Frequently Asked Questions: TeethToday’s All-on-4 Procedure
TeethToday’s clinical staff answers questions about the benefits of the All-on-4 treatment option. Below is an actual list of questions submitted to our clinical team during our consultations and from the daily phone and web inquiries we receive; now outlined here for your review. Our clinical team worked to formulate responses that would be both beneficial and valuable to you, and to help you make an informed decision regarding your overall health, appearance and well-being.
Is the All-on-4 Procedure new or experimental?
The All-on-4 procedure (AO4) has been successfully performed in Europe for almost two decades and here in the U.S. for over 6 years. Approximately 10 years ago one of the the world’s largest dental implant manufacturers, Nobel Biocare, began to study computer simulation and bio-mechanics and collect large amounts of data about this use of implants for the edentulous patient (most or all of their natural teeth missing). Our clinicians have since studied with the developers of the AO4 procedure. Recent studies of large numbers of patients treated with this procedure show a success rate of nearly 99%.*
*Del Fabbro M, et al. Tilted implants for the rehabilitation of edentulous jaws: A systematic review. Clin Impl Dent Rel Res. 2010
I've read that patients with all their teeth missing need 6 - 8 or more implants per jaw. Why do you recommend only 4 per jaw?
All-on-4 is not for everyone, but can spell relief for tens of thousands of denture wearers overnight. The research and scientific documented studies and clinical success with the All-on-4 procedure allow for the back two implants to be angled slightly, giving as much support as multiple implant placements. An implant-supported bridge attaches to these four specifically placed implants and is just as effective as being supported by many more implants using a non-AO4 technique. The results are less cost, less chair time, less healing, avoiding most grafting procedures, and a faster smile.
Most dental clinicians do not have experience in the AO4 protocol and continue to use as many implants per jaw as the bone will allow, adding to the cost factor, trauma factor and treatment time. At the TeethToday Center, we recommend the most cost effective denture replacement procedure that is appropriate for you.
How experienced are the clinicians at TeethToday?
We are a private practice and have been placing dental implants successfully for over two decades. In fact, we have placed over 20,000 implants with an outstanding success rate. Each one of our clinicians are board certified offering you the very best care available. Even though we are a periodontal practice, we specialize in tooth replacement, be it single tooth, multiple teeth, or all your teeth. Our clinicians perform a high number of traditional and AO4 procedures monthly with outstanding success rates. We encourage you to speak to some of our success stories and hear first hand of the life changing dramatic effects TeethToday has had on our patients.
How long does it take to complete a case, as I’ve heard stories where people had to wait almost two years?
To answer “how long does it take”, let’s first examine how long it used to take using traditional implant procedures. The surgery would normally involve 6 – 8 implants per arch, often preceded by bone grafting and sometimes grafting of the sinuses. Several visits to the surgeon, restorative dentist, CT scan facility, and off site dental labs would add to the time table. This could easily translate into the patient being without teeth, or with a temporary denture for 6 months or up to two years.
Now, with the TeethToday procedure (which for the most part eliminates bone grafts and other ancillary procedures) after the initial examinations, any extractions, implant placement, the new temporary implant-supported bridge, and adjustments take one day, and happen in one facility. In one day you will be walking out with a new smile and renewed quality of life.
After sufficient healing of the bone , gum and implants (3 – 6 months), your final and permanent tooth-supported bridge will be prepared and attached to your implants giving you a lifetime of smiles.
MY dentist told me that if I had this procedure performed and it didn't work that there was nothing that could be done to fix it.
We’ve heard this statement often, and can assure you it is not accurate. In fact there are even reports with pretty good results using only 3 implants. We don’t recommend this approach, for a variety of reasons, but it shows how silly the statements insulting the 4 implant design can be. We have met with and discussed the All-on-4 technique with these skeptical dentists and surprisingly these very dentists now understand the AO4 and how it can instantly give relief to their dentally exhausted patients. Even still, some of these same dentists are now resolute advocates of the AO4, advising their patients to see us for a complimentary consultation. We are experienced and will care for you. And we mean it.
If it fails, what are my options?
