Hello, I'm Dr. Merhdad, founder of Yalda Dental, and today I like to speak about a topic that I've been asked many times, several times from my patients, and it's all on four. All four is a general concept of the number of implants we place on edentulous jaws. It could be only one or totally edentulous patients who've lost all of their teeth on upper and lower arches. As I mentioned, it is a general concept because it's not always doable or logical to do the full arch, 14 or at least 12 teeth on four implants. It depends on so many different factors: depends on the patient's age, diet, health, size of the arch, and many other elements that are all involved. So I prefer to mention and to name this instead of saying all on four, we say all on X because so many times, as I mentioned, we need more than four implants for having a good force distribution and having it sturdy and functional and long-lasting. Prosthesis means the bridge on the upper or lower jaw or both. That is the all on four concept.
Who is a good candidate for an All on X implant?
Who's a good candidate for All on Four or all on X implant supported bridges or prosthesis? As I mentioned, many factors are involved: patient's health, medical conditions, the amount of bone we have, and if the bone is not sufficient for placing implants, would it be possible to augment the bone and add the bone graft. So the thickness, it means the width and the height of the bone, are very important. Another important thing is patient hygiene because we know that when we are talking about all on X, it means that the patient doesn't have their teeth anymore. It's very important to know and to spot what was the reason they lost their teeth: trauma or familial aggregation of gum disease, which is periodontitis, or decay or caries. Unfortunately, most of the cases, most of the people who lose their teeth, they lose them due to poor oral hygiene. Now we have to be careful and we have to educate our patients before thinking about all on four, six, eight, and give them implants to focus on their oral hygiene, motivate them, improve the oral hygiene, make sure that for a long time they keep up with good hygiene, and then we can do implants, bone grafts, or anything. So any magical dentistry, any professional and advanced dentistry without a good follow-up and maintenance on both sides, dentist and their hygienist and their team, obviously, and the patient, if the patient does not follow the instructions, if the patient doesn't do a maintaining of the prosthesis, anything we do as dentists, as surgeons, is not going to last long and they are going to fail.
How long does it take to make an All on X?
How long an all on four takes to be made varies a lot and depends on so many things. Do we have enough bone to begin with to place the implants as many as we need, four, five, six, eight? If we've lost the teeth or patients lost their teeth many, many years ago, most probably we don't have enough bone because the nature of alveolar bone is shrinking after the tooth extraction. Alveolar bone likes internal forces. The moment the tooth is out means there's no root inside the alveolar bone, so the bone starts shrinking three-dimensionally, horizontally, and vertically. The amount of shrinkage is very important because if we need just a little augmentation of the bone, like 10% or 20%, it will be fast, and many times we can do the bone graft and the placing of implants simultaneously at the same time. If the bone is atrophic and the bone loss or bone resorption is severe, we need way more time, sometimes a year, sometimes longer, just to regenerate the bone and augment the new bone. The bigger the graft, the longer it will take for bone regeneration.
What it looks like, it's almost always a one-piece bridge made out of different materials. It could be acrylic, it could be porcelain, it could be a combination of porcelain and titanium, and based on different cases and different situations, we choose different materials. Most of the time, it's just one piece, as opposed to our natural teeth that are individual and we have a contact type, but teeth are not attached to each other. Implant supported bridges are always attached and in one piece. In all on four or all on six, if we want to have multiple pieces and not just one piece, we definitely need to place more implants.
Can we have one implant per tooth?
Another question I've been asked is can we do one implant per tooth? We can, but we shouldn't because the more implants we have in the mouth, the more possibility for bone loss and problems with the soft tissue, gingival tissue that we call it a gum.
How long do All on X implants last?
Another question I've been asked quite frequently is how long an implant supported bridge or an all on X lasts. The goal is lifetime. New implants with very advanced surface textures and different types of platforms, they've been designed to last forever, but unfortunately, complications might happen. It depends on the patient's oral hygiene and patient's medical condition and unpredictable incidents like trauma.
What type of care and maintenance do All on X require?
What kind of care and maintenance does an all on X implant supported bridge require? A very caring and very thorough maintenance of all on X processes or bridges need a lot of work from both sides: patients, and dentist, and hygienist team. We need to have specific dental flosses, use it at least twice a day, brush like we brush natural teeth, and a water pick, and many other devices that based on the design and based on different cases, we instruct our patients.
What are the potential problems or complications with All on X?
In the end, what are the potential problems or complications with all on four dental implants? Say what are the potential problems or complications with all on four implants? What are the potential problems or complications with all on X implant supported bridges? Failure is one of them due to unpredictable trauma, poor oral hygiene, initiation of medical conditions, specifically diabetes. They all could cause bone loss and loss of support of the implants, which is bone and soft tissue means gum, and sometimes the screws that are holding onto the all on X bridge, they might break or they might lose. The good news is it doesn't happen very often.
Are All on X implants a permanent solution for missing teeth?
Are all on X implant supported bridges a permanent solution for missing teeth? They are not the only solution, but I would say they're one of the best solutions. We can have removable bridges or let the dentures on implants supported by implants. They are functional, they are really a good solution, but all on X bridge is fixed, so financially, it is more expensive, but it has a better quality and psychologically helps patients a lot because they don't need to remove that denture and again feel edentulous and with no teeth.
Are All on X implants a good option for seniors?
Are all on four implant dentures good for seniors? Yes, they are because maintaining an overdenture means a removable denture sits on implants and gets support from implants to be stable, sturdy, and stronger than we chew compared to a traditional denture. They are a better solution for senior people, for people who are handicapped, or they can't take care of their hygiene very well when they have bridges or teeth in their mouth. Implant supported overdenture is a better option because they can remove it, clean it, rinse their mouth, and put it back on. When it's fixed, it needs more care and more particular maintenance.
All-on-4 is a fixed, implant-supported treatment for patients who have lost their teeth due to gum disease, tooth decay, or injury. Replacing missing teeth with All-on-4 will benefit your appearance and your health, giving you the stable, functional, and cosmetic solution you’ve been looking for.
Dentures or All-on-4: What’s the difference?
There is a significant difference between traditional dentures and All-on-4 implant-supported dentures.
Traditional dentures commonly have an acrylic framework to match the color of the existing gums, and false teeth made of porcelain that are attached to the framework. The denture sits on the alveolar bone and gum, often with denture adhesive or paste to hold it in place. Patients with ill-fitting dentures often complain of the teeth slipping or falling out when eating or talking.
All-on-4 uses four dental implants, generally made of titanium, which are placed in the jaw bone. The denture is then attached to the implants, making it immobile, strong, and functions as well as natural teeth. Best of all, your All-on-4 prosthesis can be placed on the same day as your implants, so you don't have to wait to get the restored smile you deserve.
All-on-4 treatment does require a certain amount of quantity and quality of healthy bone, so it may not be right for everyone.
During your initial appointment at our Yardley dental office, Dr. Soheili or Dr. Saraghi will perform a comprehensive exam and take X-rays, 3D CT scans, study models, and photographs. They will present a thorough assessment, diagnosis, and treatment plan, discussing with you the advantages and disadvantages of both, and helping you decide which is right for your specific needs.
The All-on-4 Procedure
The first step in restoring your smile is implant surgery. During this stage, we complete any necessary tooth extractions and bone grafts, and place the implants. After your bone has healed and the implants are fused in place, the restorative phase occurs, during which impressions and records will be taken, and your final prosthesis will be made.
You will need to visit our Yardley dental office for cleanings and checkups every three months for two years, and then every six months. This helps us monitor the stability of your implants, the fit of the prosthesis, and the health of your gums.