What is All-on-4?

All-on-4 is a procedure that enables total rehabilitation of a full arch of teeth using just 4 implants.  All-on-4 was a concept that was first introduced in the 1970’s by professor Professor P-I Branemark,  However, implant development, particularly the angulation of the back implants, hadn’t advanced enough, until more recently, to provide predictable outcomes.   A full arch zirconia bridge is held in place by just four implants that are surgically placed in the jaw.  The treatment is ideal for those with multiple decayed teeth, within the same arch, that cannot be saved with traditional restorative methods, such as fillings or crowns.  All-on-4 is also a great solution for patients who currently wear dentures.  All-on-4 offers these patients a permanent, fixed solution, rather than removable prosthesis.  Because the implants provide solid support for the restoration, All-on-4 restorations enables those without their natural teeth to eat normally, including foods like steak and apples.

How is it Done?

  1. Consultation – To begin an All-on-4 case, an examination is completed to determine the current state of the jaw. Typically, the examination will include a 3D scan of the jaw using a CBCT machine. The 3D scan will help the oral surgeon determine the best placement for the implants in the jaw.  Typically dentists evaluate the bone thickness and bone quality  to determine implant placement location.  Additionally, the scan and computer software enable dentists to place implants in locations and angles that will provide optimum esthetics for the final restoration
  2. Removal of hopeless decayed teeth – If required hopeless, decayed teeth need to be extracted. In some cases the implants may be placed at the same time as extraction.   In other cases, dentists may want time for bone and gum tissue to heal.  For the best long-term prognosis gums and bone must be healthy and absent of periodontal disease
  3. Implant placement – While the procedure generally involves placement of just four implants in a single arch, sometimes additional implants may be required to provide the necessary support.  Your dentist will inform you during your consultation, how many implants are required to fully restore an arch of teeth. Also, the procedure can be completed on both the upper and lower arches during the same visit.While implant placement used to be more involved, modern technology and computer planning software have greatly reduced the complexity of the procedure.  In some cases the oral surgeon or dentist my use a guided stent to place the implants.  In addition, some implants can now be placed without a full incision in the gum, making it a minimally invasive procedure.
  4. Insertion of temporary restoration – The temporary restoration (prosthesis) is screwed to the implants.  For patients who were previously wearing a complete denture, your dentist may make the temporary from your existing denture.  In other cases a new temporary denture is fabricated.  The temporary restoration allows you to leave with a full smile and functioning teeth the same day as your implant placement procedure.  Temporary restorations have great esthetics.  However they are fabricated from a  composite resin.  While it is durable, it does not have the strength of a final product.
  5. Insertion of Final Restoration – Once the bone and gum tissue is healed,  the temporary restoration will be removed and final restoration will be screwed on top of the implants. The final restoration will function like natural teeth and have beautiful esthetics.  The final restoration is typically made from zirconia, a very durable material that also delivers impeccable esthetics.

At our Upper East Side, Manhattan and New Jersey locations our skilled implant team performs all-on-4 treatment.   Hear from some of our all-on-4 patients and contact us for a complimentary consultation to determine if all-on-4 is right for you.