All-On-4

What is an All-on-4?

All-on-4 concept is a dental implant technique that uses fewer implants in the upper or lower jaws than the traditional methods. This procedure can also avoid the need for certain grafting procedures. On average, a traditional full dental implant rehabilitation of the upper jaw would require between 6 and 8 implants, whereas the new technique would only need 4 implants. With the All-on-4 concept, the rear implants are inserted at a 30 to 45 degree angle rather than vertically. With this new method, patients who suffer from bone loss can still be eligible for the procedure without going through the extensive and lengthy process of a bone graft.

Who can benefit the most from an All-on-4 technique?

The ideal candidate for an All-on-4 are patients who have lost all their upper or lower teeth or patients who have bad teeth that need extraction and want to replace them. The removal of teeth with the All-on-4 procedure can be done on the same day as the implant placement.

How is the All-on-4 technique different from dentures?

Dentures are custom made to each patient’s jaw and fit over the gums. They stay in place using suction or sometimes require the help of a dental adhesive. However, over time, the supporting bone shrinks, and the denture becomes looser. Denture needs to be replaced regularly to avoid discomfort. The All-on-4 technique involves dental implants that are permanently inserted into the jaw bones. There is no risk of the teeth slipping away while eating or talking. There are several other differences between the All-on-4 concept and a denture including; a more natural look, the ability to eat all foods.

What are the advantages of the All-on-4 technique?All On Four Implants

The major advantage of the All-On-4 concept is that the patient leaves the office with teeth in their mouth and the ability to chew food on the day of the surgery. This differs from the conventional technique that requires a minimum of 3 months before putting any pressure on the implants.

Here are some more advantages of the new dental implant technique:

  • No bone graft required
  • Durable teeth
  • Easy maintenance
  • Short treatment and recovery time
  • Long-term results
  • Increases self-confidence and improves quality of life
  • Very high success rate (95%+)
  • Lower cost

What is the success rate with an All-on-4 technique?

All-on-4 dental implant technique is a fairly new approach; however, studies show good success rate after 10 years with 94.8% to 98.0%.

We will be happy to explain the All-on-4 procedure to you in details, call us today for further information!

Instructions

What are the steps to follow for an All-on-4 technique?

First your surgeon will examine the soft tissue in your mouth. They will then evaluate the jaw bone using medical imaging, called cone-beam, computed tomography. They will also discuss oral or IV sedation options for you. Don’t forget to mention the source of your reference.

  1. Following the exam, the team will provide you with the details and the estimated cost of the procedure.
  2. If you do not already have a prosthodontist, we will be happy to refer you to a specialist who can take good care of your teeth.
  3. During the appointment with your prosthodontist, they will analyze the optimal position of the implants with the help of the scan and will take an impression to make the initial prosthesis.
  4. On the day of the surgery, our oral surgical team will prepare a sterile environment for surgery which will reduce the risks of complications. Since this is one-day procedure, you will be able to leave the same day with your prosthesis in your mouth.
  5. A soft diet is recommended for 6 weeks following the procedure.
  6. A follow-up appointment will be scheduled one week after the procedure to make sure that you are healing properly.
  7. Another follow-up appointment will take place about 6 to 8 weeks after your procedure. A radiograph will be taken to see help assess the healing of the implants.
  8. Finally, with the approval of your surgeon, you will return to your prosthodontist who will create your final prosthesis.

Pre-Op Instructions

Pre-operative instructions with intravenous sedation

Intravenous sedation is a technique of administering medications through a vein to help relax you and reduce discomfort. This is done without putting you completely to sleep. It is most important that you follow the instructions below very closely.

  1. The meal before your appointment should consist of light food and fluids such as broth, tea, or Jello, and should be taken no less than 6 hours prior to your appointment. Do not eat meat, fried or fatty foods. You may drink clear fluids (water, fruit juices, carbonated beverages, clear tea, and black coffee) until 2 hours before your appointment.
  2. If you are given medication to take before your appointment, it should be taken with a small amount of water, one hour prior to the appointment.
  3. Do not take other medications on the day of surgery without checking with your surgeon. Let us know of any changes to your health status or your medications before your appointment.
  4. It is advisable to wear loose-fitting clothing to make you more comfortable. Short sleeve shirts or blouses are necessary, so we can see your arm for monitor placement and intravenous access.

After your appointment the medications used will still be in your system. The following precautions should be followed:

  • You MUST be accompanied home in a car or taxi by a responsible adult who will stay with you for the remainder of the day. No public transportation.
  • Change position slowly. Sudden standing or sitting up may cause dizziness.
  • No driving or operating machinery for the rest of the day after surgery.
  • No alcoholic beverages for 24 hours.
  • Rest at home with your head slightly elevated for the rest of the day.

If you follow these guidelines along with your surgeon’s post-operative instructions, you will find the procedure will go smoothly and comfortably.

Post-Op Instructions

Post-op risks

The main risks are infections and bleeding. If you ever experience abnormal discomfort, contact us or the Oral and Maxillofacial Surgery residents of the Montreal General Hospital. Your surgeon will take charge of the situation.

A bruise, sometimes important, in the mouth, on the face and sometimes through the neck is quite normal.

 

Post-op instructions

Postoperative instructions will be provided following the intervention by the surgical assistant. You will normally leave with a prescription from your surgeon for painkillers and sometimes antibiotics.

The following instructions have been compiled to assist you in the postoperative period. If you follow these guidelines, your recovery will be more comfortable.

  • After a All-on-4 procedure, there is often swelling of the face and sometimes bruising of the skin. This is normal. An ice pack applied to the area (30 minutes on and 30 minutes off) for 48 hours will keep swelling to a minimum. Maximum swelling usually occurs within 24 – 48 hours after surgery. Swelling can persist for 7 to 10 days. If the swelling resolves but then returns, you should contact our office.
  • Eat a light diet for the first two days; e.g. yogurt, soup, jello, milk drinks, etc. Avoid hot foods and do not use straws for the first 48 hours after surgery, as this may cause bleeding.
  • A soft diet must be followed for the first 6 weeks to ensure proper healing of the implants.
  • If the implants were done in the upper jaw, avoid blowing your nose for 3 days and use a saline spray to thin your secretions as needed.
  • Rest for the remainder of the day following your operation and keep your head slightly elevated.
  • Refrain from smoking for 2 months after an All-On-4 procedure.
  • Some bleeding is normal for the first 24 – 48 hours. If bleeding is heavy, use gauze squares folded in 4 and apply firm pressure to the bleeding area by biting on the gauze for 20 minutes. Do not spit for the first 72 hours following your surgery, as this tends to cause bleeding.
  • Gentle tooth brushing can be resumed the day after surgery. Do not brush the area of surgery until your next appointment with your surgeon.
  • It is important to keep your mouth clean. Starting the following day, a saltwater rinse (1 teaspoon salt in 1 glass of warm water) should be used twice a day after eating (ex: after your breakfast and before going to bed).
  • You will be given a follow-up appointment to check the healing, if necessary.
  • Dissolving stitches are used for most operations. It is normal for these to begin to fall out after 3 – 4 days.