A Full Mouth of Teeth Such as All on 4 Should not be Replaced in One Day
The first step to replacing a full mouth of implants with All on 4:
- Remove all the remaining teeth. Many of the remaining teeth are not any good or not worth fixing or worse yet, they may even be abscessed and causing jaw bone infection and bone loss.
- perform bone and gum grafting to repair areas where there are bony holes where teeth were removed. Depending on how much infection is in the jaw, bone grafting may not be possible on the day of tooth removal. In this case, the patient would need to have the graft on a later day. When grafts are done in areas of infection, the grafts can fail and there can be additional infections associated with a rejected bone graft.
- 4-6 implants need to be placed to support a full mouth all on 4 implant bridge. Implants take 2-3 months to heal and reach full strength. The implants need to be perfectly placed so as to properly support all on 4. But what if there is infection right where you need to place an implant? Is the implant dentist going to place the implant and possibly even do a bone graft anyway? And then, hope they are lucky and it heals perfectly while it supports an expensive new all on 4 bridge? And all this is going to magically happen before the implants, gum and bone has even healed? I don’t think this will always happen and it certainly is not predictable. Replacing a full mouth of teeth with All on 4 can lead to many problems, complications and undue risk.
- Accurate impressions of the mouth and gums and implants need to be taken to make a good fitting all on 4 implant bridge. But how can that happen since after all the teeth are removed the gums and bone are going to change shape as the mouth heals.
- The All on 4 prothesis needs to be made by an in house lab while you wait. And inserted into the mouth after surgery? What kind of bridge are you getting anyway? All on 4 can be made out of acrylic (basically plastic) or zirconia (a nice high quality porcelain). The premier service is the Zirconia or Prettau bridge. Zirconia All on 4 teeth cannot be made in house in any dental office. Prettau is a solid Zirconia bridge. Prettau is a brand name of zirconia bridge. Another Zirconia full mouth bridge option is Bruxzir. Neither Bruxzir of Prettau can be made in one day. The impressions for Zirconia are sent to a distant lab where a multimillion dollar machine manfactures the bridge. The zirconia process takes multiple patient visits and takes at least 4-6 weeks. Long story short, same day All on 4 is always done with acrylic teeth which is basically a denture which gets permanently fixed to the implants.
What Problems can happen if All on 4 Implants are done in the same day?
- Implants can fail and subsequent loss of the all on 4 bridge. Implants fail 5% of the time in ideal situations. When placed in compromise situations the failure rates can go up. If 5 implants are placed, the chances of a failure can be between 25-50%. One failure can cause an entire all on 4 case to fail and need to be totally be re-done.
- Gum and bone may not heal where you expect when final impressions are taken before implants, gums and extraction sites heal. This is an extreme case but the picture serves the point:
Notice how the gum levels healed below the level the crowns were made. The best way to do implant crown and bridgework is wear a nice temporary bridge for 2-3 months and take impressions when the gum levels can be established.
What is the Best way to do All on 4 Implants?
- Remove all remaining teeth very carefully
- Perform any necessary bone grafting
- Place into the correct position 5-6 appropriate size dental implants.
- Place a nice set of temporary teeth for a period of 2-4 months while implant and gum healing mostly completes.
- Finish case with a high quality set of Zirconia teeth using either Prettau or Bruxzir. If you are going to go through with an all on 4 case, do not settle for plastic teeth or hybrid dentures. You should get the Zirconia. Zirconia may be a little more expensive, but it does not break, stain, absorb plaques or require maintenance. Hybrid Dentures absorb bacteria, stain, teeth can break off and the acrylic material generally breaks down. Comparing Zirconia to Acrylic is like comparing a plastic cup a high quality porcelain mug (except zirconia does not break).