What is All-On-4®?

All-On-4® is the concept of placing 4 dental implants (sometimes more) into either the upper or lower jaw, and placing a set of temporary teeth on those implants the very same day or the next day. These temporary teeth remain in place for 3-6 months while the mouth heals from the implant procedure. Then, a final and permanent set of teeth are fabricated and used to replace the temporary teeth.

 

This procedure was created more than 20 years ago and has documented long-term success. Nobel Biocare®, a dental implant company that invented the dental implant, was the first company to introduce the All-On-4® concept, and subsequent dental implant companies have now adopted the protocol.

 

Who is a candidate for All-On-4®?

The best candidates for All-On-4® are those who are not satisfied with their dentures, or those who require the removal of most or all of their teeth and do not wish to wear a denture. The All-On-4® technique can be implemented for either the upper jaw, lower jaw, or both.

 

How do I know if I am a candidate?

You and your dentist must consider several factors to determine if you are a candidate for the procedure. Some primary factors include the health of a patient, and the amount and quality of available bone to secure implants.

 

What are the benefits of All-On-4®?

This technique is designed to avoid expensive bone grafting, which can result in a time-consuming healing process. This is made possible by placing implants that are tilted to avoid the sinuses in the upper jaw, and to avoid the Inferior Alveolar nerve in the lower jaw (see Fig. 1-1a).

All-On-4® is a proprietary name for Nobel Biocare®. Other dental implant companies have adopted this approach, utilizing names such as Straumann® ProArch, Revitali ZeÔ, and Teeth Xpress®. It is also marketed by dental professionals with phrases such as “Same-Day Teeth”, “Teeth in an Hour”, “Immediate Load with Immediate Function”, and “Full Arch Solution”, to name a few (see Fig. 2-2a).
 


Figure 1: The white metallic-looking objects are dental implants that are placed just in front of the maxillary sinuses (the dark/black areas on the radiograph). In this procedure, bone grafting was avoided, which can be costly and require almost a year of healing before the bone graft is mature enough to accept implants.


Figure 1a: The white metallic-looking objects are dental implants that were placed just in front of the inferior alveolar nerve of each side. There is limited bone in the posterior, which prevents implant placement. Bone grafting in this region would be expensive and can be unpredictable. In this procedure, bone grafting was avoided, which can be costly and require almost a year of healing before the bone grafting is mature enough to accept implants.


Figure 2: This patient was unhappy with his smile, and he was uncomfortable with his upper and lower removable partial dentures.


Figure 2a: He had an All-On-4® procedure, as well as lower implants placed in the posterior regions of his mouth. This procedure gave him improved chewing, improved esthetics, and confidence with his appearance and his ability to chew during social functions.
 

Dr. Enest Orphanos, Boca Raton, FL. center4smiles.com