All-on-4 Dental implants
At Dr. Svetlana’s dental office, the restoration of teeth on the upper or lower jaw is done using All-on-4/All-on-6 treatment procedure. We will help you to restore the functionality and aesthetics of your teeth in 1–2 visits. Schedule an appointment to get a free consultation and see if the All-on-4 treatment procedure can be applied to your case.
What is All-on-4, and what is the concept of this treatment
The treatment procedure involves placing four dental implants: two in the area of the front incisors and two at an angle of 25–45 degrees in the molar parts of the jaw. A temporary fixed bridge is placed immediately after the implantation (or 1–2 days later).
Who is suitable for this treatment procedure? The All-on-4 dental implants is suitable for patients who:
- miss all or most of the teeth on the jaw;
- have pathological loosening of the teeth due to progressive periodontitis/periodontosis;
- have alveolar ridge atrophy due to prolonged use of a removable denture.
The surgical judgement for All-on-4 implants is determined by the implantologist only after the survey and examination of the patient.
Pros and cons of the technology
- New teeth in 1 day
The All-on-4 technology is a one-step treatment procedure with immediate functional loading. The doctor places the implants and immediately loads them with a temporary denture (or after 2–3 days). There is no need to wait 3–6 months, as with the classic two-step technology.
- Budget savings
Twice as much as classic implantation. Achieved through the use of fewer artificial roots. In addition, there is no need for expensive bone grafting.
- Inclined placement of implants in the lateral parts of the jaw
This method of dental prosthetic rehabilitation uses angled placement of implants, which allows the use of existing bone volume without augmentation (treatment duration is reduced by 6–12 months). In addition, there is no risk of trauma to the maxillary sinuses and mandibular canal.
- Prevention of bone atrophy
Fixed denture on 4 implants evenly distributes the chewing load on the entire jawbone, stimulates the regenerative process in tissues.
- Guaranteed results
With proper planning of the surgery and compliance with the protocol, the implants last a lifetime and the prosthetic structure lasts up to 20 years.
The dental implants is not possible in case of critical bone loss.
High price compared to removable dentures.
High requirements for the qualifications of the dentist.
Contraindications are divided into:
- Absolute (in which installation of dental implants with the All-on-4 technology is categorically not possible).
- Relative (dental implantat is possible, but only after the elimination of relative contraindications).
|Relative contraindications||The solution|
|Masticatory muscle parafunction, TMJ dysfunction||We use Botox to relax the muscles and relieve the patient from pain.|
|Bite anomalies||We solve this problem by using aligners.|
|Dental diseases: gingivitis, periodontitis||One of the options is laser gum therapy|
|High degree of bone atrophy||We perform alveolar crest splitting or build up the missing volume using live human bone (fully tested, certified, with supporting documentation).|
|Poor oral hygiene||Professional cleaning of plaque and stone.|
|Insulin-independent diabetes mellitus||Before procedure, the glucose level is reduced to 7–9 mol/l.|
|Pregnancy||The surgeon consults with a gynecologist. Doctors consider the 2nd trimester to be the safest time for implantation.|
- blood clotting disorder;
- mental disorders;
- malignant neoplasms;
- severe immunopathological conditions;
- osteoporosis, osteonecrosis;
- open form tuberculosis.
Stages of the All-on-4 treatment procedure
- Examination, diagnosis, 3D modeling (1–7 days)
- The implantologist evaluates the patient’s health condition, collects medical history, and rules out any contraindications to implant placement.
- A consultation with a specialist is appointed in case you have a medical condition.
- Also, at this stage a computed tomography scan is mandatory.
- A special computer program creates a virtual model of the jaw, selects the treatment protocol and implant parameters.
- For cases where pinpoint accuracy is important (for example, if the volume of bone is minimal), we make a surgical template on four implants. We cooperate with Implant Concierge, the leader in guided surgery. We choose the ideal projection of the implant site (accuracy to 0.5 mm), which allows for proper load distribution and implantation angle. Surgical templates are printed on high-end 3D printers.
- Oral sanitation
Includes elimination of all pathogenic growths in the mouth and treatment of gum disease. Oral sanitation is performed to reduce the risk of implant rejection.
- Surgical stage: implants + temporary denture (1–3 days).
Done in one visit:
- Extraction of damaged teeth that cannot be restored (if necessary).
- Placement of 4 implants under local anesthesia, fixation of abutments and gingival suturing.
- Taking impressions to make a temporary adaptation denture (it is attached a few hours after the surgery or after 2–3 days).
- Orthopedic stage: fitting a permanent denture (7–10 days).
- After full osseointegration of the implants (after 3–6 months) the temporary construction can be replaced by a permanent full denture with ceramic or zirconium dioxide crowns. For this purpose, the doctor makes plaster casts or uses an intraoral 3D scanner.
