For those who had to prematurely part with the set of teeth that mother nature gifted them with, you would’ve found yourself in the relentless pursuit of new, bionic teeth. If you’ve done enough online research, you would’ve undoubtedly come across “All-on-4TM” advertisements. This revolutionary approach promises a complete set of teeth on just four implants, all in a single day. It seems like a miracle, but what does this jargon mean? Are you suitable for this treatment? And what other alternatives are available to you if you opt for a non-surgical approach or simply do not qualify for All-on-4TM?
I’ve written many articles on full mouth teeth replacement, the process and the treatment cost. This time I want to focus on other alternatives to All-on-4TM. such as removable dentures, fixed bridges, zygomatic implants, and biominiature implants. I will dissect the pros and cons of each, alongside approximate costs, guiding you through the labyrinth of tooth replacement possibilities.
As I go through the clinical aspects of these procedures, I’ll discuss a critical factor that often influences decision-making just as much as clinical efficacy= cost. Understanding the financial aspect of tooth replacement options is as crucial as finding the option that aligns with your expectations and financial considerations.
What is All-on-4TM Dental Implants?
In the pursuit of restoring confidence and optimal oral function for those grappling with extensive tooth loss, the game-changing concept known as “All-on-4TM dental implants” emerged as a beacon of hope. Dubbed “Teeth in a Day,” this dental restoration technique, pioneered by the visionary Dr Paulo Malo in 1998, has revolutionised countless lives, offering a fixed set of teeth.
What’s the nitty-gritty of All-on-4TM? Picture this: four strategically placed dental implants in the jawbone, with two in the front of the mouth, and two at the back. These implants create a robust foundation for a custom-made prosthetic bridge, which closely mimics natural teeth. While the term “All-on-4TM” was trademarked by Nobel Biocare, it’s essential to note that other reputable implant brands can equally champion this restorative concept. As a practitioner, my allegiance lies not with a particular brand, but with reliability and exceptional support of the final result.
The genius of the All-on-4TM approach is that it makes the most of the bone you already have, often avoiding the need for expensive and complex bone grafts. By tilting the back implants away from the sinuses, this method uses your bone efficiently, providing great stability. Yet, flexibility is key—some cases may call for more than four implants, leading to the term “All-on-X,” accommodating any number of implants, typically ‘All-on-5’ or ‘All-on-6.’
The advantages of All-on-4TM:
Fast Results: While the process can take many months to complete, most people can have a new set of teeth within days of the surgery. These teeth might be temporary and still require some adjustments, but they often look spectacular.
Improved Aesthetics: the prosthetic bridge can closely mirror natural teeth, providing a visually seamless result. You could choose a perfect smile you’ve always dreamt of or as some of our patients request a natural look. We can set them up with gaps between the teeth or even twist some teeth to mimic your natural set. The more information you provide us with about what you envisage your smile to be, the better we can understand what you want. Of course, there are some limitations, but if there is any dental procedure that has the greatest flexibility in the result, it would have to be All on 4.
Enhanced Bite Functionality: in contrast to moving dentures, All-on-4TM Concept stabilises the prosthesis, allowing you to chew a diverse range of foods. I still recommend going easy on really hard crusts, and biscuits and not cracking nuts or open beer bottles with them.
Bone Preservation: It is often said that the presence of implants stimulates bone tissue, preserving your facial structure. This is only a part of the story. Bone can recede from around the implants especially if they are not well looked after. However, if the implants are done well and are looked after, they can support your jaw bone after tooth loss. Without the implant, the rate of bone loss is significantly faster. What’s also interesting to note is that in contrast to implants, dentures promote bone resorption.
Who is suitable for All on 4TM?
While All-on-4TM dental implants can be a game-changer for many, not everyone fits the bill. Key factors include sufficient bone volume, overall health, commitment to oral hygiene, and realistic expectations. If your teeth can be saved, I would steer you away from implants altogether – you will save yourself surgery and thousands of dollars. It’s crucial to align your goals with your dentist’s insights.
