What Is All-On-4® and What Are the Alternatives?
Posted on: June 14, 2021
4 minute read
Living with major tooth loss can be devastating. It can affect how you smile, your ability to speak and chew and can have a number of knock-on effects to general health. The good news is that an innovative and long-lasting solution is available.
An increasingly popular way to replacing missing or damaged teeth is with All-On-4® dental implants. Using this new treatment option has enabled hundreds of thousands of people to enjoy a fully functioning and natural-looking smile.
What Are All-on-4® Dental Implants?
All-On-4® refers to a special technique used to place 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 posterior (back of the mouth) dental implants on a 45° angle into the upper jaw bone.
By adopting this new technique, the dentist can make the most of available jaw bone, avoiding areas in the mouth where bone is lacking. Today, All-On-4® is widely recognised for being a suitable option to replace all missing teeth.
The term All-On-4® refers to a full set of prosthetic teeth supported on just four dental implants that are placed using the trademarked technique (posterior implants at a 45-degree angle) with Nobel Biocare dental implants.
During surgery, the dentist places four titanium posts into the jaw which are attached to a fixed (non-removable) bridge of teeth within five days. 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. A new tooth bridge is attached to dental implants within five days of surgery, providing a quick and efficient solution for restoring a smile.
Benefits of All-On-4® Dental Implants
Choosing All-On-4® implants can provide a number of benefits, including:
- Replaces all teeth in just five days. Implants are placed on day one, try-in of teeth on day three and immediate final bridge fitted on day five.
- Fixed solution that looks and functions like real teeth. Implants integrate with the bone, meaning that tooth bridge attached to those implants are secured for a more natural feel and function.
- Fewer dental implants than conventional full mouth implants. Fewer implants allow for faster treatment and healing time and keeps treatment costs down.
- 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. 30-year history of predictable treatment outcomes.
- Healthier, natural-looking smile
- Willingness to smile openly. Enjoy the many benefits of smiling such as reduced blood pressure, increased endurance, reduced stress, boosts your immune system, elevates your mood.
All-On-4® Treatment Process
Success Rate of All-On-4® Implants
All-On-4® dental implants can usually last twenty years or more with good 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. Treatment factors that also contribute to dental implant 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.
Our Approach to All-On-4® Teeth
When it comes to making the first teeth after All-On-4® surgery, many dentists use a two-stage approach, first placing a temporary low-quality acrylic bridge to be worn while the mouth heals, then placing a zirconia bridge within 3 to 6 months of surgery. However, we take a single-stage approach that offers longevity to your first set of teeth.
Dr Norcross places a titanium-reinforced high-quality acrylic bridge that may last between 2 to 5 years (or longer) before needing to be replaced. Perth Dental Implant Centre’s approach avoids you having to replace teeth immediately after your mouth heals, saving you the cost of a replacement bridge within the first year of surgery.
Our dental lab technician fabricates teeth using a CAD-CAM milled titanium bar hidden within a high-quality acrylic bridge. When it comes to All-On-4 dental implants, the teeth as just as important as the implant system. A titanium frame adds strength, durability and longevity that almost always outlasts a bridge made of 100% acrylic. Using titanium to reinforce All-On-4® teeth is a tried and tested practice, however many dental labs lack the milling technology for titanium or cannot meet the 1-2 day turnaround time for surgery.
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 Dr Norcross, we can confirm whether you have enough healthy jaw bone to support dental implants.
If Dr Norcross 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 Nobel Biocare dental implants, using the All-On-4® protocol during the same surgery.
There are a few alternatives to All-On-4® treatment.
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
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
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.
Book a 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 using genuine Nobel BioCare dental implants.
Dr David Norcross has completed clinical residencies at the Malo Clinic in Portugal and Melbourne learning advanced All-On-4® techniques and delivers All-On-4® treatment from our East Victoria Park and Kelmscott clinics.
If you would like to discuss treatment options for restoring your smile, contact us at Perth Dental Implant Centre today.
- 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
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.