All-On-4 Implants

All-on-4 Dental Implants: A Permanent Solution for Your Smile

The All-on-X dental implant protocol is a revolutionary procedure designed to restore a full set of teeth in patients who have lost all or most of their teeth. It offers a permanent, stable solution with fewer implants, and is strategically designed to avoid the need for bone grafting and sinus lifting in most cases. This makes the procedure faster and minimizes the overall healing time, allowing you to enjoy the use of your new prosthesis much sooner.

Choosing Your All-on-X

Your final denture can be made from either acrylic or zirconia, each with its own benefits and considerations.

1. the type of prosthesis
2. the implant system
3. the number of implants.

Making the right choices will ensure long-term success, durability, and comfort.

1. The Prosthesis: Acrylic vs. Zirconia

When considering All-on-X treatment, there are three major factors to focus on:

Acrylic

Pros:

• More affordable initial option.
• Lightweight and comfortable.
• Easier to adjust if minor changes are needed.

Cons:

• Less durable; more prone to wear and staining.
• May require replacement in 3-5 years.

Zirconia

Pros:

• Extremely durable and resistant to fractures.
• More natural-looking and aesthetically pleasing.
• Stain-resistant and long-lasting.

Cons:

• Requires a second visit at least two months later for fabrication.
• Heavier than acrylic, requiring stronger implant support.
• Higher initial cost.

Our Recommendation: For the best long-term results, we recommend upgrading to zirconia, but only after ensuring the right implant system and number of implants are in place.

2. The Implant System: Choosing the Right One

All-on-X implants are different from single or multiple implants. Choosing the right implant system is like choosing the right car for the type of road you're driving on:

Single or multiple implants are like driving on a smooth highway—any car (or implant system) will work.

All-on-X implants are like driving on rocky, uneven terrain—you need a stronger, more durable system, just like an off-road vehicle.

Our Recommendation: We only recommend using high-quality implant systems like Straumann and Neodent. These are designed specifically for the demands of full-arch restorations, offering superior durability, precision, and long-term success.

3. The Number of Implants: 4, 5, or 6?

Implants act as the foundation of your new smile—just like the pillars supporting a house. The more implants you have, the stronger and more stable your restoration will be.

The minimum number of implants required is 4. Every additional implant provides more strength, better long-term support, and improved function.

Single or multiple implants are like driving on a smooth highway—any car (or implant system) will work.

All-on-X implants are like driving on rocky, uneven terrain—you need a stronger, more durable system, just like an off-road vehicle.

Our Recommendation: We advise placing six implants for better durability, stability, and long-term comfort.

What Should I Pay for: The Zirconia or the Implants?

Most people tend to focus on choosing zirconia but compromise on the number or quality of implants. This is a common mistake.Think of it this way:

• The prosthesis (acrylic or zirconia) is like the furniture in your home. It can be changed or upgraded at any time.
• The implants are the foundation of the house—once placed, they are permanent and cannot be easily modified.

Even if you choose zirconia, you will still walk out of surgery with an acrylic temporary denture for at least two months before getting your final zirconia prosthesis.

Why?

1. Fine-Tuning Your Bite & Smile: Since All-on-X creates a completely new bite and smile, small adjustments may be needed. This is easier with acrylic, which can be modified.
2. Muscle & Jaw Adaptation: Your jaw and facial muscles need time to adjust to the new prosthesis before finalizing the zirconia.
3. Customization: You can request changes to tooth shape, color, and size before committing to the final zirconia restoration.
4. Zirconia Cannot Be Easily Altered: Once made, zirconia is difficult to modify, so we ensure everything is perfect before finalizing it.

Final Thought: For the best long-term success, we always recommend:

✅ Zirconia Prosthesis (for durability and aesthetics)
✅ Straumann or Neodent Implants (for superior function and longevity)
✅ 6 Implants (for maximum support and strength)

Investing in the right implant system and number of implants is the best decision for your long-term oral health and comfort.

All on x Procedure

All-on-X Timeline: Currently wearing denture (with good VD), or teeth to be removed

All-on-X Timeline: No teeth remaining, no denture - new bite position to be determined

Evaluation and All-on-4 Planning

The first step is an in-depth evaluation to understand your unique situation, which includes:

• Medical History Review: To ensure you're a good candidate for the surgery.
• Smile Line Assessment: The position of your upper lip is carefully evaluated to see how much of your gums show when you smile, which impactsthe final appearance of your new teeth.
• Assessment of Current Dental Condition:

FP1

If you still have some teeth, or if they're planned to be removed, OR you have a low smile line (meaning your gum line is not visible when smiling), we might recommend an FP1 prosthesis.

