All-On-4 Implant Process?

What are All-On-4 implants?

The All-On-4 brand is a registered trademark of the Nobel Biocare company. All-on-4 implants have been specifically designed and developed to allow dentists to replace teeth with fewer implants than conventional dental implants. The overall procedure is less intrusive and less expensive.

All-On-4 are fitted with four implants per jaw. These four implants are placed in the mandible or maxilla and will then support between 10 and 14 custom-made crowns. In some cases, five or six implants may be needed to counteract lower bone density. All-On-4 consist of a gum-coloured acrylic base to resemble gum tissues, while crowns can be made of resin, zirconia or porcelain.

All-On-4 implants are fitted at a 30 to 45-degree angle rather than vertically as regular dental implants. Angled fitting increases the strength of the implant. It also allows individuals with jaw bone loss to have implants fitted without the need for expensive and time-consuming bone grafts.

How does All-On-4 work?

It takes a few steps to create a new smile with All-On-4 implants. Here’s a breakdown:

1. Initial consultation and CT scan. The dentist will assess the overall condition of your mouth and jaw and take a CT scan. If you decide that All-On-4 is right for you, the dentist will take impressions of your mouth. These will then be sent to the lab for the creation of customised prostheses - the jaw and tooth sections or bridges that will be attached to the implants.
2. Anaesthesia and extraction (if needed). When you attend the surgery to have your implants fitted, the dentist will give you an anaesthetic so that the entire process is painless. If teeth need to be extracted, this can normally be done at the same time. Your mouth is then thoroughly cleaned to remove bacteria and damaged tissue.
3. All-on-4 implant placement. Two holes are drilled at the front of the jaw and two at the rear. Your implants are then placed at a 30 to 45-degree angle and any holes are stitched with soluble thread that dissolves in a couple of weeks. Either the same day or the next day, your new teeth will be attached to the implants. When fitted, all joins are hidden behind the lip and are virtually undetectable.

Some dentists prefer to fit you with temporary implants for the first six to nine months. This is to reduce bruising and to ensure that less pressure is put on your implants as they heal. Once your mouth is fully healed, the dentist will affix your permanent implants. These are normally made from porcelain, ceramics, or another durable material like zirconia or fused metal.

What are the alternative treatments to All-On-4?

There are three viable alternatives to All-On-4 implants, and your dentist may discuss them with you during your consultation: dentures, conventional dental implants and All-on-6 implants.

Dentures: Dentures are the least expensive option. They consist of an acrylic base, which is pink or gum coloured, and teeth made from porcelain or resin. Well-made dentures should stay in place without adhesive although this is rarely the case. They don't prevent further bone loss as All-On-4 do, and over time, they will become looser as the jaw bone diminishes. Dentures have to be replaced at approximately 5-year intervals.

Dental implants: Dental implants can be chosen when one or more teeth need to be replaced. They are the most expensive option for those requiring full mouth reconstruction. People with bone loss may require lengthy bone grafts before the implant can be fitted. Unlike All-On-4 implants, where teeth can be fitted the same day, there is a four to six-month healing period between the placement of implants and teeth. The overall treatment time increases significantly if grafts are necessary, and this can add to the cost.

What should I expect?

You should expect to be in the dentist's chair for one to two hours during surgery.

Before treatment commences, your dentist will fully explain the process again and make sure that you are comfortable.

You will then be given a local anaesthetic, although a general anaesthetic may be prescribed in certain circumstances, for example, if you are extremely nervous.

Your dentist will be assisted during the process; the dental nurse will help make you more comfortable and ensure that your mouth is drained during the procedure.

Your dentist will then extract any remaining teeth and clean your mouth before placing the implants and fitting your new teeth.

After the procedure, you might feel pain and discomfort for the next few days, which can usually be managed with over-the-counter painkillers. Recovery time is usually minimum: patients go back to their regular routine a couple of days after surgery and in some cases, they are able to eat solid food right after the procedure.

Potential risks and side effects

• Implant failure (5% incidence)
• Infection
• Recent studies show that All-On-4 implants have a patient-related success rate of 94.8% and an implant-related success rate of 98.1% at five years. Results for a follow-up period of up to ten years are equally impressive with figures of 93.8% and 94.8% respectively.