What is All-on-4™ ?
Let’s dispense with the fancy words and terminology, it is now possible to insert a series of grade 4 or grade 5 titanium screws into the jawbone and have them bond with human bone. If this isn’t a miracle, I don’t know what is! Whatever terminology we assign to this treatment, be it “full mouth implants“, “full arch dental implants”, “All on 4”, or “All on 6”, the concept remains the same. A bridge of spectacular pearly whites is effectively anchored to these implants.
While the term “All-on-4™” 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 implant company support of the final result. Depending on patients’ individual needs, I select the appropriate design and brand of implants, providing them with a bigger range of implant brand options.
There are significant advantages to the newer techniques, which utilise 4-6 implants to replace all upper or lower teeth. Conventional full-arch dental implants often use 8 or more implants to replace a full arch of teeth, increasing the cost of treatment, and often requiring more invasive bone grafts and sinus lifts. The time spent on the treatment with conventional methods can be in the order of two years. Our expertise in All on Four and similar implant dentistry in Melbourne, Australia ensures lasting solutions for missing teeth, improving oral health and quality of life.
Modern techniques only require four implants, each arranged in a specific 45-degree manner so that the maxillary sinuses are often avoided, negating the need for sinus augmentation and bone regeneration to compensate for the lack of jawbone. Thus, reducing treatment time and cost.
All-on-4™ dental implants offer some distinct advantages over conventional implants:
- Only four implants are needed to support all upper or lower teeth
- Reduces the need for bone grafting to regenerate lost bone
- It’s a less invasive procedure
- Reduces healing and recovery time
- It’s a much quicker procedure
- Doesn’t require the same volume of bone if your teeth have been missing for a while
- You receive your new fixed teeth in as little as 24 hours after surgery
- Opens up the possibility of implants for previously unsuitable patients
- Great alternative for long-time denture wearers
What are Teeth in 3 days or Teeth in 1 day?
These are catchy terms that all mean the same thing. Basically, from the time your natural teeth are removed to the time when new temporary prosthetic teeth are attached to implants, is anywhere from one to three days. Depending on how quickly your dentist and technician can deliver them to you.
What are immediate full-mouth implants?
Besides a good marketing ploy, they’re the same as teeth in 1 day, the same as teeth in 3 days, or All-on-4™ dental implants, or any other term that’s commonly used to describe immediate full mouth dental implants. The difference is in the terminology and not the product.
Essentially, the difference between immediate and conventional implants is that immediate implants are inserted on the same day as teeth are removed. Whereas conventional restorative methods allow for considerable intervals between teeth removal, implant placement, and the final fixed teeth. Sometimes the difference can be up to a few years. That’s quite significant, and that’s why immediate full-mouth implants have gained popularity in recent years.
What Brand is Best for All-on-4™?
All on 4™ technique was initially pioneered by a Portuguese dentist by the name of Paulo Malo and the term All on 4™ was subsequently trademarked by a Swiss implant company called Nobel Biocare. Again, for complete transparency, I am not promoting any particular brand of implants here, my purpose is to shed some light on otherwise confusing language.
Nobel Biocare (All-on-4™) implants are great and there has been significant research published on the success of this concept. However, as mentioned earlier, any implant brand can be used, providing it satisfies the requirements of being a successful, well-researched implant that offers the flexibility and versatility of parts.
In Australia, the implant system has to be TGA (Therapeutic Goods Administration) approved and parts need to be freely available should the need for repairs or replacements arise. These days, there are many systems that meet these requirements. Such as Nobel Biocare, MIS, Biohorizon, Straumann, Neodent, TRI and many more. I tell my patients that Nobel Biocare was the original and is still a great choice but isn’t the only option anymore. So, if I were you, I wouldn’t get too bogged down with what system the surgeon uses, trust them to use the system he or she is comfortable with to achieve the best outcome for you.
What is All on 6?
The same as All-on-4™ but on six implants, simple. I could end it there but there is a bit more to it than that. Four implants are the absolute minimum to support a full arch implant restoration. However, if one implant fails, the whole structure comes crashing down like Humpty Dumpty off the brick wall. This is because three implants aren’t adequate to support a fixed implant bridge.
However, if you have six implants, and one or even two don’t integrate or perhaps they develop a problem down the track, your teeth restoration can still be adapted without too much trouble. More implants mean more support and more security for the long-term prognosis of your implants.
Are you suitable for All-on-4™?
If you’re a living, breathing person, who has lost all or most of your teeth to decay (caries) grinding (nocturnal bruxism), or your teeth are waving in the breeze due to periodontitis (gum disease), and you are fed up with failing, damaged, and missing teeth, you’re probably a candidate. Provided you are committed to turning over a new leaf and caring for your new implants daily at home.
- You are fed up with your dentures which rub your gums, cause discomfort, and move when you eat or speak
- Your teeth are failing due to significant wear, decay, or periodontitis, causing you significant pain and discomfort, affecting your confidence, how you look and your ability to eat
- You’ve been unable to replace your teeth due to conventional implant methods, insufficient bone or high-cost
Why are some people not suitable even for All-on-4™?
