Have you lost (or are you about to lose) all your teeth?
Or maybe you’re finally ready to ditch your loose, uncomfortable dentures for something more secure?
The All on 4 procedure offers a fast and predictable way to get a fixed set of beautiful and functional teeth.
In this article, we’ll discuss what is All on 4, what happens during the All on 4 dental implant procedure and key things to remember when considering this treatment.
All-on-4 is a dental implant treatment that replaces teeth in the upper or lower jaw (or both) with a fixed set of ideally 12 to 14 teeth secured by (at least) 4 dental implants.
In most cases, the tooth bridge can be fitted soon after implant placement. This means you won’t have to spend months or even weeks without teeth or wearing uncomfortable dentures — you can restore your smile and the complete function of your teeth in a matter of days.
Before All on four, traditional full mouth dental implant treatment would often require more implants, more time, more costs and sometimes painful bone grafting. It also wasn’t possible for a tooth bridge to be placed on the implants immediately after surgery. This left patients wearing a removable denture for many months before their tooth bridge could be fitted.
Today, the innovative All on 4 procedure allows us to place a full arch of up to 12 teeth on fewer implants just days after surgery. Plus, most patients avoid the need for painful and lengthy bone grafting treatment.
Below is a rundown of what to expect at each step of the All-on-4 implant procedure:
The first stage of All on 4 treatment involves in-depth consultation and treatment planning. This is where your All on four dentist will assess your teeth, gums and jaw bone, take scans, and present you with your final treatment plan. Your dentist will also begin their surgical planning for your implant placement procedure. At Macquarie Street Dental, we also begin designing how your new smile will look with our advanced Digital Smile Design technology.
Ultimately, the All on 4 procedure is the culmination of hours of meticulous planning by your dentist. The success of All on 4 largely depends on this planning stage and proper treatment planning is one of the best ways to avoid potential All on 4 problems. This is why it’s so important to work with an experienced All on four dentist.
On the day of your implant placement surgery, your dentist will place at least 4 (sometimes 6) titanium dental implants into your jaw. Using the innovative implant placement technique created by Nobel Biocare, two straight implants are placed at the front of the jaw and two angled implants are placed at the back of the jaw. The angled implants utilise more bone density to support the tooth bridge. In most cases, this helps to avoid the need for jaw bone grafting — even for patients with jaw bone loss.
The All on 4 procedure takes about 4 hours per jaw to place the implants. During the procedure, you will also have any existing teeth removed (if you have any).
The All on 4 procedure shouldn’t be painful, as you will receive a local anaesthetic to numb the area. You’ll also be placed under twilight sedation (IV sedation) which will help you feel relaxed and comfortable. Due to the amnesic effect of IV sedation, you will have little or no memory of the procedure. Afterwards, you’ll spend 30-45 minutes in recovery before you’re ready to return home. A family member or friend will need to escort you home as you won’t be able to drive or return home on your own.
Once our laboratory team has designed your initial tooth bridge, you’ll return to ‘try-in’ a 3D-printed version of your new teeth. This is an important step in the process that allows us to check how your new teeth look and feel, as well as how they fit together (your bite). Any adjustments are made and photos and records are taken. The adjusted bridge and records are then returned to the lab team to complete your initial tooth bridge.
Your initial temporary tooth bridge is securely connected to your dental implants and your dentist will perform a final check. Before you leave, you’ll get clear verbal and written instructions on the Do’s and Don’t’s during your recovery period.
In most cases, patients can have their initial tooth bridge connected in as little as 3 visits (typically, a few days) after implant surgery. This initial tooth bridge is worn for around 6 months while the jaw and gums heal. Once healing is complete, you’ll return to have your definitive tooth bridge connected to your implants.
Most patients are surprised by the speed of their recovery after the All-on-4 procedure. However, we do recommend that you take some time off work and/or your usual activities to rest and adjust to your new teeth.
It’s normal to experience some discomfort, bruising and swelling for a few days after the All on four surgery, but this can be easily managed with over-the-counter pain medication.
During your recovery, it’s crucial that you follow the clear aftercare and All on 4 cleaning instructions provided by your dentist.
Here’s a quick breakdown of the dos and don’ts after the All on 4 procedure:
All on Four dental treatment is fast gaining momentum amongst the general Australian public, due to an onslaught of advertising by many clinics in online, print and radio advertising. Whilst it is being portrayed as a simple, easy and effective way for patients to have comfortable, fixed teeth with a minimum of downtime – there are a whole host of important considerations that you need to pay attention to when choosing to have this treatment. Keep in mind; this is an invasive medical procedure, and definitely not a decision that should be based purely on cost!
From our experience in treating many patients with All On Four implant treatment, these are some of the points that we feel are most critical in delivering a world-class, quality result:
As we mentioned above, your dentist’s experience in planning and performing the All on 4 treatment is key to achieving a successful outcome.
