What Is All-on-4® and What Are the Alternatives?

4 minute read

Living with major tooth loss can significantly affect quality of life. It can affect how you smile, your ability to speak and chew and can have a number of implications for overall health. The good news is that an innovative and long-lasting solution is available.

A fixed teeth alternative to dentures known as All-on-4® or full mouth dental implants is becoming more commonly used. This treatment approach has used to treat hundreds of thousands of people worldwide, providing functionality and a healthier-looking smile.

What Are All-on-4® Dental Implants?

24-Hour Teeth

All-on-4® refers to a special technique used to place full mouth dental implants. This technique was developed by Professor Paulo Malo in the 1990’s, in conjunction with Swiss dental implant company Nobel Biocare. The technique involves placing two dental implants at the front of the mouth and two implants at the back of the mouth on a 45° angle into the upper jaw bone.

By adopting this technique, the dentist can make the most of available jaw bone, avoiding areas in the mouth where healthy bone is missing. Today, All-on-4® is widely recognised for being a suitable solution to replace all missing teeth.

The term All-on-4® - sometimes known as All-on-X or full arch dental implants - refers to a full set of prosthetic teeth supported on four to six dental implants that are placed using the unique surgical technique.

During surgery, the dentist places four titanium posts into the jaw which are attached to a fixed (non-removable) bridge of teeth. Placing implants on an angle in the upper jaw can avoid or reduce the need for a bone grafting procedure for patients who lack enough jaw bone for conventional dental implants.

Teeth are attached to dental implants within 24 hours of surgery, providing a quick and efficient solution for restoring a smile.

Benefits of Full Arch Dental Implants (All-on-4®) Dental Implants

Choosing Full arch dental implants including All-on-4®, can provide a number of benefits, including:

• Replaces all teeth in just 24 hours. Implants are placed on day one, an custom-milled PMMA (acrylic) bridge is custom-milled overnight in our dental lab, and then attached to implants the very next day.
• Fixed solution that looks and functions like real teeth. Implants integrate with the bone, meaning that fixed bridges attached to those implants are secured for a more natural function and look.
• Fewer dental implants than conventional full mouth implants. Conventional full mouth dental implants involve replacing an implant for every tooth. Fewer implants allow for faster surgery time, healing time and lower costs overall.
• May remove the need for a bone graft. Reducing or avoiding the need for a bone graft allows for quicker treatment and healing time and lower overall costs.
• Easy to clean and maintain. You can floss and brush your teeth as if they were real teeth.
• Tried and tested technique with 94% - 98% success rate. Long history of predictable treatment outcomes.
• Healthier, natural-looking smile
• Willingness to smile openly. Enjoy the many benefits of smiling such as reduced stress, enhanced immune system and mood elevation*.

*Cross, M. P., Acevedo, A. M., Leger, K. A., & Pressman, S. D. (2022). How and why could smiling influence physical health? A conceptual review. Health Psychology Review, 17(2), 321–343. https://doi.org/10.1080/17437199.2022.2052740

All-on-4® Treatment Process

• Consultation & 3D Smile Planning
• Implant Placement & Immediate Teeth
• Healing & Guided Reviews
• Crafting your Long-term Teeth
• Ongoing Care & Maintenance

Success Rate of All-on-4® Implants

All-on-4® dental implants can usually last twenty years or more with proper care and regular dental check-ups. A success rate of 94 - 98% makes them a reliable option for people missing all of their teeth.(1)

Successful outcomes are easier to predict with careful treatment planning, precision surgery and ongoing follow-up care.

Other factors that contribute to treatment success include:

• Jaw bone density and strength
• Location of the implant (the back upper jaw being the most difficult location with less bone height and density)
• General health and the person’s ability to heal
• Good oral hygiene
• Not smoking

Risks and Complications

All-on-4® and dental surgery in general has risks, we’ve listed a number of these below. Before proceeding with any treatment plan, your dentist will explain possible risks in detail and answer any questions you may have.

Risks can include:

• Temporary numbness in the chin or jaw
• Temporary speech issues
• Temporary pressure or gaps under teeth (resolved by adjusting the bridge)
• Loose bridge (requires tightening or replacing screws)
• Chipping or breakage of new teeth
• Implant fails to integrate with the jaw bone and needs removing and replacing
• Jaw bone loss is rare, but can occur and cause implants to loosen

While every effort is made to reduce risks and complications, no dentist can guarantee implant success. Roughly one in every 20 dental implant fails to integrate with the jawbone or becomes loose over time, usually due to a number of contributing factors.

In the unlikely event that a dental implant fails to integrate with the jaw bone, it’s simply removed and then replaced after a few months, at no extra cost.