FP3

If you currently don’t have any teeth (meaning they were removed long ago), OR you have a high smile line (meaning your gum line is visible when smiling), we'll consider using an FP3 prosthesis.

Design

Uses only tooth-colored parts (white), and the prosthesis will have "ovate" pontics that gently come out from the gums for a more natural look.

Uses tooth-colored (white) and gum-colored (pink) parts to mimic the natural look of your teeth and gums. The gum portion is flat and parallel to your bone and gum.

Bone reduction

Less to none

Requires flattening
(changes narrow ridge to wide ridge, easier hygiene, hide transition zone)

• Assessment of Current Denture Condition:
  • Good Denture Fit (Vertical Dimension): If your current denture fits well, restores your facial profile, and your speech sounds (like “S,” “F,” and “V”) are clear, we can use it as a reference to match the new All-on-4 denture.
  • Poor Denture Fit: If the denture feels uncomfortable or doesn’t restore your facial profile well, we might recommend creating a new temporary denture. This removable, acrylic temporary denture allows us to test your bite, phonetics, and comfort before proceeding with the implant surgery.

Day of Surgery: Placing the Implants

On the day of surgery, we begin by removing any remaining teeth if necessary. We then place 4-6 implants in your jaw. After the implants are secured and show good stability, the final acrylic denture is fixed onto the implants. This denture provides both an immediate functional and aesthetic result.

Recheck After Surgery

fter surgery, we conduct a thorough recheck, where we assess the implant sites to ensure proper healing and we evaluate the fit and function of your new denture. This final check ensures everything is in order before you travel back home.

Post-Surgery Care

After surgery, it is recommended to follow a soft diet for about 1-2 weeks. This allows the implants to properly integrate with your bone before you start chewing hard foods.

The All-on-4 prosthesis is secured to the implants but is also detachable by your dentist if maintenance or adjustments are needed.

Options and Add-Ons

There are options to enhance your All-on-4 treatment:

Bar: If your final denture is made of acrylic, we may recommend adding a bar. This bar reinforces the acrylic, increasing durability and stability.

This can be prepared before placing the implants.

Add-on cost:

 

Zirconia Denture: For a stronger and more natural appearance, we can create a zirconia denture. Note that this requires having an acrylic set of teeth placed for 1-3 months as a trial before moving to zirconia.

Alternatives to All on X

While All-on-4 is a popular choice, there are alternatives like full-mouth bridges and overdentures. Your dentist will help you choose the best option based on your needs.

Full Mouth Bridge: Requires placing 6-8 implants, and 3-4 sets of dental bridges. This option provides the closest look and feel to having natural teeth, but is known to be more invasive, costly and requires more healing time.

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Over Denture: This is an option where the dentures fit over implants but can be easily removed. It’s ideal for patients who prefer something removable. This option requires a minimum of only 2 implants. Patients can always choose to upgrade and up to 4-6 implants for better stability of the denture. Ultimately, patients can also later upgrade to a more fixed solution like the All-on-4 denture.

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Removable Full Dentures: This is the conventional method of restoring full mouth missing teeth. Although these dentures are initially more affordable than All-on-4 implants and are easier to modify and replace, they can shift, or feel loose or cause discomfort while eating. Overtime, with no tooth root present in the jaw bone, the bone will slowly recede, making it more difficult to place implants later. Patients are also recommended to avoid certain foods, use denture glue and ‘reline’ the dentures regularly to compensate the bone loss and regain the denture’s tightness.

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Which is Better: All-on-4 or Overdenture?

There are many factors to consider:

• Personal Preference: Would you prefer your teeth to be fixed in place (All-on-4) or removable (overdenture)? Your peronsal preference will be considered as part of treatment planning.
• Cleaning Needs: With All-on-4, you’ll need to use a Waterpik (water flosser) or similar tool to keep your prosthesis clean. If you require help maintaining hygiene, cleaning the denture or struggle with dexterity, an overdenture would be more suitable as it can be removed and cleaned outside your mouth.