The All-on-4TM journey
So you’ve done your research and decided to proceed with All-on-4TM, now it helps to understand the process. Depending on your individual needs, it can vary from person to person, but in simple words, it will follow this pattern:
1
CONSULTATION
The process begins with a comprehensive examination, exploring your dental history, approximate fees, goals and options. Photographs and 3-D scans might be taken at his stage for reference. This is a good time to ask any questions you might have.
2
3-D SCAN
Proceed with a scan (Cone Beam CT) to assess the volume and density of your jawbone and suitability for full mouth implants.
3
PLANNING
After the scan, your dentist can discuss a realistic treatment plan, possible complications, recovery, the actual fees and the timeframe for your treatment. A series of pre-surgical appointments will be scheduled to take the measurements of your mouth and remake your temporary teeth.
4
SURGERY
A qualified anaesthetist will administer general anaesthesia. You will have a relaxing day asleep while we work away removing your remaining teeth, inserting new implants, and taking measurements for your new teeth. The amazing thing about immediate implants is that this will all be done in one day while you are asleep.
5
NEW TEETH
Voila! You will go home overnight and return within a few days for your new but temporary teeth. This is exciting! Very exciting for all of us. We attach an acrylic bridge to your new implants and now you can go home smiling.
6
RECOVERY
The mouth heals surprisingly quickly and provided you follow our instructions and take your medications, it usually happens uneventfully. We will give you clear instructions on what to do and not to do after your surgery as well as how to care for your new implants. It will take five to six months for your jawbone to grow around your implants, so particular care should be taken to eat soft foods and not apply undue pressure on them.
It is normal to experience some bruising and swelling, which starts subsiding within a few days. With the help of anti-inflammatory medications, you shouldn’t experience much pain. It often surprises patients how smooth the recovery process is.
7
SUTURE (STITCHES) REMOVAL AND REVIEW
You return in two weeks to have your sutures removed.
You will need to see us every month for quick reviews to make sure the healing process is proceeding well
8
NEW BRIDGE
In about five months, provided your implants have integrated with the jawbone, it’s time to make you a new, final bridge. Again, we’ll see you several times to take measurements and try your new teeth to make sure they fit and suit your face and you are happy with them.
9
MAINTENANCE AND CARE
Please care for your implants and your new teeth like you would for your most precious possession and visit your friends at the dental office once every six months for checkups and cleans.
The Price of All-on-4 Dental Implants:
As with any advancement, All-on-4TM comes with considerations, including cost. The approximate fee range in Australia is $25,000 to $35,000 per arch, contingent on the bridge material you select, the number of implants used, any additional bone grafting requirements, and whether or not the surgery is performed under general or local anaesthesia. General anaesthesia will incur additional costs in the order of $5,000 – $10,000 but the good news is that you will qualify for a generous Medicare rebate on the anaesthetic service.
Beyond All-on-4TM:
While understanding the fundamentals and benefits of All-on-4TM is paramount, it’s equally crucial to acknowledge that alternatives exist. Whether it’s due to general health constraints, financial considerations, or a preference for non-invasive solutions, it is important to explore all the options. This guide empowers you to make an informed decision that aligns with your unique dental needs and aspirations.
All on 4TM Alternatives
While “All-on-4TM” remains an economical and modern way to replace teeth, it, might not be a one-size-fits-all answer. I’ll talk about some alternative paths for those seeking tooth replacement options other than All-on-4TM, each with its unique merits and considerations. So here we go…
Traditional Dental Implants
The main difference between All-on-4TM and traditional dental implants is that in people who still have their teeth, teeth are removed, and then you wait about three months for your jaw to heal before the implants are placed. In contrast to immediate implants, this process takes more time. Traditional dental implants take a more measured, step-by-step approach. Unlike All-on-4TM implants, which can give you new teeth in just a few days, the traditional method takes longer but has a long track history.
