Dental Implant Procedure – All-on-4
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All four titanium implants are placed so that the bone will grow around and secure them in place. With only four implants, there is much less invasive and lengthy surgery.
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Once the implants are in place, we will attach the abutments which the new replacement teeth will be secured.
The Restorative Dentist fits the replacement teeth on the abutments and adjusts the bite for comfort and a beautiful smile.
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The All-on-4 Dental Implant Procedure uses four implants, with the back implants angulated to take maximum advantage of existing bone. Special implants also were developed that could support the immediate fitting of replacement teeth. This treatment is attractive to those with dentures or in need of full upper and/or lower restorations. With the All-on-4 Procedure, qualified patients receive just four implants and a full set of new replacement teeth in just one appointment—without bone grafts! The real appeal is how quickly permanent implants can be placed so that patients can leave the same day with fixed, non-removable replacement teeth.
Traditional approaches to restoring a full arch of teeth usually involved bone grafts, six or more implants, and as many as 18 months of treatment. That meant that a patient often would be without any teeth, or with ill-fitting temporary dentures for more than a year. Dr. Koyfman will always make sure that ALL patients leave with teeth!
With the All-on-4 Dental Implant Procedure, the patient has one or two visits to the office to allow Dr. Koyfman gather information for a treatment plan. Then the patient will return to their restorative dentist to have the teeth fabricated prior to surgery. Following this consultation, the patient is scheduled for surgery implantation and the new teeth are fitted and adjusted, all in one appointment (even when extractions are necessary). The patient comes to the office in the morning with unhealthy (or no) teeth, and leaves in the afternoon with a beautiful set of fixed, functional teeth.
The patient will return for occasional check-ups over the next several weeks and months. After almost six months, when the gums have fully healed and the implants are fused to the natural bone, your restorative dentist will take new impressions of the patient’s mouth and prepare a final, stronger, permanent set of teeth adjusted to a perfect fit.This helps ensure that the teeth will last for decades, and provide maximum support, beauty, and function to the patient.
Frequently asked questions section
How is the All-on-4 different from a denture?
The All-on-4 Procedure provides patients with new teeth that are firmly fixed in place, and look and function as close to natural teeth as possible.
A denture or partial denture is a removable appliance, and should be taken out every night for cleaning. Additionally, since a denture is not fixed in place, it will often slip or sometimes fall out, under even normal use. For this reason, a multi-billion dollar market for denture adhesives has developed, to try to hold dentures in place. Even with adhesives, many people find that eating, laughing, being active, and sometimes just talking can be a challenge with dentures.
All-on-4 provides the patient with a set of teeth that are connected to the implants, and are solidly fixed in place (what we call an implant-supported fixed bridge). They may only be removed by the dentist, are bushed and cleaned like normal teeth (though flossing is different), and are the closest thing possible to natural teeth in terms of look, feel and function.
The All-on-4 bridge also allows the patient to bite with much more force than dentures, since the stresses are transferred directly to the bone rather than to gum tissue as with dentures. This means that patients can eat almost any of their favorite foods without worrying about their teeth.
Will my implant supported teeth be uncomfortable and push on my gum tissue like a partial or a full denture does?
Absolutely not! And this is the best part of dental implant treatment vs. conventional removable dentures. Not only will your implant supported teeth be fixed in place, without slipping, lifting, rocking or needing to be removed for cleaning, but since your teeth are supported by the implants, they do not push down on the gum tissue and therefore do not create any of the discomfort common with dentures. In addition, since this pressure is eliminated, you also will not experience the destructive dissolving of the bone from underneath the denture. The implants will actually save your jawbone from dissolving away from under a non-implant supported denture.
What about the line between the new fixed bridge and my jaw bone? Can people see it?
This line will be hidden behind your lips so that when you smile it cannot be seen. During your initial examination I will evaluate your smile to determine where the junction of the fixed bridge and the jaw bone will be. During the procedure, I will actually adjust your “smile line” to ensure that your new smile is not too “gummy” and that the top (or bottom) of your bridge is completely hidden.
My friend had a full-arch procedure done at another dentist using 8 implants. Why does the All-on-4 Procedure with Dr. Koyfman use only 4 implants?