- Fabrication of a complete permanent denture with 12 crowns. We work with a highly skilled dental technician who can produce a design of any complexity and takes into account all anatomical features of the jaw.
- After the fitting, the denture is fixed securely.
- The dentist schedules several routine examinations to check the condition of the artificial roots and orthopedic structure.
What materials are used to make a permanent denture?
In our implantology center, crowns for permanent dentures on four implants are made of metal-free ceramics (porcelain or E-max) or zirconium dioxide (monolithic and multi-layer). Either option will last at least 15–20 years if you follow the recommendations of your orthopedic dentist (regular oral hygiene, preventive examinations every six months).
What implants are used in the clinic?
They belong to the economy class implant systems. They have been produced since 1995 and are successfully used in 75 countries around the world. In this short period, they have proven themselves in the best way. The company is constantly evolving and offering state-of-the-art solutions for implantology. For example, a new “B+” surface with increased hydrophilicity (accelerates the process of osseointegration) was developed. Product lines for different types of bone have been created (including loose bone).
- Nobel Biocare (made to order)
A premium high-priced segment known around the world. The manufacturer produces a wide range of models for various clinical situations. For example, there are several series produced specifically for the All-on-4 procedure (Nobel is the developer of this technology). The surface of all products is coated with phosphorus ions and is hydrophilic. That is, they are better at attracting bone, which is especially important in the case of a single-step implant protocol with immediate loading.
We use MIS (Israel) and Nobel Biocare (USA/Sweden) implants in case of total absence of teeth in the upper or lower jaw.
Before & After photos
|Type of implantation||Cost, $|
Hybrid denture: titanium frame + acrylic denture (up to 7 years)
Zirconia denture: monolithic, durable 3D-printed structure according to the anatomy of the patient’s jaw (maximum naturalness, reliability, and aesthetics for 20 years)
We provide a guarantee on:
- The implant
We’ll change it for free if it doesn’t assimilate within a year.
- The dentures
Up to 5 years (if there was a laboratory error).
Peculiarities of lower and upper jaw implantation
Upper jaw. The jawbone is looser, thinner, and easier to resorb (bone grafting is required more often). If the alveolar crest is slightly atrophied, a All-on-4 dental implant without a sinus lifting can be performed on a completely edentulous jaw. However, for this, often 6 or 8 titanium rods are used instead of 4. Full osseointegration of the implants after 5–6 months. Another feature is the proximity of the maxillary sinuses in the area of the 4–8 chewing teeth.
Lower jaw. The bone is denser, the process of atrophy is slower. Bone grafting is rarely needed, even 4–5 months after teeth loss. Four bearing pins are sufficient for total prosthetics. Implants take just 3–4 months to take root (sometimes 2–3 months, depending on the constitutional peculiarity) and you can install a permanent orthopedic structure. The doctor needs to be careful not to hit the trigeminal nerve (during anesthesia, when taking the bone material or directly during the installation of an artificial root).
How the All-on-4 and All-on-6 protocols differ
Technically, the All-on-4 concept is no different from All-on-6. The only difference is the number of implants under the denture: instead of four, there are six (two additional implants are placed in the lateral sections of the jaw, one on each side). What’s the advantage?
- Ability to place a denture with 14 crowns rather than 12, as with All-on-4 dental implants.
- Guarantees a more secure fixation of the cover denture due to two additional supports.
- Removes restrictions on implants for patients with periodontitis/periodontosis, bruxism, or large jaws.
Doctor’s opinion: What’s the best choice?
If your bone volume allows you to put more implants, I recommend the All-on-6 protocol. Its cost is not different from the All-on-4 implants procedure. But most importantly, the implantation of 6 rather than 4 implants helps better distribute the load on the jaw and guarantees the primary stability of the system (prevents micro-movement of the implants).
Frequently Asked Questions
No, it doesn’t. We use modern anesthesia, which completely eliminates pain during the operation (oral, inhalation with the addition of nitro N2O, buffer, injection anesthesia).
After 14–21 days. This also includes acidic, spicy, and salty foods. Following this recommendation will help reduce mucosal irritation and promote healing of the postoperative wound.
- The first six months. Clean with a soft brush, lightly, without pressure. Then you can proceed to a brush of medium hardness.
- Toothpaste composition. Minimal abrasives, no calcium or fluoride.
- With a doctor’s recommendation, you can start using an irrigator to remove plaque and keep your gums toned.
- Visit the dentist’s office every six months to have your dentures cleaned of tartar and plaque.
Yes. We have seen many patients over the age of 70 who have successfully undergone total prosthetics on one or both jaws.