Even if you are sick of your teeth, and are ready to replace them, there are very important questions that need to be asked before considering this treatment:
Can your teeth be saved? If your dentist recommends a quicker, cheaper, and more effective treatment option for you, it’s in your best interest to listen. There is nothing better than your natural teeth. We understand that you might’ve lost all faith in them and they’ve given you trouble over the years, but if there is a good chance that we can save them, take that chance. We are happy to educate you and show you how to look after them and maintain them at home. Keeping your natural teeth is always a better option than replacing them.
Do you smoke? Smoking reduces blood oxygen supply and impairs healing, hence why people who smoke have lower success rates. Both in the initial phase of healing, as well as over the long term. We encourage our patients to quit smoking permanently. This increases your chances of a good outcome. Understandably this is easier said than done. However, we can discuss strategies to assist you and prescribe medications you can take to help you quit. If you’re not ready to quit, doesn’t necessarily mean that you can’t have implants, it just pays to be aware of reduced surgical and long-term success rates.
Is your diabetes uncontrolled? Uncontrolled diabetes can also impede healing and result in a higher risk of implant failure. Diabetes potentially renders people more susceptible to infections and vascular diseases. It’s not all doom and gloom, if you work with your medical practitioner to get your diabetes under control first, you would be perfectly suitable to have dental implants.
Do you have high blood pressure? Hypertension is one of the most common conditions in Western countries. With the help of healthy whole food plant-based nutrition, antihypertensive medications, and adrenaline-free local anaesthetics, blood pressure can be stabilised, ensuring that it’s safe for you to undergo implant surgery.
Are you under the age of 25? Some rare genetic conditions can result in young adults missing their natural teeth. You would need to wait until you’re over 25 to have all your teeth replaced with implants.
Do you have a systemic disease? Certain systemic conditions such as Leukaemia, radiotherapy, and chemotherapy can impede healing, so it’s not advisable to have oral surgery until you’ve recovered.
What if you have osteoporosis? This is one of the common questions that patients ask. Interestingly, jawbone isn’t as likely to succumb to osteoporosis as weight-bearing bone, so most people with osteoporosis can still undergo implant surgery. There is one caveat – you must not be taking medications that inhibit bone turnover. If you do, it is important to consult with your medical doctor to assess your suitability for implant surgery.
Are you taking medications for osteoporosis? Some medications such as bisphosphonates slow down bone healing and would require careful consideration before committing to implants.
Do you have periodontal disease? Advanced gum disease is one of the most common reasons people lose their teeth and require full mouth implants. Patients often get concerned that their new implants will also be affected by this condition. This is both true and false. In assessing your risk it’s important to understand that periodontal disease is not only treatable in the first place but it’s also preventable. Few people can believe this fact when they are facing the prospect of having to lose all their teeth. Nevertheless, this is true, and if your dentist treats it in time, coupled with meticulous home care, periodontitis can usually be treated.
Implants can develop a similar condition called peri-implantitis. Whereby bony support is similarly lost around your implants to what would happen to a natural tooth with gum disease (periodontitis). It’s still not well understood and thus has limited treatment options, although this area of science is evolving. Both the skill of the surgeon as well as meticulous home care of your implants can minimise the risk of this condition. In other words, with appropriate care, you would be a great candidate for implants.
Have you been told you don’t have enough bone even for All on 4? For some candidates who don’t have adequate bone and require sinus lifts and bone grafting to even place implants, full arch immediate implants aren’t the best approach. A delayed or staged approach is more appropriate, which means that you get the same result but over a longer period. Teeth are removed first, followed by bone grafting, which is followed by the placement of implants. With at least a few months between each stage, you can appreciate that this process would take longer than if bone grafting was not required. This is not a contraindication as such, just a variation to the immediate approach. If a dentist determines that there is not enough bone in your mouth to anchor implants. Bone grafting could be considered before implants are placed.
What is the process?
Ok, so to sum it up, here are the steps at our practice:
1
Consultation
We begin with an initial consultation to discuss your concerns and identify the time frame and treatment options. This is an extended consultation so you will have an opportunity to ask plenty of questions. Dr Helen will begin her investigative process by examining your mouth and assessing your current situation, overall health, and suitability for full mouth implants.
2
SUITABILITY 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
Arrange a series of appointments where we take photographs, 3-D scans and impressions of your mouth as well as the preparation of your immediate 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 the following day 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.
7
Suture (stitches) removal
You return in two weeks to have your sutures removed.
You will need to see us on a monthly bases 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 in 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 check ups and cleans.
1
Consultation
We begin with an initial consultation to discuss your concerns and identify the time frame and treatment options. This is an extended consultation so you will have an opportunity to ask plenty of questions. Dr Helen will begin her investigative process by examining your mouth and assessing your current situation, overall health, and suitability for full mouth implants.
2
SUITABILITY 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
Arrange a series of appointments where we take photographs, 3-D scans and impressions of your mouth as well as the preparation of your immediate 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 the following day 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.
7
Suture (stitches) removal
You return in two weeks to have your sutures removed.
You will need to see us on a monthly bases 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 in 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 check ups and cleans.
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