- A fixed prosthesis in complete edentulism
- Planning without grafting in most cases
- In suitable cases, a temporary fixed prosthesis within a few days of surgery
- Surgery: Mehmet Taş, DDS, MSc · Prosthesis: Aycan Işık Taş, DDS
In short: All-on-4 is a treatment concept that involves planning a fixed prosthesis on 4 implants in complete edentulism. The aim is to support the prosthesis through angled placement of the implants. Suitability is determined by examination.
What is it?
In the conventional approach, a fixed prosthesis in a completely edentulous jaw requires 6–8 implants and often bone augmentation. In the All-on-4 concept the two front implants are placed upright and the two rear implants at an angle of 30–45°; the angled implants stay clear of anatomical limits such as the sinus (upper jaw) and the nerve canal (lower jaw) and allow longer implants to be used. The four implants carry a single-piece prosthesis that is screwed onto them. Depending on the amount and quality of bone, a six-implant (All-on-6) plan can also be made.
Who is suitable?
- Patients who are completely edentulous or whose remaining teeth cannot be saved
- People who have problems with retention and chewing with a removable complete denture
- Cases in which, because of bone resorption, conventional implant planning would require grafting
- Those whose general health is suitable for surgery (the assessment criteria on the implant page apply)
Suitability is determined only by three-dimensional tomography: no decision is made without measuring bone volume, density and anatomical limits. The condition of the remaining teeth, the jaw relationship and lip support also affect the planning.
The process
- Assessment and digital planning: Examination, tomography, intra-oral and facial photographs; the implant positions and the prosthesis design are planned on the computer.
- Surgery: Extractions if necessary, and placement of four (or six) implants in the same session. It is carried out under local anaesthesia, with sedation support if desired; the duration is generally 1.5–3 hours per jaw.
- Temporary fixed prosthesis: If the initial stability of the implants is sufficient, a temporary prosthesis is screwed on within a few days. During this period a soft diet and avoiding stress on the implants are important.
- Healing: 3–6 months. At the check-ups, the fit of the gum and the prosthesis are monitored.
- Definitive prosthesis: After impressions and try-ins, the definitive prosthesis (zirconia, ceramic on a titanium framework, or acrylic hybrid) is made and screwed on. The prosthesis can be removed and cleaned by the dentist; it is not removed by the patient.
Which dentist does what?
The surgical stage and implant planning are carried out by Mehmet Taş, DDS, MSc, and the prosthesis design and prosthodontic stages by Aycan Işık Taş, DDS. Digital planning is done jointly by the two dentists; the shape of the prosthesis is determined before surgery.
Care
The underside of the prosthesis is cleaned every day with special floss (superfloss), an interdental brush and a water flosser. Once a year the prosthesis is removed and the implants and screws are checked. If there is a clenching habit, a night guard is recommended.
Visit plan for patients coming from abroad
First visit (7–10 days): examination, tomography, surgery and the temporary fixed prosthesis. Second visit (after 3–6 months, 7–10 days): the definitive prosthesis. A panoramic X-ray or tomography is needed for the remote preliminary assessment.
Points to consider
- During the temporary prosthesis period, an adjustment period of a few weeks is needed for eating and speaking.
- Inflammation around the implants, a fracture of the temporary prosthesis or screw loosening may occur; all of these are problems that can be resolved at a check-up.
- Smoking and inadequate hygiene significantly increase the risk of complications.
- If check-ups are neglected, bone loss around the implants can progress; the annual removal of the prosthesis and cleaning are important.
- Extracting the remaining teeth is an irreversible decision; the alternatives are assessed together at the examination.
Frequently asked questions
Is All-on-4 suitable for everyone?
No. Bone volume, density and anatomical limits are measured with tomography; in some cases six implants, bone augmentation or a different type of prosthesis may be more suitable.
Are four implants enough?
Thanks to the angled placement and the splinting of the implants to one another, the concept distributes the load. If bone quality is low or chewing forces are high, six implants are planned; the decision is made with tomography.
What can I eat with the temporary prosthesis?
For the first 8–12 weeks a soft diet is followed; hard and sticky foods put stress on the fusion of the implants. After the definitive prosthesis, the dietary restrictions are largely lifted.
Can the prosthesis be removed?
It is not removed by the patient; the dentist can remove it by unscrewing it for check-up and cleaning. This is the fundamental difference from a removable denture.
How is the planning done?
By clinical examination, three-dimensional tomography and digital planning based on photographs; the prosthesis design is determined before surgery.
How many visits does treatment take?
Generally two: 7–10 days for surgery and the temporary prosthesis, and 7–10 days after 3–6 months for the definitive prosthesis.
Is there a difference between the upper and lower jaw?
Because the bone structure is different, the planning varies according to the jaw.
What should be kept in mind in the long term?
Regular check-ups, oral hygiene and prosthesis care are important.
The information on this site is for general guidance only; diagnosis and treatment require an examination by a dentist.