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What are All-on-4 dental implants?

All-on-4, a registered trademark of Nobel Biocare, is a technique for replacing teeth using fewer implants than traditional methods. This technique has the following three traits:

1. As few as four implants per jaw

Where a full mouth of implants using traditional methods would require 8-10 implants per jaw, the All-on-4 technique uses just four. Sometimes five or six are needed on the upper jaw due to lower bone density.

2. Angled rear implants for optimum strength

Rather than being inserted vertically, the rear implants are at a 30-45 degree angle. This angle reduces the need for bone augmentation and means even patients who have suffered bone loss should be eligible for All-on-4, without having to go through the costly and lengthy process of a bone graft.

3. The ability to be implanted and fitted in a day

This last trait has earned them the nickname ‘teeth in a day’, ‘smile in a day’ or ‘same day teeth’. This is a drastic improvement in traditional implant procedures which can take six months or more to complete with extensive recovery time at each step of the process.

The following animation shows how All-on-4 treatment works:

A reason to smile again: Full mouth dental implants

Can just four implants replace all of the teeth on the top or the bottom of your mouth? Thanks to advances in dental implant technology, that answer is a resounding yes.

Believe it or not, tooth loss is extremely common among adults, especially as we age. More than 35 million people in America are missing all of their upper and/or lower teeth. Rather than living with the discomfort and hassles of dentures, many people are opting for what is called full mouth dental implant restoration.

What is the All-on-4® treatment concept?

The All-on-4® treatment concept is a cost-efficient, graft solution that provides patients with a fixed full-arch prosthesis on the day of surgery. 

Characteristics include:

• Full-arch rehabilitation with only four implants 
• Two straight anterior implants and two implants tilted up to 45º in the posterior
• Immediate Function (fixed provisional bridge)
• For patients meeting criteria for immediate loading of implants
• Graftless procedure
• Bone grafting is avoided by tilting the posterior implants, utilizing available bone

All-on-4 procedure pros

All-on-4 dental implants offer many benefits over conventional implants and removable dentures. These include:

• Short treatment and recovery time
• Implants placed on the same day as extraction
• Comfortable and stable structure to support crowns and bridges
• Fixed in place; no need to remove for cleaning
• Don’t slip or fall out
• Suitable for patients with jaw bone loss
• Cheaper than traditional techniques that use 8-10 implants

All-on-4 procedure cons

Of course, All-on-4 dental implants have problems as well: 

• Results may not be as good as with traditional implants
• Some people report problems with spitting or hissing while speaking
• Some dentists see it as a ‘shortcut’ to replacing teeth properly
• Not a fully customized solution
• A single implant failing can cause problems with the whole jaw
• The artificial gum bridge may feel bulky in your mouth

Keep reading for more information about each of these pros and cons and how they might affect you.

All-on-4 vs. dentures

All-on-4 implants are sometimes mistakenly referred to as ‘All-on-4 dentures.’ That’s probably because the traditional way to replace a full jaw of teeth is with removable dentures. Also known as ‘false teeth’, these consist of a gum-colored acrylic base and teeth made from resin or porcelain.

Dentures fit over the gums and stay in place either with suction alone or with a dental adhesive. Properly fitting dentures shouldn’t require any adhesive.

However, the supporting bone shrinks over time as there are no teeth for it to hold in place, and this change of shape will cause dentures to become loose. This means they need to be replaced regularly to avoid discomfort and problems eating.

Removable dentures are custom-made to precisely fit the patient’s mouth. The upper denture covers the roof of the mouth and the lower one is a horseshoe shape to allow room for the tongue. They must be removed for cleaning, usually overnight (hence the cliché of false teeth in a glass on the bedside table).

In contrast, All-on-4 implants are fixed in place and should act just like natural teeth in terms of appearance, chewing, and comfort. There is no risk of them slipping out of place while the wearer is talking or eating.

Although the prosthetic teeth are fixed to an artificial gum, this covers only a small area of the real gum when compared to dentures. The join is hidden far enough behind the lips that it won’t be visible when you smile.

Dentures offer a clear cost advantage over any kind of implants but they do need to be replaced every five years on average.

There is a tooth-replacement method that exists somewhere in between standard removable dentures and All-on-4 implants, and that would be snap-in dentures. They normally require fewer than four implants, providing less security than All-on-4s, but more than dentures. Like dentures, they are removed at night.

Another cheaper option that is very similar to All-on-4s is G4 by Golpa implants. These can also be placed with as few as four implants, but they cost considerably less and the whole procedure is done within 24 hours. You can read our G4 implant article for more information.

All-on-4 vs. regular implants

The conventional way to replace a full jaw of teeth with a set of full dental implants would be with a combination of single-tooth implants and implant-supported dental bridges. Bridges allow several ‘teeth’ to be supported by one implant at each end instead of one implant per tooth. This technique usually requires 8-10 implants per jaw for full dental implants.

While both techniques involve drilling sockets in the jaw bone, All-on-4 requires fewer implants. This makes the process quicker, easier, and more comfortable for the patient. It can also be considerably cheaper because of the reduction in time and materials required.

Aside from the lower cost, a big advantage of All-on-4 is the reduced treatment time. Dentures can be affixed as soon as the implants have been placed, rather than the patient having to wait six months or more for healing as is the case with traditional implants. Usually, temporary dentures are placed on the day of surgery and permanent ones are added a few months later.

