Replace Denture with a Fixed Arch of Teeth
All-on-4® is a very popular and cost-effective treatment for replacing all of your teeth in the upper and lower arches. It can be used by anybody facing complete tooth loss or already experiencing the complete loss of natural teeth. All-on-4® uses teeth similar to a denture affixed to 4 dental implants that are strategically placed throughout the front 1/3 of the jawbone.
The implants used for All-on-4® are inserted differently compared with conventional dental implants:
- Two dental implants are inserted vertically into the front of the jaw
- Two dental implants are inserted either side but are placed at a 45° angle, tilting backward in the mouth
The reason for placing these dental implants at an angle is to take advantage of the better bone quality at the front of the jaw.
Tilting the implants allows for longer implant posts to be inserted, increasing contact with the surrounding bone. This provides increased stability in comparison to straight implants in the same position. Also, tilting the implants moves the top attachment (abutment) further back in the mouth, extending the length covered by the implants so that a greater number of teeth can be supported.
Why Choose All-on-4®?
All-on-4® is a treatment that is suitable for people missing entire arches of teeth or who have suffered complete tooth loss. All-on-4® is the best treatment for individuals who have limited bone and cannot, or will not accept the placement of additional implants.
People missing an upper or lower arch of teeth, or who are entirely edentulous will often struggle with full dentures that are a far from perfect solution for tooth loss. Changes to the shape of the jawbone can reduce denture retention, so they begin to slip and move uncomfortably, making it difficult to eat and even talk confidently.
Implants-4-Life® dental implant treatment is the best solution for most, but jawbone loss can affect implant placement and limit the opportunity for more than 4 implants.
Often supplemental treatments like bone grafting are necessary to augment the implant sites. This allows for adequate healthy bone to support the implants. While bone grafting is highly effective, the additional procedure increases the cost and the time needed to complete the treatment. Bone grafts often require several months to attach and grow with existing bone. While the fastest and cheapest option is almost never the best, some people are not suitable for bone grafting or are unable to undergo the grafting procedure.
All-on-4® is useful for people who have low jawbone quality or quantity that makes them unsuitable for conventional implant treatment. All-on-4® offers edentulous patients the benefits of implant treatment even if they have very little bone in the back of the jaw. Previously these patients would have no other options besides traditional dentures or Snap-on-Dentures.
Who Is Suitable for All-on-4®?
People wishing to have All-on-4® dental implants need to be in reasonable health. You cannot have active periodontal disease and any failing or infected teeth may need to be removed before implant treatment. Diabetes and heart disease need to be under control. Immune suppression therapy may need to be modified. A complete, transparent discussion about your health should be had prior to moving forward with treatment.
All-on-4® is specifically designed to maximize the use of healthy bone in areas where it is naturally stronger and thicker. However, because of the limited nature of the treatment, the long term prognosis is more questionable than with traditional Implants-4-Life®.
The ideal candidate for All-on-4® is someone who understands the risks and rewards of the procedure. Long term studies for All-on-4® are not reliable and have not been presented to the public with honesty. The rewards of the procedure can be great but non-biased long term studies are not currently available. If a single implant is lost due to periimplantitis, overloading, or poor hygiene, the entire set of teeth becomes useless. A new implant has to be placed and a completely new set of teeth has to be created. All at an additional cost to you, the patient.
What is the Procedure for All-on-Four®?
You will require an in-depth consultation with Dr. Bergman to determine your suitability for All-on-4® dental implant therapy. The consultation will cover your dental and medical history, as Dr. Bergman must be aware of any medical issues and medications that could affect the success of treatment. The consultation is your opportunity to ask questions and to learn about the procedure and the costs associated with it. It is the time to discuss anesthesia and sedation, materials used, length of procedure, and timeline to completion.
A facial CT scan is required for All-on-4® implants. It is sometimes called a CBCT and is a detailed, 3-dimensional representation of the jawbones and the surrounding structures. With the CBCT, the quantity and quality of bone can be evaluated. The scan also shows other facial structures in great detail, including the sinus cavities, nerves, blood vessels, the nasal floor, and abscesses of teeth.
All-on-4® requires good bone quality towards the front of the mouth. Because the bone is naturally stronger in this area, quality is often not a problem. The width and height of bone then become the determining factors.
A scan of the remaining teeth and jawbones in the mouth is then taken. The dental term for this procedure is an intraoral scan. A camera is used to capture thousands of images that are compiled into a single 3-dimensional image of the mouth. A bite registration is then taken with the camera to show how the upper and lower teeth and jaws come together. The intraoral scan and CBCT are joined together in specialized computer software to plan for the implants.
Planning Implant Treatment
The facial CT scan and intraoral scan are then used to plan the implant surgery. The images are manipulated digitally, allowing Dr. Bergman to insert each implant in the best position, ensuring it has the greatest contact with strong and healthy bone.
The images provide Dr. Bergman with information to ensure excellent aesthetics and functionality. Once your treatment plan is complete, a surgical guide is created, allowing the implants to be placed in the exact position of the digital plan.
Placing Your Dental Implants
The surgical guide is placed over your gums, allowing our dentist to replicate the treatment plan accurately. It ensures every implant is inserted to the correct depth and angulation. The surgical guide often allows for a smoother, more accurate surgery.
Fitting Your Replacement Prosthesis
Before beginning the surgery, we create teeth to attach to the implants. The teeth are called a prosthesis. The prosthesis splints the implants together, preventing unwanted movement during healing. Although the teeth are temporary, they will allow you to eat comfortably and to talk, laugh, and socialize with others during the healing process. If you have any questions or concerns about the teeth you will receive on the day of surgery, they need to be addressed during the planning stages of implant therapy.
After your implants have fully joined with your jawbone, the permanent prosthesis can be fabricated. The permanent prosthesis can be a duplicate of the temporary or changes can be made to make the permanent teeth different. At Southern Utah Implants, we want you to be very happy with your permanent prosthesis, so additional steps are taken to assure you are pleased with the look and fit prior to attaching it to the implants for good.
What Happens After Having the All-on-4® Procedure?
Because only four dental implants are required, healing is usually uneventful. Any discomfort is often easily controlled with over-the-counter painkillers. We will provide precise instructions on how to care for your mouth during the healing process, and our dental team is always here to answer further queries or concerns.
A strict diet of soft foods is required for the first 6 weeks. A diligent effort to keep the prosthesis clean and free from plaque is necessary as well. Smoking and alcohol are off limits. For the first week, care should be taken not to perform any activities that would cause undue stress. Last of all, no contact sports are allowed, of course.
What Are the Advantages and Disadvantages of All-on-4®?
Advantages of All-on-4® include:
- A good solution for limited bone where the back teeth should be.
- May avoid the need for bone grafting.
- Fewer dental implants.
- Reduced cost compared to Implants-4-Life®.
- Dental implants can be immediately loaded, reducing treatment time.
Disadvantages of All-on-4® include:
- Treatment isn’t suitable for everyone.
- Adequate width and height of bone is required for immediate loading.
- Only 4 implants support the entire set of teeth.
- If an implant is lost, the teeth are lost too.
- Long term studies are questionable.
When correctly planned and placed, All-on-4® is a more cost-effective solution for people who have significant jawbone loss and who may have lost teeth many years before.
Bone grafting is not always necessary due to the angled position of dental implants. As with all dental implant treatments, there is a risk of implant infection, so your proper care for them can give the best opportunity for long term success. Make sure to see your dentist regularly for checkups and cleanings.