All-on-4 Upper and Lower Implants
All-On-4 is an advanced technique whereby a whole arch of teeth is supported by only 4 implants. Its success rates are similar to those of traditional implant techniques but it differs in that the back implants are deliberately tilted towards the back of the mouth. For the vast majority of patients all-on-4 overcomes several of the problems associated with previous techniques.
- Load distribution is maximized. A functional arch of teeth can be supported by a reduced number of implants.
- Bone deficiencies at the back of the jaw are avoided. Complex grafting procedures and extended healing times are no longer necessary.
- The replacement teeth can be placed immediately (within one to three days of implant placement). Immediate oral rehabilitation is now possible without patients having to go through an intermediate removable denture phase.
- Using only 4 implants means reduced initial cost, reduced surgical complexity and long term, easier cleaning and maintenance.
Patients who are not suitable for all-on-4 are generally those with a very heavy bite or with insufficient bone. These patients can still often be treated in the conventional manner using 6 or more implants, generally with grafting. Zygomatic implants are also available where bone is minimal.
Preliminary - Assessment, radiology and diagnostic work-up
The first step is to make an appointment with the prosthodontist for an assessment and to discuss appropriate treatment options. Special CT scans are required to assess bone availability and determine optimal implant position. Photos and models are used to plan the replacement teeth for optimal function and aesthetics. A surgical guide records this information and directs the surgeon as to where to best position the implants. The dental laboratory also uses this information to make other special guides to help us record the implant and proposed tooth position at the time of surgery.
Where necessary, remaining teeth are extracted and the jaw bone is reshaped using a procedure called 'alveolectomy'. The implants are installed, resorbable sutures are placed, impressions of the implants are taken, and temporary plastic caps are used to cover the implants. While the patient sits back quietly and relaxes, elsewhere in the office models are fabricated and the replacement teeth set in wax. About two hours later the teeth are tried in the mouth with any necessary adjustments being made before the patient goes home. The patient can approve the final look and knows exactly what to expect when the new teeth go in 3 days later.
At the laboratory
The teeth are now set in acrylic and the base is reinforced with a metal framework. All the fine detail needed to make your replacement teeth and gums look natural is incorporated.
3 days later
The temporary caps are unscrewed and the replacement teeth are gently inserted. Biting on the new teeth doesn't put pressure on the healing gums beneath and patients can smile with confidence, sometimes for the first time in years. Avoiding hard foods for the next few months will allow the bone to heal properly around the implants.
Short term follow up and adjustment
One of the great things about this procedure is that it usually requires minimal postoperative adjustment. It's true the first days are spent at home without teeth but at least there is no painful or loose denture to rub against and cause pain to the treatment area. Providing they take proper care, patients usually report minimal swelling or pain. There is usually a little bruising but it is generally not a big problem.
The sutures dissolve away by themselves and are usually completely gone after two to three weeks . Function and aesthetics are checked at day 7 and then again a month later.
Long term - Replacement
Every case is different but the initial replacement teeth can function for up to 5 years.