A technique that’s being heavily advertised on TV, radio, print and on the web is All On 4 dental implants. Promoted as a fast and economical way to escape the discomfort and embarrassment of wearing dentures, All On 4 refers to a very specific dental implant treatment plan that can replace all or most of a patient’s missing teeth in the upper or lower dental arch.
The appeal of All On 4 is that is involves only 4 strategically placed implants, as opposed to 5 or even 6. In essence, the patient gets a nearly full complement of teeth, but needs only four implants. ALL the missing teeth are replaced by restorations that are supported by only 4 implants: All. On. 4.
It’s pretty obvious why All On 4 dental implants could be popular. The treatment plan:
- Involves Less Surgery: Only four implants need to be placed and bone grafting procedures such as sinus lifts are often not needed.
- Is More Economical: Only four implants are placed, thus reducing the cost of the surgery as well as that of the final restoration.
- Takes Less Time: Because advanced surgical procedures are often avoided and the time and number of visits required to fabricate the final restoration is reduced, the entire procedure requires fewer hours in the chair.
When a patient fulfills most of the clinical requisites for a successful outcome and with careful planning on the part of the dentist All On Four can be a very viable and economical choice for patients who are either wearing (or facing the prospect) of full dentures.
In fact, success with this technique can be a real game-changer in the quality of life of the person who pursues such care. To be able to smile, to eat, and to live in comfort without being concerned that one’s teeth may fall out, is something that was unheard of for denture wearers just a few years ago.
All On 4 Dental Implants Are Not For Everyone
Before embarking on the All In 4 treatment course many considerations (clinical, anatomical, and above all biomechanical) must be taken into account. Failure to do so will most assuredly, in my personal and professional opinion, lead to dramatic disappointment for both the patient and his or her dentist.
While it is the dentist’s (or team of dentists’) responsibility to determine whether All On 4 is a viable treatment option, it is the patient’s prerogative to ask a lot of questions about the pros and cons of such treatment. And the most important question of all is this:
What Happens if One of the Implants Fails?
With thorough and thoughtful diagnosis, carefully planned and proper surgical techniques, well fabricated restorations, and the appropriate follow-up care, the majority of implants are highly successful. In fact, some literature indicates a greater than 95% success rate.
But the reality is this: some of the implants will fail. Aside from surgical failure, the most common reason for an implant to fail is overload. In other words, after an implant is restored with a crown or as part of a bridge, it is then put into what we call function. This implant works hard: it bites, chews, and it grinds.
When an implant is part of a bridge, one of its jobs is to help support and carry the load that normally would have been carried by natural teeth. When the load becomes excessive, it’s common for the patient to lose some of his or her supporting bone. That is what leads to implant failure.
Management of these forces is one of the most crucial aspects of long-term implant success. Here are two of the many considerations that must be taken into account when deciding if All On Four is a good choice:
- The more missing teeth that are replaced, the greater stress and strain is placed on the implants and the supporting bone around them.
- If the opposite dentition is overly strong, the implants will be subjected to incredible forces. Imagine a large man with powerful jaw muscles and the force his implants will endure. The greater the force, the more support (number of implants) will be needed to help share or distribute the load.
Getting back to All On 4. Remember, there are just four implants to support the functional load of an entire dental arch. If the force factors are relatively low and there is an abundance of bone to support properly sized and angled implants, the All On 4 treatment can offer years of service to a very satisfied patient. But should just one implant fail, there will be trouble. First, the entire restoration must be removed. Next, additional implants must be placed. Finally, a new restoration must be made. This is costly in time and money.
If you lose one implant on All On 4 you are left with None On 3
As a highly trained implant dentist, it is my goal to properly address the clinical and biomechanical demands that will be placed on my patients’ teeth and implants in the future. It’s not my goal to over-engineer a planned dental implant restoration, but it’s prudent to provide some built-in fail safes.
Okay, so maybe I do lean towards being a bit conservative. But when I design All In 5 or All In 6 restorations, my patients are confident that one single implant failure will not necessarily doom the entire restoration. Most often, a simple chairside modification is made and the patient endures not even one full day without teeth.
Thanks to both dental ingenuity and a lot of publicity, All On 4 has become a very popular and sought-after treatment option. It can be a valuable service to the edentulous (a nice way to say “toothless”) person seeking better function, esthetics and comfort, less time in the dental chair, and a lower overall investment. But it is only a good In the appropriate circumstances.
Therefore, All On 4 is not for everyone and I fear it is being overused. In the long run, the cheapest route is not necessarily the most economical one.
Stay tuned (and subscribe) for more of my thoughts on the All In Four dental implants procedure and something else that concerns me: Teeth In A Day.