Key Differences and Advantages of Traditional Implants over All-on-4TM:
Longer Treatment Duration: Traditional implants require a longer timeframe compared to All-on-4TM approach. The process involves several stages: first, the damaged teeth are removed, and then there’s a waiting period of about three months to allow the jawbone to heal and integrate. This healing period is crucial for ensuring that the bone is strong enough to support the implants. After this healing phase, the implants are surgically placed into the jawbone, followed by another healing period to allow osseointegration, where the bone grows around the implant. Finally, the abutments and crowns are attached. This entire process can take from several months to over a year, depending on individual healing rates and any additional procedures needed. Why go through this, you may ask? Sometimes it’s necessary. New research has shown that bacteria from existing dental infections or active gum disease can reinfect freshly placed implants, so unless these diseases are under control, a staged approach should be considered. Other times, infections can dissolve bone to the point that immediate All-on-4TM implants are simply not possible, again necessitating a staged approach.
Easier Surgical Procedure: It is easier to place dental implants into already healed bone, rather than trying to anchor them in the hollow socket left after tooth extraction. Whilst this still requires considerable skill, it makes the procedure easier for the surgeon, and therefore more predictable. Modern advancements in dental technology, such as guided surgery techniques and 3D imaging, have significantly improved the precision, predictability, and comfort of the procedure, thus this factor alone is not significant enough to base our decision on.
Allows bone regeneration: The quality and quantity of the jawbone play a critical role in determining whether a patient is a suitable candidate for traditional implants. If the jawbone has insufficient volume, which can be caused by prolonged tooth loss, periodontal disease, or other factors, bone grafting might be necessary. Bone grafting involves adding bone material to the jaw to create a solid foundation for the implants. This procedure adds to the overall treatment time and cost but is essential for ensuring the success and longevity of the implants. The assessment of bone quality is done through clinical examination and imaging techniques like X-rays and CT scans. The downside of this process is that temporary dentures cannot be worn during this time. Let’s face it, going without teeth is hardly acceptable these days.
Cost
Traditional implants at times are more expensive than the All-on-4TM method. The higher cost is due to the multiple stages involved, the higher number of implants and materials used, and the additional procedures that might be required, such as bone grafts. On average, a single traditional implant can cost between $4,500 and $6,000. For a full-mouth restoration, the cost can range from $20,000 to $45,000 or more, depending on the number of implants needed and the complexity of the case. While the upfront cost is substantial, traditional implants are known for their durability, stability, and natural appearance, which can make them a cost-effective solution in the long run.
In summary, traditional dental implants take longer and can be more costly than All-on-4TM implants, but they offer a highly reliable and long-lasting solution. Instead of making up your mind on a particular approach, it’s best to have an experienced dentist evaluate your needs and make a recommendation on the most suitable approach for you.
Dentures
Removable dentures are a cost-effective way to replace some missing teeth when at least a few good natural teeth remain, but they come with some trade-offs. They don’t provide the same stability as dental implants and are significantly less comfortable to eat with. Made of acrylic or a combination of Cobalt/Chrome metal and acrylic, dentures can cause discomfort, and ulcers, affect speech, and need careful cleaning and maintenance. However, if cost is a big consideration, you can add as many teeth to a partial denture at little additional cost.
Types of Dentures
1. Partial Removable Dentures:
- Metal Framework: These have a metal base with acrylic teeth and gums. They are durable and less bulky.
- Acrylic Framework: These are all-acrylic and often used as a temporary solution. They’re less expensive but not as strong or comfortable as their metal counterparts.
2. Full Dentures:
- Conventional Dentures: These are made after all your teeth are removed and your gums have healed for three months. They fit well and feel comfortable, but you’ll be without teeth during the healing period
- Immediate Dentures: These are pre-made before your teeth are removed, so you can wear them right after extraction. While convenient, they may need to be relined and refitted as your gums heal and shrink.
Advantages of Removable Dentures:
Affordability: Removable dentures are significantly cheaper than dental implants or All-on-4TM, making them accessible to more people.
Non-Invasive: The process of getting dentures involves fewer dental visits and no surgery, which is easier and less stressful for many patients.
Quick Replacement: If dentures break or need adjustments, the process is usually straightforward and quick. You can also add teeth to partial dentures if you lose more teeth.
No Surgery: Since dentures don’t require implants, you avoid the risks and recovery time associated with surgical procedures. If you taking medications such as bisphosphonates for osteoporosis, depending on how long you have been taking them, implants might be a risky option, and therefore dentures are preferable.