The following table shows the key differences between dentures, regular implants, and All-on-4:

	All-on-4	Traditional implants	Dentures
Placement	Attached to 4-6 titanium implants in the jaw bone	Attached to 8-10 titanium implants in the jaw bone	Rest on the gums; may require adhesive
Eligibility	Suitable for patients with bone loss	May require a bone graft	Suitable for most patients
Eating	Fixed in place; act like natural teeth; few eating restrictions once healed	Fixed in place; act like natural teeth; few eating restrictions once healed	Can move when you chew; certain foods must be avoided
Longevity	10+ years	10-15 years	Will need to be replaced as the gums change shape (every 5 years on average)
Bone loss	Implants help maintain the bone	Implants help maintain the bone	Continued bone loss is inevitable, causing the denture to loosen
Coverage in the mouth	Artificial gums with minimal contact	Crowns attached directly to existing gums	Acrylic plate covers much of the gums and roof of the mouth
Appearance	Like natural teeth; gum join hidden behind lips	Like natural teeth; no artificial gum	Like natural teeth; loss of bone may cause face to sag over time
Cleaning	Cleaned like normal teeth	Cleaned like normal teeth	Must be removed for cleaning (usually overnight)
Cost per jaw	$12,000 – $25,000	$20,000 – $45,000	$300 – $8,000 depending on material

 

The fitting procedure

Initial consultation

Your first step in the procedure will be a consultation with your chosen dentist. During this consultation, they will examine your mouth and do a CT scan. This scan lets them assess your suitability for implants. They can check your existing jaw bone density to determine precisely where the implants should be inserted.

Your dentist should also discuss alternative treatment options with you before you commit to anything.

If you are a suitable candidate and decide to go ahead, the next step will be dental impressions. These are sent to a lab where your new dental bridge is designed to fit and look just like natural teeth.

Your dentist may also take some x-rays to help with planning your treatment.

Surgery

If you need to have teeth extracted before your implants are inserted, this can usually be done on the same day.

Your dentist or oral surgeon will probably offer you a sedative to help you relax during the procedure. Then they will anesthetize you so you don’t feel any pain. If you would prefer to have a general anesthetic for your All-on-4 treatment, ask your dentist about this at your initial consultation.

After any remaining teeth are extracted your mouth will be thoroughly cleaned to remove any damaged tissue and bacteria.

The dentist drills two or more holes at the front of your jaw to hold the front implants. Two holes at the rear, one on each side, are angled to offer greater support to the rear of the bridge.

Once the implants are placed, your mouth is cleaned again and any incisions are stitched up. It’s common for dentists to use dissolvable stitches which disappear after a week or two.

Either the same day or the following day you’ll be fitted with your new teeth. Some dentists create a temporary overdenture at this stage which is then replaced a few months later. This is often made from resin, a lighter but less durable material, which puts less pressure on your All-on-4 implants while they heal.

Aftercare

Patients usually experience some bruising, swelling, and general discomfort in the days after their surgery. You’ll probably want to take a couple of days off work to recover fully and get used to your new teeth.

Your dentist will advise you on the type of foods you can and cannot eat in the months after your treatment. For the first few months, you’ll probably have to stick to very soft foods so you don’t disturb the process of the implants fusing with your bone. You might also be advised to avoid things like smoking and heavy exercise for a while.

These implants are cleaned just like your normal teeth, by brushing once a day. Your dentist will also show you how to floss with special tools. You might want to invest in a water flosser with special attachments designed to clean around implants.

Final checks and fitting

6-9 months after surgery, your implants should be ready to support a permanent overdenture. This is usually made from porcelain or some other durable and high-quality material.

If you look after your new teeth carefully, they should last for 20 years or longer.

You’ll need to return to your dentist for regular checkups and maintenance. Check whether these visits are included in your treatment cost or whether you’ll have to pay for them separately.

Where can I get All-on-4 dental implants?

Look for an implantologist who specializes in All-on-4 treatment. Make sure they have some experience with this type of implant since not all dentists use the same systems. You can find an All-on-4 dentist the same way you would find any dentist, by using an online or hardcopy directly. You should also ask your dentist if they offer All-on-4 implants, or if they can recommend anyone to you. 

Once you find your All-on-4 dentist, they will discuss your treatment plan at your initial consultation. Remember, if you’re not a suitable candidate for All-on-4 they will recommend an alternative treatment.

Many Americans travel to Central America or other destinations to take advantage of cheaper dental work. If you live near the Mexico border this can be very convenient and extremely cost-effective. Find out more about US dental tourism here.

FAQs

How much does the All-on-4 procedure cost?

All-on-4 dental implants cost between $12,000 to $25,000 per jaw. This average cost of full mouth dental implants is considerably cheaper than the $40,000 it would cost for a full set of traditional implants. 

How long do All-on-4 implants last?

All-on-4 implants are made to last at least 20 years, and potentially a lifetime with proper care. This makes the cost of All-on-4 implants worth it for many people.

What are All-on-4 Implants?

All-on-4 dental implants are a way to replace multiple missing teeth with fewer actual implants. This type of full teeth implants is more affordable and faster than traditional individual implants.

How much is full dental implants? (Traditional)

The average cost of full dental implants is $40,000 for a whole set, whereas the All-on-4 dental implant procedure costs between $12,000 and $25,000.

How can I find All-on-4 dental implants near me?

The best way to find an All-on-4 dentist near you is to simply ask your dentist if they perform the procedure, and if not, if they could refer you to someone who does. 

Resources:

dentaly.org

clearchoice.com

nobelbiocare.com

We love our patients and love to help them form healthy dental life that will last them a lifetime. For more information call us to answer all of your questions so get an appointment today