Suitability for All-on-4® Implants

All-on-4® dental implants can be suitable for current denture wearers or those who have lost most or all of their teeth. The ideal candidate should:

• Have healthy jawbone and gums. This means having enough healthy jaw bone and gum to anchor down dental implants.
• Have good health to undergo surgery. Patients with compromised health, such as uncontrolled diabetes may not be eligible for dental implants. During a consultation, we’ll ask for your full medical history to rule out any prescriptions, medications or allergies that can interfere with surgery and recovery.
• Do not smoke. Smoking can cause gum disease and lead to implant failure.(2) It’s advised to give up smoking before you commit to treatment.
• Maintain proper oral hygiene. Prosthetic teeth require regular brushing and flossing just like natural teeth. This helps to avoid plaque build-up, gum disease, inflammation and infection.

All-on-4® Teeth Designed in-house

At Perth Dental Implant Centre, your All-on-4® replacement teeth are custom-designed and milled by our dental technician in our in-house dental laboratory. Having an on-site lab allows our team to maintain close oversight of the entire process, helping ensure your new teeth are carefully tailored to your individual needs, smile and bite.

A custom-milled PMMA bridge is typically attached within 24 hours of surgery, allowing you to leave with fixed teeth the next day. This temporary bridge is worn for approximately 3 to 4 months while the implants integrate with the jawbone and the mouth heals.

Once healing is complete, the temporary bridge can be replaced with a highly durable and aesthetic monolithic zirconia bridge designed for long-term function and appearance.

What is Bone Grafting?

Bone grafting is the process of building up enough jaw bone to support dental implants. It involves taking small amounts of bone from other areas of the mouth, combining it with artificial bone and placing it in the area where bone has been lost. The transplanted bone is then covered and left to heal over time.  The procedure can either be done prior to getting dental implants placed or at the same time.

All-on-4® makes the most of existing jaw bone by placing implants in the optimal position in the jaw. This can sometimes avoid or reduce the need for a bone graft. After a comprehensive examination and 3D bone scan with your dentist, we can confirm whether you have enough healthy jaw bone to support dental implants.

If your dentist determines that extra support is needed for your new bridge, he may discuss placing additional implants or longer implants with you. Pterygoid and zygomatic implants are longer implants that can sometimes be used instead of a bone graft. These implants are placed in additional to four dental implants, using the All-on-4® protocol during the same surgery.

All-on-4® Alternatives

Implant-Retained Dentures

This is essentially a denture you clip on and off dental implants using denture abutments. As little as two dental implants can support a lower denture and four implants can support an upper denture. Just like full removable dentures, these overdentures need to be taken out for cleaning and overnight. Benefits include:

• Lower cost
• Easy to clean by removing the denture
• Patients with severe bone loss get added support for facial muscles
• Helps prevent further bone loss

The major disadvantage with implant-retained dentures is that while the same amount of surgical effort (and often cost) is applied to carefully place implants - the prosthetic teeth used for implant-retained dentures are made of custom-milled PMMA (acrylic) and are prone to higher wear and tear than ceramic restorations like zirconia.

Full Removable Dentures

This treatment alternative has the longest history of providing patients with replacement teeth to improve their smile, enable chewing, and make speaking easier. The materials used to make dentures have greatly improved and some people choose this option for the following reasons:

• Lower cost
• Easy to clean
• No surgery required

Full Removable Dentures

Hybrid options

It’s possible to replace missing teeth using a combination of dental implants in the lower jaw and a full denture in the upper jaw. Upper dentures typically have good suction because they cover the entire roof of the mouth, making them more tolerable than lower dentures.

Ask you dentist about your options during a free consultation.

Book a free implant consultation

Perth Dental Implant Centre is proud to be recognised as an All-on-4® Centre of Excellence by Nobel BioCare, home of the All-on-4® treatment concept. One of a handful of All-on-4® Centres of Excellence across Australia, this designation demonstrates our surgical experience and completed training in All-on-4® techniques .

Our experienced dentists have adapted the All-on-4 technique for clients who require All-on-6, full mouth dental implants or longer pterygoid or zygoma implants, and can tailor the most suitable treatment plan to your needs.

If you would like to discuss treatment options for restoring your smile, contact us at Perth Dental Implant Centre today.

References

1. https://meridian.allenpress.com/joi/article/37/4/431/2383/The-All-on-Four-Immediate-Function-Treatment
2. https://www.nature.com/articles/6400670
3. Malo P, de Araújo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4® implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc 2011;142:310-204
4. Cross, M. P., Acevedo, A. M., Leger, K. A., & Pressman, S. D. (2022). How and why could smiling influence physical health? A conceptual review. Health Psychology Review, 17(2), 321–343. https://doi.org/10.1080/17437199.2022.2052740

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.