All-on-4 Implant Dentures

Millions of Americans are missing all of their teeth.  Millions more have extensive dental disease that requires the extraction of all the teeth.  In the past, the only option for these millions of people was traditional dentures – plastic teeth in acrylic gums that simply rest on top of the patient’s jaw.

Thankfully, that is no longer the only option.  All-on-Four is a way to replace all of missing teeth in a single arch using four dental implants.  An arch simply means all of the teeth in one jaw.  You have an upper dental arch, which includes all of the upper teeth, and a lower dental arch, with all of the lower teeth.  All-on-Four replaces all of the teeth in one arch with four implants.

How Does All-on-Four Work?

All-on-Four allows your dentist to replace all fourteen teeth in an arch with just four dental implants.  The implants require a unique contouring of the jawbone and precise positioning and angling to support the prosthesis (sometimes called a denture or bridge).  The contour of the bone and the specific position and angulation of the implants properly distributes the chewing forces for the best long-term success.

Once the surgeon creates the best contour of the jawbone and places the dental implants in the prescribed position and angle, your dentist fits the prosthesis, or new teeth.  The new teeth are one continuous unit that attaches to the dental implants with small screws.  These attachments keep the teeth firmly in place throughout any normal function.  An all-on-four prosthesis is not removable by the patient.  Your dentist can remove it, but you cannot.

What are the Advantages of All-on-Four over Implant Supported Dentures?

Another tooth replacement option for an entire arch is an implant-supported denture.  While they may seem similar at first glance, there are some important differences between all-on-four and implant-supported dentures. 

What are Implant-Supported Dentures?

Implant-supported dentures are more similar to traditional dentures than to all-on-four, despite the presence of implants.  Implant-supported dentures require removal of the denture and still use pink acrylic material to act as the “gums” that hold the plastic teeth.  Implant-supported dentures are better than traditional dentures in that they attach to implant anchors for a secure connection to the jaws.  They stay in place during eating, talking, and laughing.

How is All-on-Four Better?

All-on-Four has a few advantages over implant-supported dentures. 

  • Embarrassment-Free – As stated earlier, you are not able to remove all-on-four prostheses.  The unit of teeth attaches to the dental implants with tiny screws.  Your dentist can remove the prosthesis if needed, but you cannot.  This means you sleep with your teeth in place.  There is no reason for anyone to know that you have “false teeth”.
  • Little to No Staining – The teeth in an all-on-four prosthesis are usually either porcelain or a tooth-colored material called zirconia.  These highly polished, glossy materials do not collect stain as easily as plastic does.  This means your smile stays beautiful for longer!  It will not pick up dark colors from coffee, tea, red wine, or tobacco.
  • More Natural Appearance – Because all-on-four prosthetics replace only the missing teeth and not the gums, they are less bulky under the lips and cheeks.  Sometimes dentures (both traditional and implant-supported dentures) can make the cheeks and lips look too full because of the bulk of acrylic material underneath.  This allows you to maintain the natural contours of your face. 

What is the Process for All-on-Four?

Even though the typical all-on-four treatment happens in one day, it involves a significant amount of planning on the pre-operative end and follow-up on the post-operative side.

Before Surgery:

The pre-operative planning for all-on-four implants includes both imaging and lab time.  Your dentist and surgeon require three dimensional imaging of the jawbones and any existing teeth.  This imaging makes exact implant positioning and angulation possible.  During the pre-operative planning process, you will take part in the process of designing the new teeth.  You communicate to your dentist the color, shape, and alignment you prefer for your new smile.  Then your dentist works with a dental laboratory to make your prosthesis.

Surgery Day:

The actual surgery consists of several different parts.  The dental surgeon will remove any remaining teeth first.  Then he or she will contour the existing jawbone to create the right dimensions to support your new prosthesis.  Once the bone has the perfect contour, the surgeon will place the four dental implants according to the specifications set during the pre- operative planning.

Then your dentist fits and attaches the new prosthetic teeth.  This can be done immediately or within the first 24 hours.  We call this immediate loading, meaning the implants start working immediately.

This is a big day!  Many patients opt to have sedation during the treatment so they are unaware of what is happening.  This is the route many people take to go to sleep and wake up with a new smile.

After Surgery:

Immediately after your surgery, you have your new teeth, but you also have a significant healing process to undergo.  You should expect moderate post-op pain for the first ten to fourteen days. 

All-on-four dental prosthetics do require that you eat a soft diet for the first six weeks.  This is important to allow the implants to adequately heal into the jawbone before they bear the weight of chewing forces.

After healing is complete, you return to normal function.

What Maintenance is Required for All-on-Four?

Just because you no longer have any teeth does not mean you are done with the dentist or oral hygiene!

As stated above, your dentist has the ability to remove the all-on-four teeth, and this should happen at least a year for professional cleanings.  At this yearly maintenance visit, your dentist detaches the prosthesis from the underlying Implants, evaluates the health and stability of the implants, and cleans the area of gums around each implant.

At this visit, your dentist will also clean the prosthesis, removing any stains or plaque buildup.

Home Care

The oral hygiene requirements for all-on-four teeth are definitely simpler than those for real teeth, but they are still very important. The teeth are all connected, so you cannot floss.  The goal of oral hygiene with an all-on-four is to prevent any accumulation of plaque or food debris underneath the teeth (between the prosthesis and the gums).  You can best accomplish this with a few steps. 

  1. First, rinse your mouth 1-2 times each day with an antiseptic, alcohol-free mouthrinse.  This will help flush out any buildup from under the teeth. 
  2. Use a tool like a Waterpik to clean under the teeth with pressurized water.  This keeps your gums healthy and lowers the risk of gum disease around the implants.  Dental implants cannot get cavities, but they can lose bone as a result of gum disease.
  3. Brush the teeth with a soft bristled toothbrush and a NON-whitening toothpaste.  Do not, under any circumstances, use whitening toothpaste on an all-on-four prosthesis.  You can scratch the porcelain and make staining more likely.

More Questions about All-on-Four?

Call Definition Dental today to schedule a free consultation with Dr. Agarwal. She can answer all of your all-on-four questions and help you get started on the smile of your dreams.

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