Implant failure is rare but it happens. Under most circumstances, a single implant will fail, not all of the implants. Treatment options depend on when it happens and why we think it happened. Ordinarily implant failure happens very early in treatment. If so, we usually will replace it using a slightly larger implant or by moving to another site near the original one. In this situation, we modify the provisional bridge to insure that you can continue to have fixed teeth while the new implant heals. Ordinarily, this is done without charge unless the patient deliberately sabotages the treatment or ignores our simple post-operative instructions. Late failures of single implants are very unusual. We will work with you to troubleshoot this situation. Late failures are usually associated with poor hygiene. As with natural teeth, dental implants and the implant-supported bridge must be cleaned daily, including brushing, flossing and periodic check-ups including hygiene maintenance. If an implant fails, it will normally happen in the first few months. At TeethToday, we will replace the implant and make you a new temporary bridge that will easily last until your final implant-supported bridge is ready. Complete failures are exceedingly unusual and are usually associated with general health problems like immune system collapse, uncontrolled diabetes, cancer treatment with aggressive chemotherapy, etc. In this situation, we will work with your physician to manage the problems.
Why don't all dentists recommend the AO4 for people with missing or bad teeth?
Most dentists are not familiar with the wealth of professional experience and depth of experience associated with TeethToday and AO4. We have many better educated and experienced general dentists that have referred their patients to us for their implant procedures including single tooth, multiple teeth, and especially patients missing all their teeth. They have seen the results we have achieved for other patients and therefore they believe in the benefits of the AO4 for those suffering with dentures or compromised teeth. They also realize that board certified clinicians with years of implant dentistry experience, in a specially designed dental facility, is necessary to efficiently provide the best possible environment to perform these procedures. The TeethToday Center has all of the necessary components in one place – including progressive instrumentation and technologies, and in-house dental CT imaging capabilities, along with surgical and restorative suites. We even provide facilities for your family and friends to wait in comfort.
Why don't all dentists recommend the AO4 for people with missing and compromised teeth?
Most dental implant specialists lack the experience and the facilities, including the high end technological advances needed to perform the AO4 in one facility in one day. In addition, the TeethToday Center has a complete team of surgical and restorative assistants, dental hygienists, patient education coordinators and a customer service team ready to help your experiences with us be as comfortable and rewarding as possible.
What is the overall success rate of the AO4 technique?
With the AO4 technique, fifteen year studies indicate a success rate of 98.2% in the upper jaw, and up to 98% in the lower jaw – and that is with only 4 implants per jaw. These numbers are consistent with implant procedures using 6 or more implants per jaw, showing that the success rate does not decline when only 4 strategically positioned implants are used vs. 6 or more. In extremely rare cases an implant may fail. If so, in all likelihood it will fail within the first two months of the procedure. If that occurs, we will replace the implant and rework the implant-supported bridge whenever there is a less than desirable occurrence.
Are there any medical conditions that would cause instances in which the All-on-4 procedure cannot be used?
Our Board Certified clinicians are specifically trained and will work closely with any patient who may have contraindications for implant placement; however, the vast majority of people are candidates for the All-on-4 procedure. As with all medical procedures we thoroughly evaluate each person and collaborate with their physician should the situation call for it. Uncontrolled diseases such as diabetes, cancer, organ failure, severe immune deficiency or other significant medical conditions are usually contraindications for treatment. If these conditions are controlled, then treatment is usually acceptable. AGE IS NOT A CONTRAINDICATION FOR TREATMENT. We have successfully replaced teeth in patients who were over 100 years old.
Are there any PHYSICAL REASONS the All-on-4 Procedure cannot be utilized?
Many of the patients seeking our advice have been told by other surgeons, their general dentists or their medical clinicians that they were not candidates for dental implants. Their doctors were either not aware of the All-on-4 procedure, did not have enough experience to comfortably recommend the procedure, or were unaware of implants as the standard of care in replacing missing teeth. We will examine each case individually and give recommendations for all viable treatment options, which may or may not include the All-on-4, therefore helping the patient make an informed decision. We will do so in collaboration with your existing medical team. The vast majority of patients can be successfully treated with AO4. Occasionally, patients with very advanced, severe bone loss require more sophisticated procedures. These patients have usually had facial trauma or resective surgery of the jaws. We recommend you come in to the office to be examined to determine of you are a candidate for treatment.