Implant surgery is a finely honed clinical skill, which sadly, does not require any specialist or registered training. This means that all dentists can theoretically place implants; however, the level of training, experience and knowledge is variable. Hence, pay attention to the credentials of your implant surgeon, and be sure to inquire about their years of surgical experience. Best of all – ask them to show you clinical cases with long-term outcomes. These shouldn’t come from their website – but their own on-site records.
Ideally, your All on 4 dentist will have the expertise to use a combined restorative/surgical approach, considering both the placement of the implants and your final replacement teeth. This cohesive planning typically provides the most ideal results. A surgeon who places implants, without consideration of the final tooth position, could potentially compromise your final aesthetic and functional result.
Likewise, beware of those that appear ‘gung-ho’ in booking you straight in for treatment without a thorough assessment of your whole mouth, as well as your treatment needs now and into the future.
At Macquarie Street Dental, we review the health and status of your whole mouth thoroughly before determining whether All On Four treatment is the most appropriate option in your particular case. For example, if you have a denture in one arch only, then the opposing teeth are important in your future bridge design and treatment. We don’t want to compromise your implant treatment in any way, and in some instances, simple treatment of remaining teeth may be needed to ensure longevity and reduce any post-treatment complications. These important details may be missed or skipped over completely if a surgeon doesn’t have the experience (or doesn’t allow the time) to properly assess your case and predict future outcomes.
The biggest differential that affects the cost of All on 4 treatment will be the type and quality of implants and laboratory support they use. There are hundreds of dental implant manufacturers in the world, but only a small handful of industry leaders in terms of both historical success and clinical and long-term research data. It is essential that a high-quality dental implant with proven long-term success is used in your treatment. This not only helps to ensure a successful outcome, but also ensures that maintenance needs are met predictably.
Imagine having this treatment, only to find that in 5 – 10 years you require some form of maintenance and the implant system you received is no longer recognised or used! Your dentist is then left scratching their head wondering how they are going to find the means to help. This is an increasingly common scenario with those patients heading overseas for All on 4 dental implants in countries like Thailand and India. There are a number of ‘moving parts’ in this treatment – and the ability to resolve any needs with ease is critical. Just remember: what seems like the ‘cheapest’ All on four to you now, can often end up costing you a lot more than you bargained for in the end.
Secondly, the methods and techniques to build the replacement teeth or All-On-Four bridge are very important. Be sure to ask what your replacement teeth are made from and whether any warranty is offered with the treatment.
Practices offering a lower cost All on four procedure will typically simplify the construction of the replacement teeth. This could mean you end up with a simple off-the-shelf acrylic ‘denture type’ set up with a basic thin wire re-enforcement. In some instances, they even convert the denture that the patient has been wearing.This approach is typical of the clinics that advertise their All on 4 implant treatment as done in the one appointment or ‘done in one day’. The issue with these types of replacement teeth is that they can be quite unstable and fracture or break easily. Plus, they can also be quite bulky and ill-fitting leading to cleaning difficulties. As a result, patients who have paid less for treatment initially find that it costs a lot more in the end due to ongoing maintenance or repair needs.
At Macquarie Street Dental, we work with an accredited Sydney dental laboratory and ensure your replacement teeth are custom-built with a high-quality milled titanium framework. We also add the important extra step of a ‘try in’ of your All on Four teeth, to ensure we have the most ideal shape, shade and arrangement for your replacement teeth – and to make sure that they are truly ‘you’. Our bridges also come with a warranty for those who follow our maintenance protocols.
You can download our comprehensive All on 4 guide below to read more about the All on 4 procedure and choosing your surgeon. The guide comes with a handy checklist of questions to ask your potential All on 4 surgeon.
Look at it this way: you wouldn’t choose a heart surgeon based on his treatment being the cheapest — so complex and invasive dental procedures shouldn’t be any less important. When it comes to the All on 4 procedure, it always pays to base your decision on the experience of the surgeon and the quality of the materials — not the cheapest quote or the fastest ‘done in one day’ treatment time.
There is no doubt that the All On Four dental implant treatment option is life-changing for those struggling with painful, embarrassing removable dentures, or a debilitated dentition with missing, loose or painful teeth. However, as we explored above, this treatment can still have potential pitfalls if the right surgeon and practice are not chosen. It pays to research carefully, and to ensure that the cost is not the only determining factor in your decision.
'The bitterness of poor quality remains long after the sweetness of low price is forgotten.' - Benjamin Franklin
Dr Dunn has a special interest in dental implant treatment and has spent over 20 years transforming thousands of smiles with the All on 4 procedure. To see some of the incredible transformations Dr Dunn has achieved, check out our All on 4 before and after gallery.
If you’d like to discuss the All on 4 procedure with Dr Dunn in person, you can book a free consultation online or contact us on 02 9247 1394.
To help you in your All on 4 journey, we have written an extensive All on 4 patient guide that you can download below. This guide has everything you need to know about the All-on-4 procedure, including:
