You should read this post if you have heard about All on Four / Teeth in a Day and would like to learn more about this treatment approach, you are missing all your teeth, or your remaining teeth are in a hopeless and compromised state and you would like to learn about this treatment option.
For majority of patients, dental implants are the best option in the replacement of missing and hopeless teeth.Despite numerous benefits, treatment acceptance of implant restorations is restricted by their high cost and long treatment time.
This is especially true for patients who would like to have implant restorations of all their teeth in one or both jaws because this type of treatment requires several or more implants and in some instances need for additional surgical procedures such as bone grafting.
In order to address these problems dental industry and dental profession continues to innovate with surgical techniques and designs of the dental implants and dental restorations.
The current trend is to provide a more affordable and expedient treatment options for our patients. In relative short amount of time we have seen development of new treatment approaches such as All-on-4™ and Teeth in a Day® for the restoration of teeth in one or both jaws.
If you do some research on the web you will find a number of marketing names which in essence address the same thing- cost effective, comfortable and expedient restoration of the one or both jaws with a prosthesis supported by the dental implants (immediate function with minimal number of implants). I will not dwell into definitions and will use the terms All-on-Four/Teeth in a Day since they are most commonly used names for this type of restorative approaches.
What is All-on-Four / Teeth in a Day Procedure?
It is a surgical and prosthetic technique for the replacement of all teeth and restoration of functions in one or both jaws.
It is indicated for patients with hopeless and compromised teeth and for patients who are missing all teeth in one or both jaws.
The procedure includes placement of minimal number of implants (usually 4, but in some situations your dental team may recommend placement of additional implants) which support a dental prosthesis. In addition by placing implant in strategic locations and at angle the need for bone grafting can be minimized or completely avoided. Due to the reduced number of implants dental prosthesis typically holds 10 to 12 teeth.
A procedures typically includes placement of fixed provisional teeth on the same day after the surgery. These provisional teeth are designed in such way that they look and feel much like natural teeth and allow comfortable function for the patient.
After appropriate healing time final prosthesis is fabricated and attached to the dental implants. Final dental prosthesis is usually a fixed bridge (it can be a removable bridge) and designed in such a manner so it can be removed by the dentist for servicing.
What are the Pros and Cons of All-on-Four / Teeth in a Day?
- Expedient and comfortable restoration of teeth and oral functions
- Minimizes or completely avoids need for bone grafting
- Provisional teeth connected to the dental implants on the same day of surgery
- Maintains jaw bone over time
- Reduced cost in comparison to some implant options
- Complex treament
- Risk of surgical complications (see section below)
- Risk of restorative complications (see section below)
- Expensive (much higher cost than dentures and higher cost than some implant options)
Who is a Candidate for this Procedure?
Patients with hopeless, compromised, and missing teeth, who are in good general health and have adequate jaw bone are candidates for this type of restoration. Factors taking into account and which determine if you are a good candidate for this approach include:
- State of your general health
- Condition and state of your jaw bone
- Condition and state of the remaining teeth
What are the Success Rates with All-on-Four / Teeth in a Day Procedure?
All-on-four / Teeth in a Day procedure is supported by a clinical research. For an experienced team success rate of dental implants is in the area of 95%.
What is the Treatment Process?
This treament includes the following steps:
- Initial evaluation
- Fabrication of provisional teeth (immediate dentures) and pre-surgical preparation
- Surgical procedure and connection of provisional teeth to the dental implants
- Fabrication of a final bridge
- Maintenance stage
All-on-4 / Teeth in a Day is an interdisciplinary approach and treatment team typically includes a restorative specialist (prosthodontist), a surgical specialist (oral surgeon, periodontist, anesthesiologist), and a dental technician.
Do Provisional Teeth Always Get Connected to the Dental implants on the Day of Surgery?
It is desirable to connect provisional teeth to the dental implants since fixation of the provisionals provides better comfort for the patient. However in some instances it is not always possible to accomplish. For example, the stability of the dental implants in the jaw bone may not be adequate to support provisional teeth. In that case an immediate removable denture is given to the patient. Although less comfortable it provides a cosmetic and functional replacement of the missing teeth.
Does the Whole Treatment Process Takes One Day to Complete?
That would be great but unfortunately the answer in No. The most important part of the whole process which is surgery and placement of the temporary bridge does take one day.
Usually several appointments are required for fabrication of provisional teeth and and pre-surgical preparation. You may also need to come back several times for the follow up care and adjustments after the surgery. It also takes several appointments to fabricate a final bridge.
All in all it may take around 9 months or more to complete the whole treatment.
What are the Surgical Complications of All-on-Four / Teeth in a Day?
In the hands of experienced team the rate of surgical complications is very small. When occurs most common problems include:
- Postoperative swelling and discomfort
- Failure of dental implant to integrate with the jaw bone
- Infections around dental implant and gums
- Nerve paresthesia (partial or permanent numbness/pain in the area of mouth and face)
What are Restorative Complications of this Procedure?
The number of restorative complications is somewhat variable and depends on the clinical condition of the patient. In some situations restorative complications are very rare and in others are more common. Most common problems include:
- Loosening and fracture of the connecting parts such as abutments and screws
- Wear and fracture restorative materials
If you find this information helpful you may also want to read: What is a Denture? and Dental Implants: What You Need to Know.
Thank you for reading!
Dr. Alex Shor