All On 4 Implant Treatment
The All on 4 treatment concept is a highly complex surgical and prosthodontic procedure that has received much attention with successful and extensive marketing as a “quick and minimally invasive procedure”. As a result, it is fast becoming a popular option and is sometimes relied upon as the “default” treatment for prospective patients. Additionally, some dentists even model their practice as All on 4 implant clinics or centres.
At Perth Prosthodontics, we believe that All on 4 implant procedure is only one of many surgical and prosthodontic techniques available for patients with either all teeth missing or terminal dentition – where teeth are determined unrestorable or hopeless in prognoses with absolute certainty.
If the prognoses of your teeth are determined to be fair to sound, we believe in saving your teeth through restoration and preservation using high quality dental materials and advanced techniques. Advanced prosthodontic knowledge and skills are required to pursue this challenging goal. Unless this investigative path is explored with other treatment options considered, patients should not resort to the irreversible process of tooth extraction (removal), bone removal and prosthetic replacement as entailed by the All on 4 implant procedure. We do not believe in prescriptive treatment for our patients – even when it is more difficult to save your teeth.
With high expectation for long term functional and aesthetic / cosmetic results, our clinicians at Perth Prosthodontics have an unbiased understanding of this complex procedure, amongst other treatment alternatives, to professionally advise you on its advantages, disadvantages, risks and complications.
To determine whether you are suitable for the All on 4 implant procedure, we will need to perform detailed analysis of dento-facial profile. This involves assessing the quality and volume of gum (soft tissues) and bone tissues, the relationship between jaw and lip line during rest and smile position, ideal tooth/teeth positions, ability to control of causative factors that led to tooth loss (i.e. gum and bone (periodontal) disease, tooth wear, poor oral hygiene measures) and stability of underlying medical conditions (i.e. diabetes).
If the All on 4 implant procedure is suitable for the replacement of your terminal dentition, our clinicians at Perth Prosthodontics will work in collaboration with highly experienced dental specialists, such as an oral and maxillofacial surgeon and a periodontist to plan for:
- the extraction of all remaining teeth
- the removal of jaw bone for the creation of a stable platform
- immediate surgical placement of 2 vertical dental implants and 2 tilted dental implants in the front and back part of the jaw respectively
- immediate temporary implant supported dental bridge (acrylic material with minimal reinforcement) installation on newly placed implants – within 1 week of tooth extraction and implant surgery
- final implant supported dental bridge (high strength acrylic or ceramic material with underlying customised titanium alloy or zirconia framework) installation on osseointegrated implants – around 6 months after healing
Unfortunately, many patients often misunderstand the temporisation phase as the end point of treatment and becomes disappointed when gum and bone tissues heal and continue to resorb / shrink away over a few months. This results in space developing under the immediate temporary implant supported dental bridge, which leads to a food and plaque wedging problem and impacted speech with air escape.
A simple acrylic addition (reline) to the immediate temporary implant supported dental bridge may be offered to address this space problem. However, as its name entails, it is a temporary prosthesis. Unless it is made with high strength framework reinforcement as available now in newly emerging techniques, this should not be passed as the final treatment result given low mechanical strength and high risk of fracture.
Ideally, a final implant supported dental bridge, made of high strength acrylic or ceramic material with customised titanium alloy or zirconia framework, should be constructed for a long lasting functional, aesthetic / cosmetic and hygienic result.
FACT: Unless it is removable, it is not “easy to maintain and clean”. Meticulous oral hygiene measures are required for its daily maintenance. Hence, a fixed (non-removable) implant bridge may not be the best solution for those who have lost their teeth due to problems such as decay and uncontrolled gum and bone (periodontal) disease arising from poor oral hygiene and those who lack the manual dexterity to perform meticulous oral hygiene measures.
At Perth Prosthodontics, we know all procedures carry benefits, associated risks and complications. It is best for our clinicians to balance these factors and provide professional advice to help you make an informed decision on whether the procedure should occur.
For All on 4 Dental Implant Treatment in Perth, please contact us at Perth Prosthodontics to make an appointment to discuss your needs.