All-on-4 Procedure – implant teeth, graft bone, graft gum

FAQs

Are all All-on-4 Procedures the same?

No. Dr Gen Russo of Gentle Dental Care has studied the All-on-4 Procedure in depth over many years. He has also made several trips to Europe (where the All-on-4 procedure was developed) to learn more about it.

At Gentle Dental Care:

• All All-on-4 procedures are performed by an experienced Oral Surgeon, not general dentists or other non-surgical specialists. This is critically important since the procedure involves anesthesia and many cases can be very complex given the general health and bone condition of the patient.
• Gentle Dental Care has extensive experience in treating All-on-4 patients with all types of bone conditions. Many dentists that offer the All-on-4 procedures have very little experience with difficult cases.
• Gentle Dental Care has done enough cases to be able to refine the procedure and enhance the protocol for handling almost any bone condition.

How does All-on-4 differ from a denture?

The All-on-4 Procedure provides patients with new teeth that are firmly fixed in place, and look and function as close to natural teeth as possible.

The main differences include:

• A denture or partial denture is a removable appliance and should be taken out each night for cleaning.
• Dentures often slip (or sometimes fall out) even under normal use. Even with adhesives many people find that eating, laughing, being active and sometimes just talking can be a challenge with dentures.
• Many foods are off-limits due to the risk of dentures slipping or falling out.

All-on-4 teeth are connected to the implants and are solidly fixed in place (what we call an implant-supported fixed bridge). They are bushed and cleaned like normal teeth (though flossing is different) and are the closest thing possible to natural teeth in terms of look, feel and function.

The All-on-4 bridge also allows you to bite with much more force than dentures since the stresses are transferred directly to the bone rather than to gum tissue. You can eat almost any of your favorite foods without worrying about your teeth.

Will my implant supported teeth be uncomfortable and push on my gum tissue like a partial or a full denture does?

No. Your implant-supported teeth are fixed in place. They will not slip and do not need to be removed for cleaning. They do not press on the gum tissue and therefore do not create any of the discomfort common with dentures.

Can people tell if I have had the procedure?

An initial examination assesses your smile to determine the location of the junction between the fixed bridge and the jawbone. We are able to adjust your smile line during the procedure to make sure your new smile is not too gummy and that the top (or bottom) of your prosthesis is completely hidden.

Some procedures use as many as 8 implants. Why does the All-on-4 Procedure at Gentle Dental Care use only 4 implants?

Research done by Nobel Biocare, and clinical experience at Gentle Dental Care, show that in most cases 4 implants (specially placed with some angulated) are as effective in supporting a full arch fixed bridge in either jaw as 5,6, or 8 implant restorations. On rare occasions (where bone is soft or worn down) additional implants may be needed, but these situations are the exception and usually only in the upper jaw.

Gentle Dental Care has long experience with the All-on-4 protocol. While many dentists continue to use older techniques (using as many implants as they feel the bone will support) Gentle Dental Care has shown that in most cases no more than 4 implants are necessary.

Additional implants expose the patient to unnecessary surgery, treatment time and costs.

Does the All-on-4 Procedure involve bone grafting?

In most cases (even the most difficult ones) Gentle Dental Care dentists are able to place 4 implants and restore a full arch of teeth without bone grafting. This is accomplished by the special placement and angulation of the implants which takes maximum advantage of the available bone without grafting.

The use of the All-on-4 technique can eliminate the need for bone grafting in more than 95% of full arch cases.

How long does an All-on-4 Procedure take?

Previous approaches to restore a full arch of teeth usually involved 6 or more implants, bone grafting, and as many as 18 months of treatment. That meant no teeth or a temporary denture for more than a year!

The All-on-4 procedure requires just one or two visits to allow the dentist to prepare the case (CAT Scan, X-rays, impressions, photos, etc.). After this initial work-up, the patient is scheduled to have the implants and the new teeth placed in just one appointment (even when extractions are necessary). The patient comes to the practice in the morning with bad (or no) teeth and leaves in the afternoon with a beautiful set of fixed, functional teeth.