Considerations for Removable Dentures:
1- Stability: Dentures can move around in your mouth, and cause sore spots, especially while eating or speaking. This can be uncomfortable and may require adhesives to keep them in place.
2- Maintenance: Dentures need daily cleaning to prevent fungal infections, bad breath, and stains. Improper care can lead to oral health problems like gum disease.
3- Replacement: Dentures can wear out or lose their fit over time due to changes in your mouth. Regular check-ups and adjustments are necessary to maintain comfort and function. You will need to replace dentures from time to time.
4- Dietary Restrictions: Certain foods, especially hard or sticky foods, can be difficult to eat with dentures and might damage them. You will need to adjust your diet.
5- Speech Challenges: It might take some time to get used to speaking with dentures. Initially, they can cause lisping or slurred speech, but this usually improves as you adjust.
Cost
Removable dentures are the most budget-friendly option for tooth replacement, with costs ranging from $1,500 to $6,000 or more depending on materials and complexity.
In conclusion, removable dentures offer an affordable solution for significant tooth loss, balancing cost with basic functionality. They do have limitations, including potential discomfort, the need for regular maintenance, and dietary adjustments. When considering dentures, it’s important to weigh these factors based on your specific needs, health, and personal preferences.
Fixed Bridges
Dental bridges can be supported by either natural teeth or dental implants. For the sake of this exercise, here I’ll focus on tooth-supported bridges as an alternative to implants. The main advantage of dental bridges is that they’re the only non-surgical option to “All-on-4TM” that offers fixed teeth. However, bridges rely on healthy adjacent teeth for support, so it’s crucial that you have enough strong, healthy teeth to hold a bridge. The strength of these neighbouring teeth is vital, and any problems with them can affect the entire bridge.
Advantages of Fixed Dental Bridges
Why choose bridges in the era of implants? Implants are great, but not everyone can have implant surgery. Here are some benefits of bridges over implants:
No Surgery: This is a big plus. Some people aren’t ready for surgery or can’t have it due to health reasons. For instance, smokers, those on certain osteoporosis medications (like bisphosphonates), or people with uncontrolled diabetes might not be good candidates for implant surgery.
Fast Results: All-on-4TM and implants take time and can be a slow process. Bridges, on the other hand, can sometimes be made in as little as a week.
No Bone Grafting: If you don’t have enough bone for implants, you might need bone grafting. With bridges, you can skip that.
Cost: The cost of bridges can vary, but they can sometimes be more cost-effective than All-on-4TM.
What to Consider?
1- Adjacent Tooth Health: The teeth next to the bridge (called abutments) need to be free of gum disease and ideally not have had root canals. All decay must be under control. If you’re prone to decay, change your diet first to avoid future problems.
2- Maintenance: Bridges require diligent oral hygiene to prevent gum disease and decay. You’ll need to use special floss, called “superfloss,” to clean under the bridge. This needs to be done daily.
3- Replacement: A fixed bridge can’t be easily removed for maintenance or repairs. Any issues may require a complete replacement.
4- Complications: One possible complication of a bridge, crown, or even a large filling is that the nerve in the supporting tooth can die as a result of being shaved for the bridge, and become infected, needing root canal treatment.
Cost
The cost of bridges can vary widely, sometimes even exceeding that of All-on-4TM. Depending on the configuration and the number of teeth being replaced, bridges can range from $3,700 to over $20,000.
In summary, fixed dental bridges offer stability, aesthetics, and a less invasive alternative to All-on-4TM, but they depend on the strength of neighbouring teeth. They are a good option when implants aren’t possible, balancing advantages with potential issues. Careful consideration and a consultation with your dentist are key to making an informed decision among tooth replacement options, including All-on-4TM.
Biominiature Implants
In the world of tooth replacement, implants have become a favoured option for both dentists and patients, but what happens if the isn’t enough bone to hold conventional implants? An interesting alternative has emerged in more recent years – Biominiature implants. Biominiatures should not be confused with their inferior predecessor, miniature implants. Miniature implants have earned themselves a bad name due to their poor design-related complications. However, Biominiatures are also small implants but with a much better design to negate the problems of their predecessor.