Research done shows that in most cases, 4 implants, specially placed with some angulated, are just as effective in supporting a full arch fixed bridge in either jaw as a 6, or 8 implant restorations. On rare occasions where bone is soft or severely worn down, additional implants may be needed, but these situations are the exception and usually only occur in the upper jaw.
My friend’s procedure involved bone grafting to “build up” the bone before the implants were placed. Does the All-on-4 Procedure involve bone grafting?
In most cases, even the most difficult ones, Dr. Koyfman is able to place only 4 implants and restore a full arch of teeth without the need for additional bone grafting. This is accomplished by the special placement and the angulation of the implants, taking maximum advantage of your available bone, without the need for additional grafting.
What is the success rate of the All-on-4 Procedure?
Published studies indicate a 98.2% implant success rate when using the All-on-4 technique in the lower jaw. Similar studies show a 97 to 98% success in the upper jaw for the same procedure.
Occasionally, an implant will fail. If this happens, I simply place a new implant in a slightly different position to take advantage of existing bone, and the fixed bridge is adjusted to align with the new implant.
What type of follow-up visits are necessary?
For the all-on-four procedure, the implants are placed the day of surgery and follow-up checks are done at one week, two weeks, two months and four months. At the end of the four month period, fabrication of the permanent teeth begins, and requires one or two additional visits over the next few months until the final teeth are delivered.
What will my diet be like after the All-on-4 Procedure? When can I eat solid food again?
Solid foods can be eaten by a patient that has undergone the All-on-4 Procedure that same day. However I need to define what is meant by solid foods. I am talking about a modified food diet, defined as foods that are soft enough to be cut with a fork. Examples of the modified food diet are scrambled eggs, meatloaf, mash potatoes, hamburger, fish & pasta.Please do not eat foods that require any tearing or biting with your front teeth i.e.: Pizza, sandwiches, and bagels. Also, avoid hard foods such as carrots, chips, apples, nuts and absolutely no gum chewing!
This modified diet is to be maintained until you receive your permanent prosthesis, usually about six months. Once your final bridges are made with the titanium frame as reinforcement you can resume a normal diet.
Why do I have to wear a provisional set of teeth and not my permanent new teeth right away?
On the day of your procedure Dr. Koyfman will place the implants and a new set of teeth called a “long-term provisional” prosthesis. This provisional set of teeth is fixed in place, is fully functional, and provides you with a beautiful smile. You will laugh, talk, play sports, and be normally active, without having to worry about your teeth.
This provisional set of teeth is made entirely of acrylic resin, which places less stress on your new implants during their first few months of use. We will ask you to be selective in the foods you eat the first few weeks following your procedure, but you will soon be back to a normal diet (without hard, tough, or brittle foods for a while longer).
Once your gum tissues have healed and the implants have become completely stable (usually about six months) your restorative dentist will fabricate a permanent bridge with acrylic or porcelain teeth, but this time with a titanium framework inside for strength. Think of the titanium as a reinforcement bar to give your teeth extra support and long-term strength. This permanent set of teeth is carefully adapted to your healed gum tissues and is adjusted to be sure we achieve an ideal fit in your mouth and that your bite and smile are perfect.
If I need both upper and lower full-arch replacements, do they both have to be done at the same time?
In many cases, where the patient has several broken or missing teeth or has an uneven bite, it is best to do both arches at the same time to avoid compromising the final result. This allows me to control the patient’s biting plane and bite. This way your “new” teeth will not be made to fit together with your existing teeth which may be severely crooked, uneven or have large spaces between them.
In some cases, treatment can be sequenced to meet the financial, health, or other individual needs of the patient.
Are some people not a candidate for the All-on-4 Procedure?
Very few people who need a full arch of replacement teeth are not candidates for the All-on-4 Procedure. However, each candidate is fully evaluated to determine the most appropriate plan of treatment to address their individual dental needs.
Importantly, Dr. Strout requires all candidates to be stable medically before entering treatment. That may entail contacting your physician about any existing medical conditions, and getting your doctor to provide medical clearance.
In some cases, the All-on-4 Procedure is not the indicated treatment approach. Based upon dental condition, some people are better off being treated with conventional dental procedures done by other dental practitioners. Dr. Strout and your restorative dentist will initially determine the appropriate treatment approach.