Can both the entire top and bottom jaws be done the same day?
Thanks to our all-in-one facility, our technological advantages, and with implants being such a large part of our practice, we can easily perform a “double arch” case in one day with the same outstanding results. Our doctors will greet you first thing in the morning and stay chair side throughout the procedure until you have your new teeth and the first steps to your renewed quality of life. Our clinicians and technical support team are well versed in patient comfort and will see to it that you are treated like family while under our care.
How painful is the procedure?
Like all surgical procedures, there are varying degrees of discomfort. Before we begin, our patient coordinators will review your medical history, prescribe any pre- and post-surgical medication, and have everything ready for you to make your transition as comfortable as possible. During the implant placement, we often recommend sedation when performing the AO4 procedure, simply for the comfort of the patient. We will, however, give you exceptional care during your visit and the days following. Now, many implant patients comment on how surprised they were with the minimal discomfort they felt during the procedure, and most returned to work within days of treatment, if not the next day. There will be some swelling, but for the most part nothing that cannot be controlled with ice and over the counter pain reliever for any discomfort.
In addition, unlike dentures and partial bridges, your new teeth rest on the implants and not on the gum tissue, therefore avoiding any associated tenderness from the surgical area.
How does an AO4 treatment option differ from dentures?
A denture is a removable device that is inserted in the mouth and removed from the mouth by the patient, and needs to be removed daily for cleaning and maintenance. It sits on the gum. In the case of a partial denture, it is attached using metal hooks to adjacent teeth – further leading to failure as it grinds against natural dentition and the gum line. Patients who are missing most or all of their natural teeth and are wearing dentures know the pain and discomfort brought on by these appliances, and most seek alternative treatment. In addition, dentures do not replace the tooth root, which in turn will cause the jawbone to melt away due to lack of stimulation, causing even more pain and embarrassment for denture wearers.
Now there are viable options to help restore your smile. And one cost effective, proven option is the All-on-4 procedure. The AO4 provides for new teeth that are attached to 4 implants per jaw, and look, feel and function like naturally healthy teeth. In fact, dental implants are the closest thing we have to the roots of the natural teeth. And the implants stimulate bone growth, just like your natural tooth roots helping to eliminate that sunken facial collapse which is so prevalent with denture wearers.
How strong will my new teeth be, and will I be able to eat more easily than I can with dentures?
You will be able to eat just about anything without worrying about slippage or your teeth falling out. The bite force with implants is far greater than with dentures. Your bite force with dental implants is about 250 pounds per square inch, whereas with dentures, it’s about 6. Basically, you can now eat anything you want. Go ahead – chew on that carrot stick, bite into that apple. Of course, we’d prefer you to hold off for a couple of months post surgery – our patient coordinators will give you instructions as to when you can eat just about anything. And, your new implant-supported bridge can be cleaned like natural teeth while in your mouth by brushing and flossing. Only your clinician can remove the prosthesis for periodic maintenance, if necessary. You now have a permanent solution to dentures and/or partials and an enhanced lifestyle with lots of healthy food waiting for you, and the added bonus of worry free smiles.
Will my new implant-supported bridge be comfortable, or will it irritate my gum tissue like my existing partials (bottom) and dentures (upper)?
There is no irritation with implant-supported bridges. The new teeth are supported by the implants and not the gum, allowing freedom from the distress dentures can cause, and the unsightly metal from partial denture wearers. Also, because there won’t be any devices covering your palate, you will be able to enjoy the taste of all the foods you’ve been missing, and you won’t need any potentially toxic dental adhesives to hold your new teeth in place. No more slipping, no more sliding, no more bad breath, no more worrying about your teeth falling out, no more mashing up your food, or even covering up when you speak. Just smiles from here on.
Will the line between the implant-supported bridge and the underlying jawbone be obvious?
