technique has proven to be highly successful for those patients who are candidates for the procedure.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309