All on 4 Restoration
All on 4 Restoration refers to the immediate replacement teeth, giving you many benefits such as low warranty and maintenance costs; easy to clean, shortened treatment duration,...
What is All On 4?
The term ‘ALL-ON-4’ refers to the immediate replacement of ALL teeth of both jaws ON FOUR dental implants, which support them.
Dental implants themselves are small titanium fixtures that are inserted into the jawbone and have, for a long time, been used to support a tooth or a ‘Bridge’ of a segment of teeth. The fixtures form the foundation for the prosthetic replacement teeth.
However, when a patient is missing a full jaw of teeth, full jaw restoration is required to replace the upper or lower jaw.
With this All-on-4 technique, we do not need to place an implant under every tooth. Instead, we place 2 implants in the front of the arch and 2 in the back at a 45o angle.
By placing the implants at an angle, we are able to avoid the parts of the jawbone that are of typically poor quality. This also means that we can avoid the need for bone grafting. All in all, this technique offers higher-quality and more stable restoration.
Besides, by using fewer dental implants to support the prosthesis there is a smaller number of components, thus more versatility to design the most optimal function and aesthetics. Importantly there is also less in the way of cleaning, which helps simplify the hygiene and maintenance over time.
This procedure is the most common treatment in The East Rose Dental (Old Rose Dental Clinic), suitable for patients all of the teeth in one jaw or both. All-on-4 technique is also applicable for patients with soft jaw bone.
You can watch this All On 4 video here:
Immediate replacement teeth
The All On Four concept involves immediate dental restoration, meaning 1 or 2 days after the surgery, permanent prosthesis placement can be carried out. There’s no need to wait for 6 months like other conventional techniques.
All-on-four dental implants are usually carried out under anesthesia or pre-anesthesia, requiring highly experienced dentists who have extensive expertise and special training of this technique. In addition, advanced facilities and equipment also contribute to the success of the procedure.
Features of All On 4
- Immediate teeth
- Cheaper to maintain
- Easy to clean
- Improved appearance
- Shortened treatment duration
All On Four 2-day process
Immediate Teeth All-On-4 technique requires several steps as follows:
Step 1: Your dentist will order a general oral exam, imaging tests, and blood work.
Step 2: CT scan is necessary for a more accurate diagnosis.
After the dentist has assessed your health, x-rays and clinical situation, you will be given a treatment plan which outlines all the treatment stages as well as the costs involved.
Appointment Duration: 30-60 minutes.
Step 3: Once you decide to proceed with oral rehabilitation involving any the treatments All On 4, All on 4 Plus in The East Rose Dental (Old Rose Dental Clinic), you will need to attend the clinic for photos, models and other records as required, so as to enable the dentist to plan the optimal set-up of the replacement teeth in terms of both appearance and function.
The whole All On 4 treatment process takes from 2 to 3 days
Day 1 – All On 4 Dental Implants Surgery
- Removing the teeth (if any), cleaning out any remnants of disease and preparing the jaw bone to accept the fixtures.
- The surgery is typically done under General Anaesthetic or some form of sedation (I. V sedation)
- Impressions are then taken of the implants through a tiny opening in the gum, and this is sent to the laboratory to produce permanent dental bridges.
Day 2 – Try-in of the new arrangement
This try-in may occur a few hours or a day after the surgery. During this visit, all cosmetic and functional adjustments will be tailored to your needs. Before you leave, you get to see what the final teeth are going to look like.
Appointment Duration: 30-60 minutes
Day 3 – Smile
After the try-in appointment, you come back the very next day to have your replacement teeth fitted. There is no need for any sort of anesthetic at this appointment.
Appointment Duration: 30-60 minutes.
After your surgery
Hygiene and Diet
In the immediate period after your surgery, you can expect to have swelling, bruising and maybe some pain or discomfort. A doctor will prescribe you medication, but it is not uncommon for patients not to feel the need to take the pain medication.
As the teeth are not removable, brushing and cleaning follow the same principles as if they were your own healthy natural teeth, just a standard toothbrush 2 times per day.
Whilst it is common for patients to describe their teeth as feeling instantly solid and fully functional, it is important to stay on a softer diet (ﬁsh, pasta, eggs, stir-fry, etc.) for the initial 3 months of healing so as not to disturb the biological process of osseous-integration.
At 3 weeks after your surgery, once the swelling had subsided, and you have become more accustomed to your new teeth, our team will show you simple additional methods to effectively clean your new replacement teeth. These include water flosser, bridge floss, and brushes with specialized tips.
