- Dr. Greg Grobmyer
All-On-4 Dental Implants: The Good, the Bad, and the Ugly.
Dental implants have been around for a long time, but in recent years a technique called All-On-Four has gained immense popularity as a way to replace missing or bad teeth in an entire dental arch. So what is All On Four and why has it become such a trendy treatment option? Are there downsides to this treatment or better choices of procedures available?
What are All On Four dental implants?
First you should understand what a dental implant is and how it works. Dental implants are essentially metal posts, usually titanium, that are surgically placed into the bone of the jaw and can act as anchors for attaching replacement teeth.
Titanium is generally chosen for several reasons. First, it is very strong and durable and can sustain the pressures and demands of chewing without breaking or wearing out.
Second, it is a biocompatible material, meaning the body does not see it as a foreign object and reject it.
Third, titanium has the unique characteristic of actually fusing with bone as it heals, a phenomenon called osseointegration. This leads to strong, durable supports for dental restorations that can last a lifetime.
For individual tooth replacement, single implants may be placed with a top, called an abutment, screwed onto the implant and a crown made to replace the tooth.
For multiple missing teeth, a series of attached crowns, called a bridge, may be used or a removable denture can be fitted that snaps onto the implants, giving it much more stability than a conventional denture.
Placing implants can be an expensive undertaking, so minimizing the number of implants needed to replace teeth is very beneficial to the patient. For many years, placing a minimum of six to eight implants was considered the standard for replacing an entire arch of teeth with a fixed bridge.
Over time, technology has advanced to the point where four implants tied together with a metal framework act as a base for a fixed bridge, significantly reducing the cost and surgical sites needed for a predictable and long lasting dental restoration. This procedure has come to be called All On 4, or sometimes Ao4, and has gained widespread use as a standard for replacing a full arch of teeth.
All On 4 dental implants cost
In the United States, the average cost for Ao4 full mouth implants is reported to be $59,000. This includes the restoration of both the maxillary (upper) and mandibular (lower) jaws with permanent teeth.
This price can vary greatly, however, and what you get as your final restoration may also vary. For example, some practices may refer to snap on dentures, implant supported dentures, or even mini-implants as “All-on-4”. This is very misleading and differs from the permanent fixed bridge that defines a true Ao4 restoration.
Certain dental offices may also hit you with hidden fees or only quote for part of the procedure, such as charging a fee for the consultation, another for the surgery, and another for the placement of the final restoration. Be sure if you get an estimate that what you are quoted includes the complete procedure, with all fees disclosed.
All-On-Four dental implants procedure
Having full arches of teeth replaced using the All on 4 method requires multiple visits, sometimes to multiple doctors, and often months of healing time between stages.
The first visit necessary is usually a consultation appointment. At this visit, x-rays are taken of any remaining teeth to gauge their health and impressions of each jaw are taken to create precise models of your mouth.
3D images of the jaws are taken if the proper equipment is present on site, or a referral may be made to take such images at a diagnostic imaging center. These 3 dimensional images are used to gauge thickness of bone, where the sinus cavities are located, and the anatomical location of nerves and other structures in the jaws.
Photos, health history, and other information is gathered and the consultation usually ends with financial estimates and arrangements being made and future appointments added to the schedule. Prior to the first surgical appointment, the dentist or oral surgeon will review the records and plan the procedure from beginning to end. They then use the 3D images taken of the bone of the jaws to create surgical guides, which will allow the surgeon to precisely place the implants while avoiding critical anatomical features like nerves and sinus cavities.
The first surgical procedure will be to remove any remaining teeth that need to come out. Sometimes this can be done in conjunction with implant placement, but depending on the location of the teeth to be removed, it may be necessary to do extractions and then wait for the mouth to heal before proceeding.
Occasionally, bone levels in the jaw are insufficient to support implants or sinus cavities are simply in the way. In these cases, a separate surgery may be required to augment the bone with bone grafts or sinus lift procedures may needed to make space for the future implants. These procedures often require months of healing before the implant placement surgery can occur.
Once space and bone requirements are clinically observed, the implant surgery can be performed. The patient is locally numbed and possibly sedated for the procedure. The surgical guides are used to precisely drill small holes in the bone in planned positions, depths, and angles. Four areas are prepared in this way in the Ao4 procedure.
Titanium posts are then placed into these holes and a small peg called a healing cap is placed on top of the implant. This allows the bone and gums to heal and attach to the implant before any load is placed on them. In most techniques, this healing process may take three to six months, during which the patient has to wear a temporary denture or go without teeth in the surgical area.
After the healing phase is complete and the implants are firmly anchored to the bone, custom tops, called abutments, are attached to the implants. These abutments are then used as the base for the creation of crowns or bridges, which are made by a dental laboratory and then permanently attached to the abutments.
All-On-4 recovery time
All On 4 dental implants are a big improvement as far as cost compared to traditional implant supported bridges, but still need the same healing time as traditional implants. This may include 3 or 4 months of healing time after extractions, sinus lift procedures, or bone grafting, an additional 3 or 4 months after implants are placed to allow them to fuse to the bone, and then another month or more before the final restorations can be fabricated and placed. All in all, it may take a year or more before the procedure is complete and the permanent teeth are in the mouth.
All On Four dental implants problems
Most people are happy with Ao4 restorations, but there are definitely some negatives to the method.Obviously, the time it takes for All On Four implants start to finish is a drawback for many people. Normal All On Four implants may take as much as a full year start to finish, especially if there are issues requiring bone augmentation or a sinus lift.
Many times it is necessary to go to an imaging center for 3D scans, to an oral surgeon for extractions or bone augmentation, and to another dentist to have the final restorations completed once the implants have healed.
Additionally, the cost of All on 4 implants can be steep for many people. Certain offices break the procedure into parts and patients can find themselves surprised by fees that end up much more than what they were expecting.
Lastly, a true Ao4 procedure includes four titanium implants and a permanent fixed bridge. Offices utilizing acrylic dentures or less durable restorations are offering a lesser product and not a true Ao4.
Cheapest way to do an All-On-Four dental implant
Patients needing All On Four often shop around to try and find the lowest price for the procedure. While it’s fine to do so, it is difficult to compare different offices because they are rarely offering the exact same product and same level of expertise.
Prices quoted by some offices may also increase once treatment is underway if the price is not guaranteed to be comprehensive.
You should also consider G4 Implants as an alternative to Ao4. G4 implants, created by Dr. Mike Golpa, solve many of the issues found with Ao4. This revolutionary procedure delivers permanent restorations in a single 24 hour period instead of taking weeks or months.
All treatment occurs in a single facility by an individual, experienced clinician. The price quoted includes everything, so you know what to expect, and the overall price is generally much lower than the cost of a traditional All-On-Four restoration.