Attempts at coming up with a method to achieve successful dental implants have been around for a very long time. In fact, since the 1700s scientists and dentists have been hard at work trying to find a successful method of implanting a false tooth into a human jaw to replace a missing tooth. These include the earliest (unsuccessful) attempts of taking a dead person’s tooth and sticking it in the extraction socket of a living person; to years of trial and error using different tooth root shaped designs of different metals and ceramics and finally to today’s highly technical modern dental implants with 92%-99% success rates.
One innovation directly related to these implant advances was discovered through research and named “All on 4”. This technique is a real breakthrough for patients who wear full dentures. This unique means of utilizing implants eliminates the problems inherent in patients having to wear removable full or “complete” dentures. Some of these inherent problems include:
- Loose or ill-fitting dentures
- Having to use increasing amounts of denture adhesive to stabilize dentures
- Avoiding foods that are very difficult or impossible to eat
- Having to remove dentures at night.
- Needing to have them replaced every three to six years
- Having long-term wearing of dentures cause gradual bone loss of the supporting ridges
- Negative psychological factors involved in wearing removable “false teeth”.
“All on 4”
“All on 4” is a very apt description of the procedure. It means attaching a complete (ALL) set of non-removable artificial teeth to four (4) dental implants; “All on 4”.
The procedure is straight forward and patients can have a temporary (provisional) set of teeth placed immediately (24-48hrs) after the surgery.
- Each patient will have a complete oral examination and consultation.
- Special x-rays are taken to evaluate the amount and condition of the bone for implant treatment planning.
- A temporary non-removable set of replacement teeth similar in form and function to the final permanent restoration will be fabricated by a dental laboratory before the implant surgery. If the patient has an acceptable set of dentures, they may be used instead as the temporary denture.
- An antibiotic treatment is ordinarily started 2 days before surgery and continued for ten days after.
- Most patients are given intravenous conscious sedation and/or nitrous oxide and local anesthetic for the duration of the surgery. Some patients may require general anesthetic.
- The bone is exposed and inspected to make sure it is suitable for the implants and if there are any teeth needing removal, they will be extracted.
- The 4 implants are placed in each arch; two near the front of the arch and two in the back part of the arch. The two in the back are tilted which is the main feature that allows only 4 implants to support a full set of artificial teeth.
- The gum tissue is sutured back around the implants.
- The temporary denture is adjusted and attached to the 4 implants.
- Follow up visits are scheduled at 1 week, 2 weeks, 3 weeks and 3 months.
- At the 3-month appointment, the implants will be inspected and if indicated by complete and correct healing, the temporary denture will be removed and the permanent replacement attached to the implants.
- Follow up implant maintenance appointments are scheduled.
In some rare cases at the time of surgery unexpected, unfavorable conditions may be discovered that may require placing standard implants, delaying the placement of a temporary denture that is attached immediately to the implants.
Standard implants have many things in common with the implants used in the All on 4 procedure. The basic surgery is similar as are the shape, material, etc., of the implants.
The primary difference is that standard implants are placed into the jaw, and are covered back up completely by the gum tissue and allowed to heal for 3 months and the temporary replacement is not attached to the implants.
During this healing time, a temporary removable denture will have been fabricated for patient use, or the patient’s existing denture will be adjusted and refitted to serve as a temporary replacement. So, until the standard implants have healed enough for the attachment of the permanent set of teeth, the patient will be wearing a conventional type denture.
Immediate Versus Delayed Loading
The All on 4 procedure uses a concept known as immediate loading. Immediate loading means that the patient receives a functioning temporary dental restoration that is placed at the same time as the implant surgery. In the case of the All on 4 full mouth procedure, the patient can eat, and function with a full set of temporary teeth which immediately places a force or load on the implants, hence immediate load.
Advantages of Immediate loading include:
- Improves bone healing over traditional implant procedures (osteointegration).
- No need for a removable temporary replacement and its attending maintenance.
- Eliminates standard implant exposures from the wearing away from the pressure of a removable temporary appliance (partial denture, denture).
- Gingival (gum) tissue shaping is facilitated.
- Can’t be used on every patient.
- Shortened treatment time.
- Only one surgical procedure.
Dental implants need to be screwed into the channel made in the bone. The amount of pressure applied to the implant is called torque. As an example, if you have a flat tire and neglect to tighten the lug nuts enough the wheel may become loose and fall off. On the other hand, if you overly tighten the lug nuts, you may not be able to loosen them to take the wheel off.
Dental implants are similar in some ways to the lug nuts of a car. With implants, if you do not tighten the implant with enough torque, the implant has a greater chance of failure. Conversely, overtightening the implant also carries a risk of greater failure. To lessen this chance, dentists use a torque wrench or hand piece to precisely measure the correct torque which usually has a range of 30 ncm to 60 ncm. There are some disagreements among dentists concerning the range of torque.
Delayed loading is defined as it sounds once the definition of immediate loading is understood. For various reasons, some implants cannot withstand any force being placed on them immediately until they have healed and are stable. In these instances, other temporary replacements are used that do not put any stress on the implants. In these cases, putting any pressure or a load on the implants is put off or delayed, until complete healing of the implants, hence delayed load.
At Tooth and Go dental clinic we have the latest training, equipment and modern facilities to provide our patients with quality and affordable All on 4 procedures. We also provide standard implants. See what our implant plans can offer you at Tooth and Go.