The All-on-4 procedure (AO4) has been successfully performed in Europe for almost two decades and here in the U.S. for over 6 years. Approximately 10 years ago one of the world's largest dental implant manufacturers, Nobel Biocare, began to study computer simulation and bio-mechanics and collect large amounts of data about this use of implants for the edentulous patient (most or all of the natural teeth missing). Our clinicians have since studied with the developers of the AO4 procedure. Recent studies of large numbers of patients treated with this procedure show a success rate of nearly 99%.*
*Del Fabbro M, et al. Tilted implants for the rehabilitation of edentulous jaws: A systematic review. Clin Impl Dent Rel Res. 2010
All-on-4 is not for everyone, but can spell relief for tens of thousands of denture wearers overnight. The research and scientific documented studies and clinical success with the All-on-4 procedure allow for the back two implants to be angled slightly, giving as much support as multiple implant placements. An implant-supported bridge attaches to these four specifically placed implants and is just as effective as being supported by many more implants using a non-AO4 technique. The results are less cost, less chair time, less healing, avoiding most grafting procedures, and a faster smile.
Most dental clinicians do not have experience in the AO4 protocol and continue to use as many implants per jaw as the bone will allow, adding to the cost factor, trauma factor and treatment time. At the TeethToday Center, we recommend the most cost effective denture replacement procedure that is appropriate for you.
We are a private practice and have been placing dental implants successfully for over two decades. In fact, we have placed over 20,000 implants with an outstanding success rate. Each one of our clinicians offers you the very best care available. We are a periodontal practice, specializing in tooth replacement, be it single tooth, multiple teeth, or all your teeth. Our clinicians perform a high number of traditional and AO4 procedures monthly with outstanding results. We encourage you to speak to some of our success stories and hear first hand of the life changing dramatic effects TeethToday has had on their lives.
To answer "how long does it take", let's first examine how long it used to take using traditional implant procedures. The surgery would normally involve 6 - 8 implants per arch, often preceded by bone grafting and sometimes grafting of the sinuses. Several visits to the surgeon, restorative dentist, CT scan facility, and off site dental labs would add to the time table. This could easily translate into the patient being without teeth, or with a temporary denture for 6 months or up to two years.
Now, with the TeethToday procedure (which for the most part eliminates bone grafts and other ancillary procedures) after the initial examinations, any extractions, implant placement, the new temporary implant-supported bridge, and adjustments take one day, and happen in one facility. In one day you will be walking out with a new smile and renewed quality of life.
After sufficient healing of the bone, gum and implants (3 - 6 months), your final and permanent implant-supported bridge will be prepared and attached to your implants giving you a lifetime of smiles.
We've heard this statement often, and can assure you it is not accurate. In fact there are even reports with pretty good results using only 3 implants. We donâ€™t recommend this approach, for a variety of reasons, but it shows how silly the statements insulting the 4 implant design can be. We have met with and discussed the All-on-4 technique with some of these skeptical dentists and surprisingly these very dentists now understand the AO4 and how it can instantly give relief to their dentally exhausted patients. Even still, some of these same dentists are now resolute advocates of the AO4, advising their patients to see us for a complimentary consultation. We are experienced and will care for you. And we mean it.
Implant failure is rare but in extreme circumstances it may happen. If implant failure does occur, it will most likely affect only one implant, but not all of the implants. Treatment options depend on when and why the implant failed. Ordinarily implant failure happens very early in treatment. If so, often it will be replaced using a slightly larger implant or by placing a new implant in another site near the original site. In this situation, we modify the provisional bridge to insure that you can continue to have fixed teeth while the new implant heals. Ordinarily, there is no charge for these procedures unless the patient deliberately sabotages the treatment or ignores our simple post-operative instructions. Late failures of single implants are very unusual. We will work with you to troubleshoot this situation. Late failures are usually associated with poor hygiene. As with natural teeth, dental implants and the implant-supported bridge must be cleaned daily, including brushing, flossing and periodic check-ups including hygiene maintenance. If an implant fails, it will normally happen in the first few months. At TeethToday, we will replace the implant and make you a new temporary bridge that will easily last until your final implant-supported bridge is ready. Complete failures are exceedingly unusual and are usually associated with general health problems like immune system collapse, uncontrolled diabetes, cancer treatment with aggressive chemotherapy, etc. In this situation, we will work with your physician to manage the problems.