These are a good option for people who don’t have enough bone for conventional implants. These small implants which range from 2mm to 2.8mm in diameter, also known as small-diameter or narrow-diameter implants, are less invasive but need to be considered carefully.
Advantages of Biominiature Implants:
Minimally Invasive: Smaller size translates to less invasive surgery, offering reduced discomfort and accelerated healing compared to traditional implants.
Bone Volume Requirements: Suited for areas with limited bone volume, Biominiature implants often bypass the need for bone grafting, catering to patients ineligible for conventional “All-on-4TM” treatment.
Immediate Function: Just like All-on4TM, these implants can support prosthetic teeth immediately post-placement, ensuring you don’t have to go without teeth for long.
What else to consider?
1- Prosthetic Limitations: Biominiature implants may not be universally applicable for all teeth replacements, but are primarily suitable in full-mouth teeth replacement situations.
2- Maintenance: Just as with All-on-4TM, rigorous oral hygiene practices are imperative to sustain the health of Biominiature implants and the surrounding gum tissue.
3- Long-term Research Gap: Despite promising short-term success rates, there is a dearth of independent research on Biominiature implants’ long-term success, limiting their widespread acceptance. At this point in time, conventional implants remain the first choice when it comes to full-mouth implant rehabilitation, followed by Biominiature implants or zygomatic implants.
Cost
The cost of restoring a full arch (upper or lower) mirrors that of All-on-4TM, ranging from $25,000 to $30,000 per arch (upper or lower).
Zygomatic Implants
If you have been told that you don’t have enough bone in your upper jaw to support All-on-4TM implants, you have another option – zygomatic implants. How do these compare to All-on-4TM and Biominiature implants? They are very long implants that anchor in the cheekbone called the zygomatic bone. These implants span the zygomatic bone and emerge in your mouth. They can be used either in combination with conventional implants or on their own.
Benefits of Zygomatic Implants
Avoiding Bone Grafts: There is definitely a place for bone grafting. However, if you require full mouth implants, it’s certainly a feat to graft the whole mouth. You won’t be able to wear dentures the whole time that the grafts are healing. Such a prospect is hardly appealing to most people. To eliminate the need for laborious and expensive bone grafting procedures, zygomatic implants become a viable choice for those with substantial bone loss.
Immediate Function: In parallel to “All-on-4TM,” zygomatic implants often deliver immediate functionality and aesthetics, providing patients with a complete set of teeth within days.
Enhanced Stability: Anchored in the robust cheekbone, zygomatic implants ensure a secure foundation for a prosthetic bridge.
The Zygomatic Implant Procedure:
The process of zygomatic implants is the same as the above-mentioned process with All-on-4TM
- Thorough examination and imaging to assess bone structure and plan implant placement.
- Placement of zygomatic implants into the cheekbone.
- Attachment of a temporary prosthetic bridge on the same day as surgery.
- Once integrated, fabrication of a final prosthetic bridge for a permanent solution.
Cost
The cost for zygomatic implants aligns with other full mouth restoration options, approximately $25,000 to $30,000 for a complete set of upper teeth.
Not everyone is a candidate for zygomatic implants. To consider this option, you would have severe bone loss in the upper jaw which makes traditional implants or All-on-4TM challenging. Zygomatic implants are a surgical procedure, so good health is a must as well as having realistic expectations.
Conclusion
Understanding the options and costs of replacing teeth is crucial before starting the journey. Being well-informed is the key to making the right decision. A single consultation with an experienced dentist will go a long way in helping you understand your options. While cost is important, consider long-term benefits, aesthetics, functionality, and maintenance against lifestyle and oral health. Restoring a smile is an investment in overall well-being, requiring collaboration with dental professionals for a choice aligned with both clinical and financial goals. Prioritise oral health by understanding your unique dental needs, considering factors like natural teeth condition, overall oral health, and your individual preferences. Each option has benefits, and the right choice will have lasting effects. If you need further advice, we can be contacted on 03 95105597 or book your initial consultation here.
