A GUIDE TO
ALL-ON-4 DENTAL IMPLANTS
What are All-on-4 dental implants?
All-on-4 dental implants are a dental prosthetic technique where "all" teeth (a full fixed bridge) is supported "on four" dental implants. It is used for the rehabilitation of the toothless dental patient and for those patients who have gum disease or seriously decayed and broken teeth.
When are All-on-4 Dental Implants the Best Option?
The replacement of teeth with implants may be appropriate under these specific oral and historical conditions:
- Prior repeated dental treatments have failed.
- There are not enough teeth or bone to support normal forces of chewing and the effects of (para) function habits.
- The shape of the teeth or bone causes unsightly conditions that can’t be treated in any other way.
- A method of tooth replacement is sought that is not removable and doesn’t cause the embarrassment of gagging and food entrapping characteristic of full dentures.
- The patient’s health, finances and availability of time permits this type of treatment.
When is “All on 4” the best choice?
An “All on 4” style of implant tooth replacement can be an appropriate choice for:
- People who have no natural teeth remaining or some teeth that will need to be removed.
It is also a good second choice for:
- People who have many missing teeth and some natural teeth which are strong enough to be useful almost indefinitely.
- People who have many teeth missing, but the remaining teeth, although damaged, can be restored so they can last 15 to 30 years or longer, with the missing teeth replaced.
What is the “All on 4” technique?
The “All on 4” technique is an offshoot of tooth replacement with implants. An implant is simply a root that replaces a tooth root. Like a tooth, the implant can be used to support a crown, a bridge, or a denture. Sometimes the choice between these depends on patient ability or expectations. Some patients have limited budgets, some are not healthy enough for implant placement, and some have limited time to invest in the procedure. In some cases, preparing for implants with a temporary procedure is the most appropriate treatment, postponing implants until the time is right.
“All on 4” is a trademarked term from Nobel BioCare that describes the use of 4 root form implants to support a fixed bridge that is attached to the implants. The bridge can be made of metal-backed plastic or completely of porcelain, with different features of both procedures.
What Makes All-on-4 Different?
In the past, replacing upper back teeth involved placing implants in the grafted maxillary sinus area. This used 8 to 10 implants plus a “sinus lift and graft” in the upper jaw. The novel “All on 4” technique (when appropriate) places implants at an angle tilted to the back of the mouth. This avoids the sinus area entirely and may eliminate the need to use grafting or a sinus lift to replace missing back teeth. Not All patients can use this technique because (for example) sometimes the sinus can extend so far into the front of the jaw, or sometimes there is too much bone missing, to use an “All on 4” approach.
Dr Korwin's advice about All-on-4
Dentistry has evolved from reactively fixing or extracting teeth when they loosen or break, to a preventive science curing dental problems before they cause discomfort or disability. Losing your natural teeth without repairing or replacing them can cause major disabilities of eating, socializing and in some cases affecting your professional ability to work.
When preventing and repairing dental problems no longer has merit, then replacing and improving on what nature gave you is a godsend. I have treated patients who were unable to eat out at a restaurant or friends’ homes, who couldn’t speak in public, and who did not even leave their own home for 10 years because of the disfiguring effects of losing teeth..
What has evolved from the fruits of technology and science is a long-lasting, comfortable, esthetic replacement of natural teeth. The patients who I have treated with this technique no longer have the sad half-closed eyes in their preliminary photographs. The new pictures show them smiling and happy, with their eyes fully opened. They are enjoying the benefits of improved self-esteem when they eat, talk and laugh with the world again. These are some of the benefits that the “All on 4” technique or similar techniques have brought these patients.
Nuts and bolts of “All on 4” planning
For the nuts and bolts of “All on 4” planning, when designing an implant-supported bridge, it is important to not only replace the teeth but also to make sure that there is an improvement in appearance as well as function. It is important to find out why the teeth will be or have been lost in the first place. The final bridge should correct the reasons for the lost teeth in the mouth as well as improving function and esthetics.
That requires some detective work and a preliminary evaluation to make sure that the final bridge will not fail. Bridge failures have been known to occur when a thorough investigation and a corrective plan is not made. I prefer photographs and model copies of the preexisting teeth so I can detect the problems that caused tooth loss in the first place. Was it a tooth crowding problem, was it lacking home care, was it “parafunctional habits” such as unconscious tooth grinding, day or night?
When all these factors have been detected, then it is time to plan a bridge that will prevent failure by providing the proper shape and the proper number of implants.
All-on-4, All-on-6, All-on-8 Dental Implants
Not all dental needs can be fixed indefinitely with 4 implants. Some patients require more than 4 implants to resist the forces of tooth clenching or grinding. These habits will continue even after all the teeth which failed because of grinding have been removed and cause even implants to be lost. The implants can fail, or the bridge can even break, if the effects of grinding are not controlled with a properly made night guard, or unless more implants than 4 are placed. Some patients with heavy musculature need 6 or even 8 implants per jaw to prevent treatment failure under any circumstances. Of course, this will improve longevity, but may raise the cost of care.
Since this type of treatment and planning is very complex, it is very important to select a dental provider who has experience, has a good track record, can incorporate improved esthetics, and function, and most importantly can make sure that the final design of the appliance will last as long as possible, or who knows how to correct and improve any problems both before and after the bridge is made.
After 35 years of dental prosthetics training, I have seen how some procedures are fads and don’t last. I know which are valuable additions to a dentist’s recommended procedures. All on 4 is not a casual procedure to recommend or provide. With “All on 4” treatment, I employ my advanced surgical skills to minimize discomfort. My implant patients have so little pain that they do not need strong pain medications the night of surgery. They report feeling great the next day. I find that the implant-supported bridge is both a procedural joy for dental treatment and is by far the most happiness-inducing, long-lasting dental care that I can provide to my patients.
About Robert Korwin DMD MAGD MICOI
Dr. Korwin is one of only 8 implant dentists in the world who has qualified for the prestigious dual Mastership Awards from The International College of Oral Implantologists and the Academy of General Dentistry.
About Advanced Dentistry with a Gentle Touch
Established in 1983, Advanced Dentistry with a Gentle Touch serves patients from the following counties in New Jersey: Monmouth, Ocean, Middlesex and the following cities: Red Bank, Middletown, Navesink, Belford, Leonardo, Port Monmouth, Keansbery, Holmdel, Lincroft, Atlantic Highlands, Hazlet, Fair Haven, Keyport, Little Silver, Srewsbury, Rumson, Fort Monmouth, Eatontown, Highlands, Cliffwood