Disclaimer: “All on 4” is a registered trademark of NobelBiocare
By Derek Gatta DMD MS FACP
Before dental implants, removable dentures were the only option for people missing all their teeth. Dentures are acrylic plates that are fitted to your gums and provide the ability to chew soft foods, speak and smile. They are certainly better than having no teeth but dentures do present challenges and are not optimal care when thinking about replacement teeth.
Great dentures usually require the combination of a great dentist and laboratory. Depending on the amount of bone loss you have, it can be very challenging to fabricate well-fitting dentures that are esthetic, functional and comfortable. You should be taking them out at night to clean them and to give your gums a rest. Every 3-5 years you will probably need to reline the dentures as your bone levels continue to resorb and decrease. Once that option is exhausted, you should have a new set fabricated. Dentures do not last forever and similar to a new car, they require regular maintenance.
The introduction of dental implants changed traditional dentures forever. Dental implants preserve and maintain your bone levels, so they do not continue to resorb over time. There are multiple options you can select when considering implant dentures. The following are the most common.
1. Two dental implants (Dentures still removable):
We can make your denture with less acrylic and they will “snap” into place using the dental implants. This greatly improves the retention and stability. You still have to take your dentures out at night for cleaning and resting your gums.
2) Four dental implants (Dentures can be removable or fixed):
A) Four dental implants greatly increase the support, stability and retention for your restoration. Dental implants buttress much of the load instead of your gums. If you chose the removeable options, the dentures still “snap” in and out and need to be taken out at night when you sleep.
- B) The “fixed” option is also available with four implants in some patients. This means the restoration in completely supported by the implants and does not come out at night when you sleep. For patients missing all their teeth, it is the most life like dental reconstruction out there. A European company called Nobel Biocare, originally designed this treatment protocol: also known as “All-on-4”. The aim is to minimize bone grafting and deliver temporary teeth the same day you receive the dental implants. We use porcelain or zirconia and the highly polished surface creates a much more realistic and biocompatible surface than the acrylic used to make traditional dentures. Not every patient is a candidate and you should consult your dentist to see availability.
3. Six or more dental implants (Dentures can be removable or fixed):
- A) This option is very similar to the “All-on-4” style restoration. We fix the restoration in place so you don’t have to take them out when you go to bed. The laboratory constructs the restoration out of porcelain or Zirconia, creating a life like prosthesis. It’s important to remember that this high-grade restoration requires high grade maintenance. Just because you don’t have any natural teeth, you still need to see your dentist for once yearly exams so he/she can design a recall plan that is appropriate for you.
- B) If manual dexterity is an issue, you may want to consider a removable restoration because it will be easier to keep clean. We can still make it in the more cosmetic material, but you have the ability to take it out. Dental implants fully supports this design and provides a similar rigidity as a “fixed” restoration.
Appointment Workflow:
Appointment 1:
Meet’n’Greet, Data Gathering: You will meet the doctor and the team will collect diagnostic information, photos, radiographs (xrays), study models of your mouth, health history, dental exam
Appointment 2:
Present findings, treatment recommendations:
Dentist will go over the case and describe how best to move forward and achieve your goals. We will provide an over view of what to expect.
Appointment 3:
Meet surgical team:
The dentist (Oral Surgeon or Periodontist) who will place the dental implant will meet you and go over your health history. They will determine if you have enough bone to place the implants immediately after any teeth need to be extracted and if you can receive immediate replacement teeth.
Appointment 4:
Surgical Day:
The surgeon will extract the bad teeth and place implants. Next , we will fit temporary teeth the same day, or we will make an impression of the implants and delivery temporary teeth within 48 hours. The implants need to heal for three months while you maintain a diet of softer foods. One month after surgery are when the implants are most vulnerable and if a failure/rejection is going to happen, usually happens at this stage.
Appointment 5:
Impression Day:
After the three month healing period passes, we will remove the temporary teeth and make a final impression over the implants. The master ceramist will use this to fabricate the final cosmetic restoration.
Appointment 6:
Delivery Day:
We remove your temporary teeth and deliver the final cosmetic restoration. Your dentist will confirm fit, comfort and esthetics.
This timeline is an estimation and everyone’s case may differ depending on your bone levels and complexity of your case. I cannot stress enough that this purchase is similar to buying a car, and yes it’s a wonderful and lifechanging investment, it does require maintenance and follow up care for long term success.