Most dentists are not familiar with the wealth of professional experience and depth of understanding associated with TeethToday and AO4. However, there are some local general dentists who are among the highly educated, and they refer their patients to us for their implant procedures including single tooth, multiple teeth, and especially patients missing all their teeth. These knowledgeable general dentists and restorative dentists have seen the results we have achieved for other patients and therefore believe in the benefits of the AO4 for those suffering with dentures or compromised teeth. They also realize that clinicians with years of implant dentistry experience, in a specially designed dental facility, is necessary to efficiently provide the best possible environment to perform these procedures. The TeethToday Center has all of the necessary components in one place - including progressive instrumentation and technologies, and in-house dental CT imaging capabilities, along with surgical and restorative suites. We even provide facilities for your family and friends to wait in comfort.
Most dental implant specialists lack the experience and the facilities, including the high-end technological advances needed to perform the AO4 in one facility in one day. In addition, the TeethToday Center has a complete team of skilled surgical and restorative assistants, dental hygienists, patient education coordinators and an administrative staff ready to help your experiences with us be as comfortable and rewarding as possible.
With the AO4 technique, fifteen year studies indicate a success rate of 98.2% in the upper jaw, and up to 98% in the lower jaw - and that is with only 4 implants per jaw. These numbers are consistent with implant procedures using 6 or more implants per jaw, showing that the success rate does not decline when only 4 strategically positioned implants are used vs. 6 or more. In extremely rare cases an implant may fail. If so, in all likelihood it will fail within the first two months of the procedure. If that occurs, we will replace the implant and rework the implant-supported bridge whenever there is a less than desirable occurrence.
Our clinicians are specifically trained to place dental implants and will work closely with any patient who may have contraindications for implant placement; however, the vast majority of people are candidates for the All-on-4 procedure. As with all medical procedures we thoroughly evaluate each person and collaborate with their physician should the situation call for it. Uncontrolled diseases such as diabetes, cancer, organ failure, severe immune deficiency or other significant medical conditions are usually contraindications for treatment. If these conditions are controlled, then treatment is usually acceptable. AGE IS NOT A CONTRAINDICATION FOR TREATMENT. We have successfully replaced teeth in patients who were over 100 years old.
Many of the patients seeking our advice have been told by other surgeons, their general dentists or their medical clinicians that they were not candidates for dental implants. Their doctors were either not aware of the All-on-4 procedure, did not have enough experience to comfortably recommend the procedure, or were unaware of implants as the standard of care in replacing missing teeth. We examine each case individually and give recommendations for all viable treatment options, which may or may not include the All-on-4, therefore helping the patient make an informed decision. We will do so in collaboration with the patientâ€™s existing medical team. The vast majority of patients can be successfully treated with AO4. Occasionally, patients with very advanced, severe bone loss require more sophisticated procedures. These patients have usually had facial trauma or resective surgery of the jaws. We recommend you come in to our office to be examined. There we can help determine if you are a candidate for treatment.
Like all surgical procedures, there are varying degrees of discomfort. Before we begin, our patient coordinators will review your medical history, prescribe any pre- and post-surgical medication, and have everything ready for you to make your transition as comfortable as possible. During the implant placement, we often recommend sedation when performing the AO4 procedure, simply for the comfort of the patient. We will, however, give you exceptional care during your visit and the days following. Now, many implant patients comment on how surprised they were with the minimal discomfort they felt during the procedure, and most returned to work within days of treatment, if not the next day. There will be some swelling, but for the most part nothing that cannot be controlled with ice and over the counter pain reliever for any discomfort.
In addition, unlike dentures and partial bridges, your new teeth rest on the implants and not on the gum tissue, therefore avoiding any associated tenderness from the surgical area.
A denture is a removable device that is inserted in the mouth and removed from the mouth by the patient, and needs to be removed daily for cleaning and maintenance. It sits on the gums. In the case of a partial denture, it is attached using metal hooks to adjacent teeth - further leading to failure as it grinds against natural dentition and the gum line. Patients who are missing most or all of their natural teeth and are wearing dentures know the pain and discomfort brought on by these appliances, and most seek alternative treatment. In addition, dentures do not replace the tooth root, which in turn will cause the jawbone to melt away due to lack of stimulation (atrophy), causing even more pain and embarrassment for denture wearers.
