The All on 4 dental implants technique

The all on 4 implant technique (also known as same day teeth and same day smiles), is a method to replace a full arch of missing teeth (hence "all") with only 4 dental implants (hence "on 4") supporting a fixed denture / bridge all in one day. Normally dental implants are placed into your jaw at a 90 degree angle to your jaw. With the all on 4 technique the 2 implants at the front are fitted as usual at 90 degrees and the 2 implants at the back of the jaw are placed at 45 degrees to your jaw. When a bridge is then attached to the 4 implants this angled placement of implants locks all 4 implants together and enables them to heal and integrate with minimal chance of failure or becoming dislodged. Also since the 2 rear implants are placed at 45 degrees this allows longer implants to be used in this area and is especially important for patients who may otherwise require bone-grafting due to minimal bone tissue in that area. In many cases all on 4 provides a solution for patients who could not previously have implants due to lack of bone.

How does all on 4 differ to the standard fixed bridge approach ?

Using a standard implant technique where all implants are placed into the jaw at 90 degrees often requires at least 6 dental implants to support a full arch and then these are left to heal for 6 months before a fixed bridge can be fitted to the implants. If the patient doest have enough bone then bone grafting may also be required. The standard technique not only takes longer but it is also more expensive (6 implants vs 4, additional bone grafting and more visits to the dentist).

Is all on 4 a tried and tested technique, what is the history ?

The all on 4 dental implant technique has been used in practice for more than 10 years now and was first developed in the late 1990s by dental implant manufacturer Nobel Biocare and Portuguese implant dentist, Dr Paulo Malo using a combination of bio-mechanics, computer simulation and extensive clinical research.

The results of their studies provided patients with high quality full teeth restoration without the use of bone grafting (which otherwise may have been required) all on one day. This was a breakthrough in implant dentistry offering patients a safe, immediate and cost effective way to replace all their missing teeth. Although the all on 4 technique is something that cannot be performed by all implant surgeons and requires additional skill and technology, those practitioners who use this technique have reported a very high success rate.

What does the all on 4 implant procedure entail?

Initial consultation and diagnostics

In order for your dentist to properly evaluate your mouth, requirements and suitability for all on 4 implants you will need a consultation where you will discuss various aspects of the treatment and also your medical history. You may need a series of diagnostics including x-rays a CT scan, measurement of bone density and impressions. This will provide your dentist with information in order to plan your treatment and determine if you will need to have any existing teeth extracted. Many dentists use specialised software and a dedicated treatment planning system such as the NobelGuide system which allows for detailed diagnostics such as identification of available bone structure, virtual implant placement according to the patient's anatomy situation and prosthetic needs, and a bespoke surgical template which ensures guided and exact implant placement.

Following this diagnostic appointment if no bone grafting or further treatment is required prior to the implant surgery, your surgical appointment will be scheduled, during which teeth will be extracted (if necessary), implants will be placed and your prosthesis fitted, all in the same appointment.

Extractions and placement of 4 dental implants

Following any extractions, four implants will be placed in the jaw in such a way that the bone will surround, anchor and secure them into place. The implants that are placed in the back part of the jaw will be placed at an angle of approximately 45 degrees to achieve maximum contact and anchorage to the existing bone structure.

Attachment of abutment and teeth

Once the four implants have been placed in the jaw, the abutments (a component which connects the implant to the teeth / bridge / denture) will be attached to the implants. The new replacement teeth are then fastened to the abutments them and adjusted to ensure a perfect bite is achieved and maximum comfort. Since only four dental implants are used in the procedure (compared to 6-8 in traditional full arch implant dentistry), the entire process is much less invasive and time consuming.

Follow up and second set of permanent teeth

Following this there will be follow up appointments over the next 6 months or so. After approximately 6 months the gums will be fully healed implants completely fused to the natural bone. At this stage, depending on your treatment plan your dentist will remove your teeth and take new impressions in order to prepare a final, stronger, permanent set of teeth which are adjusted to a perfect fit.

Comparison of the All on 4 technique to traditional full arch implant procedures

How much do all on 4 implants cost ?

The prices of treatment using the all on 4 technique will vary between clinics but typically start from £8500 per arch up to £14000 per arch and the difference in prices will depend on:

• The implant system used and diagnostic tests / software used
• The quality of the final teeth (denture vs bridge / acrylic vs porcelain)
• The experince and skill of the implant dentist (a more experinced surgeeon would generally charge more).
• The location of the clinic (in certain areas where business overheads and rents are higher the cost of treatment is naturally higher).