Though many patients are suitable for All-On-4, there are two common issues that may prevent you from being a suitable candidate for this treatment:

1)       Not enough bone to anchor the implants

2)      Severe Bruxism (Grinding of the teeth)


  • If you’ve been told you don’t have enough bone:

When a tooth is lost or extracted, the bone that surrounds that tooth begins to shrink. All-On-4 specifically only uses four implants to support a bridge of teeth, which means that those implants have to be sufficiently wide and long. To support these larger implants, an ample amount of good-quality bone is required. In cases where  tooth loss has severely diminished the amount of bone available, only four implants may not be the best course of action without risking failure of the dental implants.

  • What can be done?

o        Placing more implants: Replacing all teeth with four implants might not be the only way to replace your teeth.  In some cases, a patient may not have enough bone for four long, wide implants, but they may have enough bone for shorter implants.  By placing more implants—five, six, even more—we can get enough support for the bridge of teeth.

o        Bone grafting: In many cases, bone can be regrown. There are two types of bone grafting, horizontal and vertical. Horizontal bone-grafting is straightforward.  Vertical bone grafting can be more complex, but highly skilled surgeons will be familiar with this newer technique to make implants possible in previously unsuited candidates.

o        Zygomatic implants: There is a special type of implant available for patients with severe bone loss that uses zygomatic (cheek) bone instead of the jaw bone to anchor implants.  Zygomatic implant surgeons such as Dr Helen can discuss this option for you in cases where bone grafting or additional implants may still not provide enough anchorage for dental implants.

  • If you’ve been told your bruxism/grinding makes you unsuitable:

Bruxism is a very common condition and generally happens during sleep.  Grinding/clenching your teeth puts undue forces on the implants and can lead to dental implant failure if left untreated. Luckily, there are many solutions to make you a good candidate for full mouth dental implants:

  • What can be done?

o        Placing more implants: By using more than  four implants to help withstand the forces of grinding can give you a good long-term prognosis on your full mouth dental implants.

o        Overnight Splints: A type of hard acrylic plate custom-fitted to your bridge called an occlusal splint can be created for you.  These splints, worn while you sleep, help protect your bridge from the wear-and-tear of grinding.

o        Removable Bridges: One of the most successful ways to ensure your night-time grinding doesn’t affect your bridge or implants is for your oral surgeon to design removable bridges for you.  These bridges are fixed to the implants, so they don’t move, fall out, or rub uncomfortably, but can be easily removed at night for sleeping.

ABOUT THE AUTHOR: Dr Helen Voronina

Dr Helen Voronina is the principal dentist at "Dr Helen's Dental & Implant Studio". Having graduated from the University of Melbourne and later from the Brener Implant Institute, in her practice she places emphases on the implant, aesthetic and reconstructive dentistry. She is a member of the Australian Dental Association, The International Congress of Implantology and The Australian Society of Implant Dentistry (ASID). She is a former chairperson for the National Dental Foundation and an official dentist for the Melbourne Hearts Football Club.