Now there are viable options to help restore your smile. And one cost effective, proven option is the All-on-4 procedure. The AO4 provides for new teeth that are attached to 4 implants per jaw; and look, feel and function like naturally healthy teeth. In fact, dental implants are the closest thing we have to the roots of our natural teeth. And the implants stimulate bone growth, just like natural tooth roots, helping to eliminate that sunken facial collapse which is so prevalent with denture wearers.
You will be able to eat just about anything without worrying about slippage or your teeth falling out. The bite force with implants is far greater than with dentures. Your bite force with dental implants is about 250 pounds per square inch, where as with dentures, it's about 6. Basically, once your implants are fixed in your jawbone, you can eat anything you want. Go ahead â€“ chew on that carrot stick, bite into that apple. Of course, weâ€™d prefer you to hold off for a couple of months post surgery â€“ our patient coordinators will give you instructions as to when you can eat just about anything. And, your new implant-supported bridge can be cleaned like natural teeth while in your mouth by brushing and flossing. Only your clinician can remove the prosthesis for periodic maintenance, if necessary. You now have a permanent solution to dentures and/or partials and an enhanced lifestyle with lots of healthy food waiting for you, and the added bonus of worry free smiles.
There is no irritation with implant-supported bridges. The new teeth are supported by the implants and not the gum, allowing freedom from the distress dentures can cause, and the unsightly metal from partial denture wearers. Also, because there won't be any devices covering your palate, you will be able to enjoy the taste of all the foods you've been missing, and you won't need any potentially toxic dental adhesives to hold your new teeth in place. No more slipping, no more sliding, no more bad breath, no more worrying about your teeth falling out, no more mashing up your food, or even covering up when you speak. Just smiles from here on.
During your examination, we will determine where your "smile line" is and plan to have the area where your implant-supported bridge meets your jawbone invisible. In this manner, it does not show when you smile. Simple adjustments during the restorative procedure will assure a perfect fit, form and function.
Because of the design and nature of the implants used with the AO4 technique, only in extreme cases will bone grafting be necessary. If so, we have developed and successfully use a unique protocol for patients experiencing the most severe instances of bone loss, which does not require a patient to go without their teeth, not even for one day. The only way to accurately estimate extreme bone loss and determine the best treatment option is to have an examination and consultation with a TeethToday dental specialist.
A modified diet is required until you receive your final fixed titanium reinforced framework. The time line to your final permanent implant-supported bridge will be determined by your clinician, but is normally about 6 months. In the mean time, you can eat anything that can be cut with a fork, and does not involve biting or tearing with your front teeth. Some examples are hamburger, fish, pasta, cooked vegetables, etc. Avoid hard foods and foods that require tearing such as hard breads, pizza, carrots, corn on the cob, steak, and crunchy and sticky snacks treats such as nuts and gum. Once your final tooth supported bridge is in place, you can eat pretty much anything that a person with their natural teeth could eat, and enjoy it at the same time!
The AO4 procedure calls for the implants and temporary provisional restorations to be done in the same day. Sometimes we ask you to return a few days later to place a more esthetic and durable provisional that is fabricated by our dental laboratory. Your first official check up will be in about one week's time, with follow up appointments every 1-3 months for 4-6 months. Then, the procedure for your final restorations will begin with 3 or 4 more appointments spread out over a couple of months. Your clinician will control the time line which may differ for each patient depending on healing and other possible issues. It is important to recognize that during all this time, you will never wear dentures and will always have your teeth attached to your dental implants.
A provisional restoration, commonly referred to as the implant-supported temporary bridge is fabricated using acrylic or composite resin (tooth colored plastics) by a dental technician, the day of implant placement. These plastics are softer but easily manipulated materials which are used to replace your teeth and will not harm your implants or cause any irritation to your jawbone while the healing process is taking place. They are strong enough for you to start your active life again. Don't hold back after you are fully healed but just watch what you eat in the first couple of months - keeping to a soft diet until directed otherwise by your clinician. Provisional restorations often do not have molars on them to limit the amount of force that can be applied to the healing implants. The provisional is designed to last six-twelve months and may show some wear or breakage near the end of its use. Your final restoration is made using a titanium or Zirconia ceramic framework for strength, and is placed after sufficient healing, about 4-6 months post-operatively. These restorations typically have a couple more teeth than the provisionals and generally include molars. This restoration allows for extra support and long-term form and function for your permanent teeth. The teeth themselves are made from acrylic, composite or porcelain but it is the underlying framework which gives the strength. Regardless, the final restorations will be adapted to your new smile, look great and will act like your natural teeth for a lifetime.