A technique that’s being heavily advertised on TV, radio, print and on the web is called All On 4 dental implants. Promoted as a fast and economical way to escape the discomfort and embarrassment of wearing dentures, All On 4 refers to a very specific dental implant treatment plan that can replace all or most of a patient’s missing teeth in the upper or lower dental arch.
The appeal of All On 4 is that it involves only four strategically placed implants, as opposed to the five or even six normally required. In essence, you can get a nearly full set of teeth and need only four implants.
All On 4 dental implants have gained in popularity because of three factors:
- Less Surgery: Only four implants have to be placed and bone grafting procedures such as sinus lifts are often not needed.
- More Economical: Because only four implants are being placed, the cost of the surgery, as well as that of the final restoration, is reduced.
- Less Time-Consuming: The entire procedure requires fewer hours in the chair because advanced surgical procedures are often unnecessary and the time and number of visits required to fabricate the final restoration is reduced.
If you fulfill most of the clinical requisites for a successful outcome and when your dentist carefully plans your treatment, All On 4 can be a viable and economical choice, especially if you already wear, or are facing the prospect, of full dentures.
In fact, success with this technique can really improve your quality of life. To be able to smile, to eat, and to live in comfort without being concerned that your teeth are going to fall out, is something that was unheard of for denture wearers just a few years ago.
But All On 4 Dental Implants Are Not For Everyone
Before embarking on an All On 4 treatment course, many considerations (clinical, anatomical, and above all bio-mechanical) must be taken into account. In my personal and professional opinion, failure to do so will most assuredly lead to disappointment for both you and your dentist.
Yes, it is your dentist’s responsibility to determine whether All On 4 is a viable treatment option for you, it is your responsibility to ask the right question. And, the most important question you must ask is this:
What Happens If One Of My Implants Fails?
With a thorough and thoughtful diagnosis, carefully planned and proper surgical techniques, well-fabricated restorations, and appropriate follow-up care, the majority of implants are highly successful. In fact, some literature indicates that implants have a greater than 95% success rate.
But the reality is some implants will invariably fail. One of the most common reasons for an implant to fail is overload. After an implant is restored with a crown (or as part of a bridge) it is put into what we call function. Function means biting, chewing and grinding.
When an implant is part of a bridge it helps support and carries the load that normally would have been carried by your natural teeth. If the load becomes excessive, it’s very common to have some bone loss leading to implant failure.
Managing these forces is a critical aspect of long-term implant success. This leads me to two important aspects of your decision about All On 4:
- How many missing teeth need to be replaced? The more teeth that have to be replaced, the greater the stress and strain that will be placed upon your implants and the supporting bone around them.
- How strong is the opposite dentition? If the opposite dentition is overly strong, your implants will be subjected to some incredible forces. The greater the force the more support (i.e. the number of implants) you need.
So, in the All On 4 technique, only four implants will be supporting the functional load of your entire dental arch. If force factors are relatively low and an abundance of bone exists to support the implants, All On 4 treatment can give you years of service. But of just one implant fails, more bone must be added, more implants must be placed, and the entire restoration redone.
A lot of time and a lot of moolah!
With All On 4 If You Lose Just One Implant You’re Left With None On 3!
As a highly trained implant dentist, my goal is to properly address the clinical and bio-mechanical demands that will be placed on my patients’ teeth and their implants in the future. I will not over-engineer a planned dental implant restoration, but I do put in some fail-safes.
For example, when I design All On 5 and All On 6 implant treatment, my patients know that one single implant failure will not necessarily doom their entire restoration. If it does happen, a simple chair-side modification is usually all that’s necessary.
So, be careful before you choose All On 4 – it’s not for everyone. Because, in the long-run (and I’m always thinking about the long-run), the cheapest route is not necessarily the most economical one.
Stay tuned (and subscribe) for more of my thoughts on dental implants, dental health, and…life.
Thank you for that information Dr. Sinkin. I am about to have this very procedure done. And I had a consultation with Clear Choice. But I’m the kind of person that do research first. And I keep hearing that the all on 4 is good. But to be safe you should at least have 5 or 6 implants. And that is what I’m looking for at least 5. However I want to walk out with teeth in same day, I love that part of this procedure. Add me to your list for thoughts of the day. And tell me what you think about my situation. The lady at clear choice keeps say 6 is overload. And now i’m starting to feel like they just selling the all on 4. But they did give me the 3D scan for free.
Dr. Sinkin says
The concept behind all-on-four is sound. However, for reasons I covered in my blog if there is, enough bone support to permit additional implants I would like to see one, preferably two, more places. If one implant fails on an all-on-four restoration, the patient is left with “nothing on 3”. But just to be clear, additional implants do not preclude having implant-supported provisional/temporary teeth that are non-removable teeth (not dentures) placed on the same day. I have placed and immediately restored as many as eight implants in the same visit. Just this past week I extracted seven teeth for a patient, performed bone grafting, placed five implants, and inserted beautiful “permanent” temporary bridgework, not dentures, in the same visit.
You have the scan, so my advice is to seek out other professional opinions before committing.
I salute your efforts to get more information!
Best, Dr. Sinkin