New Teeth In Just One Day

By Dr. Jmi Asam
Interviewed by Rasa Fournier
Wednesday - June 22, 2011
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Dr. Jmi Asam
Prosthodontist at Pacific Dental & implant solutions

Where did you receive your schooling and training?

I went to Harvard for dental school and then I did my residency in prosthodontics, an additional three-year program, at the University of Illinois at Chicago. After that I worked at ClearChoice Dental Implant Centers in Chicago, the national leader in dental implant placement, restorations and full mouth reconstructions.

How long have you been practicing?

I’ve been practicing since 2005, but moved home to open my own practice, Pacific Dental & Implant Solutions, in 2009.


What is a prosthodontist?

A prosthodontist is one of the nine specialties recognized by the American Dental Association. We specialize in the diagnosis, treatment planning and restoration of complex dental conditions. It’s important to make sure that we’re treatment-planning the patient - not just the tooth - and provide patients with comprehensive, long term, predictable solutions. In the end, it’ll come down to the patient’s goals and finances, and as long as they know all of their options, they will be able to find a solution that works best for them.

Do you work mostly with dentures and implants?

As a prosthodontist, I’m able to provide a wide variety of services all in one location. From cleanings, fillings, crowns and bridges, to dentures, implants and full mouth reconstructions.

Dr. Jmi Asam views before and after shots of the All-On-Four procedure. Nathalie Walker photo .(JavaScript must be enabled to view this email address)

Can you talk about your All-On-Four (AO4) procedure?

With the AO4 procedure, qualified patients receive just four implants and a full set of new, fixed replacement teeth in just one day - no bone grafting necessary. The procedure is absolutely life changing. After an initial consultation, a patient can walk in with no teeth and walk out with fixed implant supported replacement teeth that same day. Conventional methods take up to two years with large bone grafting procedures and placement of a minimum of six to eight implants in order to achieve fixed teeth. Now we can minimize it to four implants, and we get enough stability to place replacement teeth on the implants that same day.

Is this the latest development in terms of implants?

We’ve been making these types of prostheses for a long time, but the immediate function - where you’re placing implants and putting teeth on them at the same time - is relatively new to dentistry. In the U.S., we started doing it about five years ago, but in other countries they’ve been doing it for a longer time. The AO4 procedure was first implemented about 13 years ago by its co-developer, Portuguese dentist Paulo Malo. The AO4 procedure is now recognized as one of the most significant advancements in the field of implant dentistry.

Are you the only one in Hawaii who does AO4?

I have the most clinical experience with the AO4 procedure, however, there are other dentists working to perform these cases. The AO4 is a very complex procedure and requires the experience and the highly trained skills of a prosthodontist and oral surgeon working closely together. At Pacific Dental & Implant Solutions, every AO4 case is planned with our 3D CT scan and supports the highest level of care for precise dental implant placement and restoration.


What is the benefit of the AO4 compared to other kinds of implants?

The biggest benefit of the AO4 is that patients are able to receive their dental implants and fixed teeth in just one day. Most candidates for the AO4 procedure are already in dentures or on their way to dentures because of failing teeth. Oftentimes, in order to give them fixed teeth, we’d have to go through major bone-grafting procedures with about six months of healing time. Then we would place anywhere between six to eight implants with another six months of healing time. Throw in the multiple initial and post-op visits at different offices, and in the end we’re looking at about a year-and-a-half to two years before the patient can get fixed teeth. In the meantime they’re forced to choose between wearing an ill-fitting denture over sensitive gums or simply not wearing any teeth at all.

With the AO4 procedure, we angle the implants, so most patients have enough bone that we can avoid the bone-grafting procedures. Not only is the AO4 beneficial for denture patients with low bone levels that want to get rid of dentures, but also for patients that just have lots of failing teeth due to cavities, periodontal disease and neglect. They’ve been told: We have to pull out all of your teeth and you’re going to be put into dentures. It’s devastating. But with the AO4 procedure, we can avoid bone grafting and dentures by removing the patient’s teeth, placing the implants and giving them fixed replacement teeth that same day.

So you’re now able to use only four implants because the implants are longer and you put them in at an angle?

Yes, we’re maximizing the bone the patient still has with longer, angled implants. On the top, because of the sinus cavities, we usually have to gain additional bone height through grafting. But since we angle the implants and utilize bone that they already have, we can avoid bone-grafting procedures altogether. On the bottom, by angling the long implants we also avoid the nerve canal and create a strong platform for immediate placement of teeth. With traditional implants, biomechanically, it would take twice as many implants to achieve the same success rate and bite force as the AO4 procedure. The angle and length of the AO4 implants make the difference.

What would you recommend to patients who need dental implants or have complex dental conditions?

Pacific Dental & Implant Solutions does offer free dental implant consultations and 3D CT scans. I always recommend that patients learn about all of their treatment options before making a decision. By simply educating yourself about all of your possible options, knowing the advantages and disadvantages of each, considering your dental goals and finances, you will be able to find the solution that best fits your dental needs. Remember, it’s your teeth, so it’s your decision.

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