During your examination, we will determine where your “smile line” is and plan to have the area where your implant-supported bridge meets your jawbone invisible. In this manner, it does not show when you smile. Simple adjustments during the restorative procedure will assure a perfect fit, form and function.
I was told that I have so much bone loss that I require bone grafting and that I would not be able to wear my false teeth for months. Can you provide me treatment that would not require me to go without my denture?
Because of the design and nature of the AO4 technique, only in extreme cases will bone grafting be necessary. If so, we have tremendous experience with many techniques.
The only way to accurately estimate extreme bone loss and determine the best treatment option is to have an examination and consultation with a TeethToday dental specialist.
What can I eat following the procedure?
A modified diet is required until you receive your final fixed titanium reinforced framework. The time line to your final permanent implant-supported bridge will be determined by your clinician, but is normally about 4-6 months. In the meantime, you can eat anything that can be cut with a fork, and does not involve biting or tearing with your front teeth. Some examples are hamburger, fish, pasta, cooked vegetables, etc. Avoid hard foods and foods that require tearing such as hard breads, pizza, carrots, corn on the cob, steak, and crunchy and sticky snacks treats such as nuts and gum.
Once your final tooth supported bridge is in place, you can eat pretty much anything that a person with their natural teeth could eat, and enjoy it at the same time!
Recommended follow up visits and examinations?
The AO4 procedure calls for the implants and temporary provisional restorations to be done in the same day. Sometimes we ask you to return a few days later to place a more esthetic and durable provisional that is fabricated by our dental laboratory. Your first official check up will be in about one week’s time, with follow up appointments every 1-3 months for 4-6 months. Then, the procedure for your final restorations will begin with 3 or 4 more appointments spread out over a couple of months.. Your clinician will control the time line which may differ for each patient depending on healing and other possible issues. It is important to recognize that during all this time, you will never wear dentures and will always have your teeth attached to your dental implants.
What is the difference between a "provisional" and "final" restoration?
A provisional restoration, commonly referred to as the implant-supported temporary bridge is fabricated using acrylic or composite resin (tooth colored plastics) by a dental technician, the day of implant placement. These plastics are softer but easily manipulated materials which are used to replace your teeth and will not harm your implants or cause any irritation to your jawbone while the healing process is taking place. They are strong enough for you to start your active life again. Don’t hold back after you are fully healed but just watch what you eat in the first couple of months – keeping to a soft diet until directed otherwise by your clinician. Provisional restorations often do not have molars on them to limit the amount of force that can be applied to the healing implants. The provisional is designed to last six-twelve months and may show some wear or breakage near the end of its use. Your final restoration is made using a titanium or Zirconia ceramic framework for strength, and is placed after sufficient healing, about 6 months post-operatively. These restorations typically have a couple more teeth than the provisionals and generally include molars on them. This restoration allows for extra support and long-term form and function for your permanent teeth. The teeth themselves are made from acrylic, composite or porcelain but it is the underlying framework which gives the strength. Regardless, the final restorations will be adapted to your new smile, look great and will act like your natural teeth for a lifetime.
Why are the advantages of having a periodontist place dental implants?
Periodontics is a specialty recognized by the American Dental Association. Periodontists have traditionally formed long-term relationships with patients and their restorative dentists. They make a thorough diagnosis in light of the patient’s dental and medical health. Periodontists are specifically trained in the placement and long-term maintenance of dental implants, and their expertise in managing soft tissue and bone issues is of great benefit to the patient in all aspects of implant dentistry. All of our periodontists are Board Certified by the American Board of Periodontology, which is the highest achievement in the field and signifies dedication to excellence and continued education of all of our doctors.
What is the best way to replace a missing tooth?
In most cases, dental implants are considered the standard of care for replacing missing teeth. The restorative phase of dental implant treatment is completed by your restorative dentist.
Is implant surgery comfortable?
Most patients are pleased to find out that implant procedures usually cause only minimal discomfort and may be more comfortable than other dental procedures such as extractions. Prior to and during procedures, oral sedation, local anesthesia, and intravenous sedation may be used to keep patients comfortable. Following treatment, over-the-counter pain medication is recommended. Prescription medicine is also available if needed.
Are implants expensive?