Using dental care tools after surgery
Review, Adjustments and Maintenance
At 4 months after your surgery, your dentist will see you for review to verify that implants have integrated and to ﬁne tune your teeth as may be required. At this time, it is also possible to remove the bridge to re-line its surface, or to make adjustments that require processing in the laboratory (if any)
Once we’ve conﬁrmed that the implants have integrated, at the 4 months review, you can start eating all types of food, even biting apples, nuts, crusty bread, chocolate, and steak.
Future maintenance is often uncomplicated and involves regular attendance for scale and clean, as with natural teeth, x-rays every 2 years, and may at times require certain repairs. All repairs to your bridge are included for a period of 2 years.
All – On – 4 Plus
What is All-On-4 Plus?
The All On 4 Plus® is a new technique introduced by Dr. Alex Fibishenko.
All-On-4 Plus incorporates:
1. Reshaping of the jawbone and gum surgery
When teeth are lost the gums shrink because the underlying bone undergoes natural atrophy and resorbs due to certain reasons such as infection, periodontitis, tooth extraction, trauma, etc.
The re-shaping of the jawbone is carried out with a procedure called alveolectomy. We remove the rugged areas of the jawbone to leave a flatter surface and more favourable surroundings for dental implants.
By removing the rugged areas, we also eliminate the parts of the jaw that are most susceptible to resorption and can rely on the deeper bone that is of better quality for improved health of the dental implants over time.
Apart from improving the conditions for the placement of the fixtures, the re-shaping of the bone also improves the amount of space that is available for the construction of the teeth, which improves our ability to design a restoration that is more durable and aesthetic, and helps ensure that the transition between the prosthesis and natural gums remains hidden.
The re-contouring of the jawbone also creates a flat interface of the prosthesis where it contacts the natural gums, which helps patients in cleaning and maintaining good hygiene.
2. Bone augmentation (when required)
Every case is different, and the bone anatomy can even vary in the same patient between the left and the right sides.
In some cases when the bone is in bad condition, too thin or too soft, doesn’t have the required thickness and width to support the implant and isn’t eligible for immediate load implant, the dentist will have to do a bone graft, sinus lift, and bone membrane lift.
3. Critical implant positioning using all on 4 clinic’s protocols
We locate the implant positions using all-on-4 protocols.
4. Additional fixtures (only when indicated)
A minimalistic approach to the number of implants that we place to support a full set of replacement teeth for one primary reason is used to improve your ability to clean. However, in cases such as patients being heavy grinders, or where the foundations are inadequate, i.e very poor quality bone, all-on-4 technique’s four posts can’t provide sufficient support. The dentist may need to add one or more implants for better support.
5. Delivery of final prosthesis within 2-3 days using innovative techniques
The techniques developed by Dr. Alex Fibishenko allow for the delivery of a final restoration within 2 -3 days of the surgery. The bridge is tailored to each individual patient.
6. Indication-specific restorative upgrades (when required)
3 years after the surgery, patients may replace the bridge with a higher-quality one, such as:
- A bridge with titanium frame and acrylic crowns
- A bridge with titanium frame and porcelain crowns
- A bridge with titanium frame and Zirconia crowns
The patient is missing their full set of upper teeth and suffers bone loss
Day 2 after All on 4 Plus bone graft and sinus lift
Finished and upgraded
The East Rose Dental (Old Rose Dental Clinic) offers immediate teeth replacement solutions that are aesthetic, functional and comfortable, as well as various affordable upgrade options with Zirconia and Porcelain for the long term.
Your immediate teeth with high impact acrylic
The teeth that are fitted immediately after surgery are constructed from a highly aesthetic and resilient acrylic material. The processing of this material makes it conducive to a quick turnaround using restorative protocols, and this is the only choice for immediate teeth.
The bridge is reinforced internally with metal bar support and is designed as the permanent restoration with optimal aesthetics and function, but this does not mean it will last a lifetime. Over time some wear occurs and this varies from patient to patient.
On average, the acrylic teeth require replacement every 3-5 years. This timeframe is only a guideline and it is not unusual for our patients to have worn their original restorations for 7 years or longer without requiring replacement.
Replacing the acrylic bridge does not mean re-doing the entire All On 4 treatment from the start. The process of replacing the teeth is uncomplicated and does not require any additional surgery. Old implants can be reused and only the crowns need to be changed. This requires neither surgery nor anesthesia.
- Improved Longevity
- Improved Comfort
- More Natural Feel
- Improved Aesthetics
Options for upgrading immediate implants
Option 1: Metal frame and acrylic crowns
Option 2: Titanium frame and acrylic crowns
Option 3: Titanium frame and layered porcelain crowns
Option 4: Zirconia frames and crowns