Treatment Concept

Although gaining significant traction within the dental community, the concept is still fairly new to the public at large. Our patients that have heard of the treatment typically associate it with the idea of walking into a practice with a removable denture, and walking out with a denture securely fastened by dental implants. By and large, this is one of the large components of the treatment, however there can be significantly more that is involved.

Although the treatment seems to be an obvious choice for edentulous patients (patients with no teeth on one or both arches), it can also be a compelling alternative for patients that have significant tooth decay or jaw bone loss. In such circumstances, the removal of the teeth, placement of the dental implants and their immediate restoration with a temporary prosthetesis offers a truly compelling alternative.

Traditionally, the placement and restoration of dental implants with a complete denture could be a long and arduous process for the patient. It would start with the general practitioner identifying the need for dental implants and arranging for a consult with a dental surgeon or periodontist. In many cases, before the implants could be placed, the bone in the jaw would need to be built up through a bone grafting procedure. This would be a fairly invasive procedure and would require three to six months of healing before the implants could even be placed. Once the specialist would consider the case to be viable, another appointment would be scheduled during which the dental implants (up to 8 per arch depending upon circumstances) would be placed and healing abutments would be affixed. After three to six months of healing and waiting for the implants to integrate into the surrounding bone, the healing abutments would be removed and restorative abutments would be placed. Finally, the patient would visit either the general practitioner or a prosthodontist for the restoration of the implants with a complete denture. As you can see, it was a long process that would involve numerous appointments and several dental practitioners. From start to finish, the process could take up to 12 months.

With All-On-Four®, the entire process can take place in a single appointment, hence the nickname “teeth-in-a-day”. The appointment starts with the removal of any remaining teeth when necessary. Next, four dental implants are placed whose role is to securely hold the restoration in place. Only four implants are required due to the unique shape of the implants themselves as well as the method of placement itself. The posterior implants (at the back of the mouth) are longer and are placed at a 45 degree angle. This maximizes the contact surface between the dental implant itself and the surrounding bone tissue which in turn maximizes the stability of the implants. Additionally, the angled placement minimizes the depth of bone tissue required for successful placement and minimizes the likelihood of any contact with the mandibular (lower jaw) nerve or the maxillary (upper jaw) sinus. Once placed successfully, the dental implants are restored immediately with a temporary restoration that will allow the patient nearly complete functionality within days. A patient walks out of their appointment with prosthetic teeth that are held securely in place by four dental implants.

The final restoration replaces the temporary one after the lab fabricates the restoration that has been selected (either fixed solutions such as a complete bridge or a removable solution such as a hybrid denture).