What a full arch reconstruction is
Dr. Arpan Nalin Patel is a dentist in lower Bucks County, Pennsylvania, whose clinical practice centers on full arch implant supported reconstruction, the rebuilding of an entire upper or lower set of teeth on a foundation of dental implants. It is the work he is best known for, and the work he has organized much of his career around since qualifying in 2004.
A conventional denture rests on the gum and relies on suction and the shape of the ridge to stay in place, which is why it moves when the person eats. A full arch reconstruction is different in kind. Several implants are placed into the jaw and, once they have joined with the bone, a single fixed bridge is attached to them. The bridge does not come out at night, and the load of chewing passes through the implants into the bone the way it once passed through the roots of teeth.
The material Dr. Patel uses for that bridge is zirconia, a dense ceramic chosen because it stands up to years of chewing and can be shaped and shaded to sit naturally in the mouth. It is a treatment for the person whose remaining teeth can no longer be saved one at a time, or who has already lost most of an arch and has been managing with a denture that no longer does the job.
The stages, in order
A full arch case is a long project rather than a single procedure. A zirconia bridge carried on implants across a whole arch depends on three things lining up precisely: the placement of the implants, the restorative plan that decides where the new teeth will sit and how they will meet the opposing arch, and the laboratory work that turns that plan into a fixed bridge. Those steps unfold over months, and each one constrains the next. Dr. Patel plans across all three.
Assessment and planning
Imaging of the jaw, a record of how the arches meet, and a conversation about what the person needs to be able to do. The position of every implant and the shape of the final bridge are decided here, before the first appointment in the chair.
Implant placement
Any teeth that cannot be kept are removed and the implants are placed according to the plan. This is a surgical appointment, and the person leaves with a plan for the weeks that follow.
Healing and the interim bridge
The implants need time to join with the bone. During that period the person wears a temporary bridge, and the way it feels, chews and looks is used to refine the design of the final one.
The fixed bridge
The laboratory makes the final zirconia bridge to the refined design and it is fitted to the implants. Adjustments to the bite follow, and the long term care of the bridge begins.
How the result is judged
The people who arrive for this work have usually reached the point where their teeth have stopped doing their job. They cannot chew comfortably, or they have begun to avoid certain foods, or they have noticed that their speech has changed. For that reason Arpan Nalin Patel measures the result by function. A reconstruction succeeds when the patient can eat a meal and carry on a conversation without thinking about their mouth. How the finished arch photographs is a byproduct of getting that right.
The honest caveat is that this is slow work. The calendar runs in months, there are several appointments in each stage, and a bridge fixed to implants needs the same routine of cleaning and review that natural teeth do. Dr. Patel says so before a case begins, because the people who do well with it are the ones who expected a project rather than a procedure.
About Dr. Patel
He came to this work through complex restorative dentistry more broadly, and through training that built on the D.M.D. he earned at the University of Pennsylvania School of Dental Medicine: a certification from the Las Vegas Institute of Aesthetic Dentistry, and implant credentials from both the London Institute of Implantology and Renew Smiles. He practices within a multispecialty setting in Langhorne, which matters for full arch cases in particular, because the surgical, restorative and periodontal questions on one patient can be settled in the same building by the clinicians involved.
Many of his full arch patients are also people who have been away from a dentist for a long time, and he has written about sedation dentistry as a way of making a long course of treatment possible for them. Dr. Arpan Nalin Patel belongs to the American Dental Association and to the Pennsylvania Dental Association, and he writes about reconstruction for general readers on Medium and on Blogger.