When it comes to popularity, in my experience, there aren’t many dental implant treatments getting attention/marketing as much as “All-on-4”.
It’s easy to see why: with just four dental implants, they let you restore an entire row (or arch, as we say in dentistry) of teeth.
If you’re currently wearing dentures, that translates into a tremendous upgrade in comfort, stability and function, and if you’re looking to directly restore a number of missing or damaged teeth, it’s a much more economical option compared to placing, say, seven or eight dental implants.
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About the Author
As a practicing dentist for over 35 years, Dr. Peter Balogh has placed over four thousand dental implants and spent thousands of hours pursuing advanced education in implant dentistry. He’s recognized as a fellow by several leading implantology associations like the AAID and ICOI as well as a diplomate with the ABOI.
What Does “All-on-4” Mean?
Technically, “All-on-4” is a registered trademark belonging to the company Nobel Biocare.
They originally marketed the process of pairing four individual dental implants with a high quality dental prosthetic to restore an entire upper or lower arch.
That said, many people use the term “All-on-4” to describe any full mouth dental implant technique that involves a full arch of teeth mounted on four dental implants.
For this article, we’re going to be talking about All-on-4 in the general sense rather than Nobel Biocare’s specific treatment concept.
Why I Only Use All-on-4 Selectively
As a dentist, my goal isn’t solely to help you have a healthy mouth that functions well.
The treatment certainly needs to meet one’s budget limitations, but it also needs to meet one’s functional and esthetic needs while lasting as long as possible with minimal long term issues.
In some cases, 4 implants may be adequate to support a full arch of teeth. This is most feasible in the lower jaw, but rarely feasible in the upper jaw. If the chewing forces and pressure on the implants is too great it could lead to bone loss and then failure of an implant.
And with only four implants, if one fails then the entire teeth (and probably some of the other implants) will fail.
About ten years ago I had a patient see me because she was having pain and swelling around one implant. She told me she had an All-on-4 type of prosthetic placed just one year earlier, and the discomfort around the implant started within the past month.
Unfortunately three of the the four implants were failing and the entire prosthetics had to be removed. Although a failure as dramatic and sudden as this situation is not that common, even a failure after 10+ years is something I do not wish to see, and certainly no patient wants to experience.
I’ve been placing and restoring implants since roughly 1994, and that’s given me the privilege to see many long term successful implants cases: some All-on-4, some single implants. Many still function well and are in very good to excellent condition after 25+ years of service.
Ultimately, there are many considerations that will determine the longevity of an implant and the final teeth. Here are just some of the considerations:
- The quality and quantity of bone in the implant sites
- The number of teeth the implants must support
- Any clenching or teeth grinding habits
- Past history of gum disease; oral hygiene ; tobacco use
- Your current medical condition
- The number of implants planned to support the final teeth
Patient Suitability for All-on-4
One of the biggest factors for All-on-4 suitability is the quality and quantity of bone.
The lower jaw has very dense bone, hence All-on-4 type of prosthetics can work well in the lower jaw provided the bone volume is adequate and the implants can be placed in ideal locations.
However, the bone density in the upper jaw is not nearly as good, therefore 4 implants to support a full arch of teeth are often under engineered. That is where problems with failure and complications can develop.
Because the teeth are supported by only four implants, the diagnosis and treatment planning is critical for long term success, simply because failure with one implant will lead to failure of the entire prosthetic and often the other implants (much like the case described above).
Cost Considerations
If someone already has a full denture or the last of their teeth are failing, but an All-on-4 implant solution does not fit their budget, one option is to place two implants for now to simply hold a denture in place.
Of course, it’s not as ideal as an All-on-4, which is fully supported by the implants, but if it’s planned correctly two more implants can be placed in the future and an All-on-4 can then be made.
Simply placing two implants will be less expensive, it will at least provide some initial benefit compared to a standard denture and allow one to spread the cost of the treatment over several years if necessary.
All-on-4 can be great — but make sure it’s what you really need
All-on-4 implants are a remarkable solution for many people, but they aren’t a one-size-fits-all answer.
My personal philosophy is to provide the best dentistry that is available and feasible, but also one that fits your current needs, desires, budget and long term goals.
Remember, the right choice depends on your individual circumstances and preferences.
Your dentist or dental implant surgeon is there to help you understand your options so that you can make an informed decision about your oral health.
Do some research online, absolutely, but also don’t be afraid to get a consultation, look for a second opinion, ask questions, and see what options are specifically available to you.
Get a no-obligation consultation at VCCID
If you’re thinking about restoring your smile with All-on-4 dental implants, it’d be my pleasure to lend my 30+ years of implant placement experience to you so you can make an educated choice.
It’s just like a conversation — there’s no pressure or obligation to commit to treatment. If you have dental insurance, in many cases it’ll cover the cost of the consultation as well.
When you’re ready to schedule a visit, you can do so online through our contact form or by calling our Burnaby dental office at (604) 243-0046.