Dental implants are replacement body parts that look and function like natural teeth. They give patients the ability to eat, chew, smile, and laugh naturally. Implant patients are very happy after treatment and consider their implants to be an excellent value for the dollar as well as a long-term investment in the quality of their lives.
Will my dental insurance cover dental implants?
Dental implant treatment is often beyond the scope of dental benefits. However, we will work closely with your dental and medical insurance companies to determine whether any of your specific benefits apply to dental implant treatment.
Are there alternatives to implants that are less costly?
Our philosophy is to treat patients once and treat them right. We have found that dental implants are often the most cost-effective treatment over a lifetime. Dental implants are kinder to adjacent teeth than a bridge or partial denture. Dental implants are also more natural, and they help preserve bone, which helps prevent the appearance of premature aging.
I have heard that implant treatment is available in other countries at a much lower cost. Is this true?
The issue is cost versus value. The quality of dentistry performed in other countries varies considerably. In our office, patients are treated by board certified periodontists who have extensive experience in their field. Our doctors publish, teach, and stay on the leading edge of the latest scientific advances. In our office, our motto is, “It’s never cheaper to do it twice.” Treatment performed outside the U.S. may be less than ideal, and follow up care at these facilities is impractical. At our office, we are committed to upholding the highest ethical standards of our profession and we offer ongoing follow up care. In fact, we have patients who travel to our office in Florida from other countries for treatment. These patients are seeking a “Sun and Smile” experience; they recognize that South Florida is one of the world’s leading tourist destinations and they come to us for care based on our international reputation. [I did not want to push the dangers of medical tourism too hard. Some of the dentists in places such as Mexico are U.S. trained. I took the high road and emphasized the positive.]
How do I know that implants are going to work?
We set the stage for success by creating a thorough, customized treatment plan for each patient in cooperation with the restorative dentist. Dental implants have an outstanding success rate. They are designed to last many years.
What is the role of my restorative dentist when I have implant treatment?
Your restorative dentist is a key member of the team. We stay in close communication with your restorative dentist throughout your implant treatment. After you complete treatment in our office, the restorative dentist securely attaches the final restorations to the implants. The result is a natural-looking restoration that allows you to eat the foods you want.
What can be done to minimize the risk of complications?
As with any medical or dental procedure, there is always some risk of complications. Although this risk cannot be totally eliminated, it can be minimized. The doctors at the South Florida Center for Periodontics and Implant Dentistry have years of experience and they have placed tens of thousands of dental implants. This depth and breadth of experience is significant. The doctors carefully review the patient’s medical and dental history prior to treatment and work collaboratively with the patient’s restorative dentist. The doctors believe that thorough diagnosis and treatment planning are essential for long-term dental implant success. In addition, the doctors at our modern facility use the latest equipment and materials. Finally, the doctors recommend a maintenance program that includes conscientious home care and regular professional dental visits to help ensure that dental implants will function for many years.
What is your policy regarding treating dental implant complications?
Dentistry merges art and science and there are no guarantees related to specific results, regardless of who performs the treatment. The professionals at the South Florida Center for Periodontics & Implant Dentistry (SFCPID) develop treatment recommendations with techniques and materials to provide our patients with the best treatment outcomes resulting in safe, predictable, long-lasting results. Fees include all postoperative visits including a final evaluation following final restoration by your dentist.
The confidence in our treatment is reflected in the significant responsibility we are willing to bear for your treatment success. Complications are rare, but can occur for reasons beyond our doctors’ control. We treat complications without charge provided that you follow all recommendations regarding professional follow-up and home care and maintain reasonably good overall health. However, it is important to understand that you also have responsibilities. Patients who do not comply with recommended maintenance (professional cleanings by a hygienist) and effective personal home care may void SFCPID responsibility for retreatment for complications without charge. In addition, changes in your overall health may be beyond anyone’s control and may affect dental health, success of treatment, and may therefore void SFCPID’s financial responsibility for complications.
A complete explanation of our responsibilities and your expected responsibilities to qualify for the treatment of complications without charge will be provided to you in writing prior to your treatment.
How long does it take to complete dental implant treatment?
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