Occasional check-ups are required over the following weeks and months. After six months (with the gums fully healed and the implants fully fused to the natural bone) we take a new impression and prepare a final, permanent set of teeth with additional titanium support in the bridge.

Your new, fully-functional teeth will last for decades.

Why don't all dentists use the All-on-4 Procedure?

Gentle Dental Care was an early-adopter of this procedure and has closely followed its evolution and development. Our practice is one of the most experienced users of the All-on-4 procedure in Australia.

Many dental implant practitioners continue to use older approaches that require more implants and longer treatment times. They are also unable to provide the technology and expertise to do a one-day All-on-4 Procedure.

What is the success rate of the All-on-4 Procedure used at Gentle Dental Care?

Published studies indicate a 98.2% implant success rate when using the All-on-4 technique in the lower jaw. Similar studies show a 97 to 98% success in the upper jaw for the same procedure.

On the rare occasions an implant fails we simply place a new implant in a slightly different position to take advantage of existing bone. Our lab then refits the fixed bridge to align with the new implant.

What type of follow-up visits are necessary?

For the All-on-4 procedure, the implants are placed the day of surgery and follow-up checks are done at 1 week, 2 weeks, 2 months and 6 months. At the end of the 6 month period fabrication of the permanent teeth begins and requires one or two additional visits over the next few months until the final teeth are delivered.

How will it affect my diet? When can I eat solid food again?

Solid foods can be eaten the same day – but not all solid food. Initially you must follow a modified food diet. That is foods that are soft enough to be cut with a fork.

Examples of the modified food diet are scrambled eggs, meatloaf, mashed potatoes, hamburger, fish and pasta. You can not eat foods that require any tearing or biting with your front teeth (pizza, sandwiches, fruit).  Avoid hard foods such as carrots, chips, apples, nuts and chewing gum.

The modified diet applies until you receive your permanent prosthesis (usually about six months). Once your final bridges are fitted with the titanium frame you can resume a normal diet.

Why do I have to wear a provisional set of teeth and not my permanent new teeth right away?

On the day of your procedure we place the implants and a new set of teeth called a long-term provisional prosthesis. This provisional set of teeth is made entirely of acrylic resin, which places less stress on your new implants during their first few months of use. The teeth are fixed in place and are fully functional. You can laugh, talk, play sports and be normally active. Your smile is perfect.

You must be careful what foods you eat in the first few weeks following your procedure and your normal diet must exclude hard, tough or brittle foods for a few more months.

Once your gums have healed and the implants are completely stable (usually about six months) we fabricate a permanent bridge with acrylic or porcelain teeth. These teeth have a titanium framework inside.

This permanent set of teeth is fitted to your gums and adjusted to be sure we achieve an ideal fit in your mouth and your bite and smile are perfect.

If I need both upper and lower full-arch replacements, do they both have to be done at the same time?

This best way to control your biting plane and bite is to do both at the same.

This is a complex procedure and is beyond the capacity of most dentists. At Gentle Dental Care we have the experience, facilities, in-house expertise and technology to complete both arches in one day. In fact we do so successfully almost every day in each of our centers.

However, treatment can be sequenced to meet the financial, health or other individual needs of the patient.

Is the All-on-4 procedure unsuitable for some people?

Very few people who need a full arch of replacement teeth are not candidates for the All-on-4 procedure. Each candidate is fully evaluated to determine the most appropriate plan of treatment to address their individual dental needs and we will of course let you know if the All-on-4 procedure is not suitable for you.

Gentle Dental Care requires all candidates to be stable medically before entering treatment. That may entail contacting your physician about any existing medical conditions and getting your doctor to provide medical clearance.

Where the All-on-4 procedure is not the indicated treatment approach, we may recommend conventional dental procedures. We initially determine the appropriate treatment approach at the consultation appointment and confirm that treatment plan at the evaluation stage.

The All-On-Four procedure may be challenging or difficult to perform on people with extreme bone loss. At Gentle Dental Care can consult about your specific situation and identify the best course of treatment for you.

Your health and well-being will determine our course of action and this is best assessed based on our substantial clinical experience with this procedure.

If you have any more questions, contact Gentle Dental Care to arrange a FREE initial consultation.