Tired of Fake Teeth and Dentures? Everything You Need To Know Before Your Appointment Dental Implants: All-on-4:

Disclaimer: “All on 4” is a registered trademark of NobelBiocare

By Derek Gatta DMD MS FACP

Prior to dental implants, removable dentures were the sole choice for patients missing every tooth.  Dentures are acrylic plates shaped to your gums that let you chew soft foods, speak and smile.  They are clearly preferable to having no teeth, yet dentures bring their own difficulties and are not the ideal solution for replacing teeth.

     Excellent dentures typically depend on both a skilled dentist and a skilled laboratory.  Depending on how much bone you have lost, creating dentures that fit well and are esthetic, functional and comfortable can be quite difficult.  You should remove them at night to clean them and let your gums rest.  Every 3-5 years you will likely need a reline as your bone levels keep resorbing and shrinking.  When that option is used up, a new set should be made.  Dentures do not last forever and, much like a new car, they need routine 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 Remain Removable):

We can build your denture with less acrylic so it “snaps” onto the dental implants. This greatly boosts retention and stability.  You still need to remove your dentures at night for cleaning and to rest 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.

Your Appointment Workflow:

Appointment 1: 

Meet and Greet, Data Gathering: You will meet the doctor, and the team will collect diagnostic information, photos, radiographs (x-rays), study models of your mouth, health history and a dental exam

Appointment 2:  

Present findings, treatment recommendations:

The dentist will review the case and explain the best way to move forward and reach your goals.  We will give you an overview 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 review your health history.  They will determine whether you have enough bone to place the implants right after any teeth are extracted and whether 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 estimate, and every case may differ depending on your bone levels and the complexity of your situation.  I cannot stress enough that this purchase is similar to buying a car: yes, it is a wonderful and life-changing investment, but it does require maintenance and follow-up care for long-term success.