All-On-4 FAQ

Frequently Asked Questions

Q. Is the All-on-4 Procedure new or experimental?

A. The All-on-4 procedure (AO4) has been successfully performed in Europe for over 15 years and here in the U.S. for about 4 years. Approximately 10 years ago the world's leading dental implant manufacturer, Nobel Biocare, joined implant specialists and researchers in Europe to study computer simulation and bio-mechanics to create the optimal use of implants for the edentulous patient (most or all of their natural teeth missing).

Q. 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?

A. 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 sits comfortably on these four specifically placed implants and is just as effective as sitting on many more implants using a non-AO4 technique. Sometimes we do see the need for 5 or 6 implants instead of 4. The results are less cost, less chair time, less healing, and a faster smile.

In addition, 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.

Q. How long does it take, I mean I've heard stories where people had to wait almost two years to have implant cases completed?

A. 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, bone grafting and perhaps a sinus lift would be recommended. 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 1 - 2 years.

Now, with the AO4 procedure (which for the most part eliminates bone grafts and other ancillary procedures): after the initial examinations, any extractions, implant placement, the making of 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 (4 - 6 months), your final and permanent tooth supported bridge will be prepared and attached to your implants giving you a lifetime of smiles.

Q. Are there any other instances when the All-on-4 Procedure cannot be utilized?

A. Many of the patients seeking our advice have been told by other surgeons or their general dentists that they were not candidates for 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, helping the patient make an informed decision.

Q. Can both the entire top and bottom jaws be done the same day?

A. Thanks to our all-in-one facility and our technological advantages, 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.

Q. How painful is the procedure?

A. Like all surgical procedures, there are varying degrees of discomfort. We prefer to use IV 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 the procedure, 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.

Q. How does an AO4 treatment option differ from dentures?

A. A denture is a removable device that is controlled by the patient and needs to be removed for cleaning and maintenance. It sits on the gum line, or is supported by "prepared natural teeth", normally natural teeth that can no longer function as nature intended. 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 jaw bone 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 affixed 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 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.

Q. How strong will my new teeth be, and will I be able to eat more easily than I can with dentures?"

A. 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, where as with dentures, it's about 6. 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 periodical maintenance, if necessary. You now have a permanent solution to dentures and/or partials and a lifelong guarantee of worry free success.

Q. Will my new implant-supported bridge be comfortable, or will it irritate my gum tissue like my existing partials (bottom) and dentures (upper)?

A. 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 caused, 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 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 your mouth when you speak. Just smiles from here on.

Q. Will the line between the implant-supported bridge and the underlying jaw bone be obvious?

A. During your examination, we will determine where your "smile line" is and plan to have the area where your implant supported bridge meets your jaw bone invisible, so it does not show when you smile. Simple adjustments during the restorative procedure will assure a perfect fit, form and function.

Q. 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 go without my denture?

A. Because of the design and nature of the implants used with the AO4 technique, only in extreme cases will bone grafting be necessary. If so, we have developed and successfully use a unique protocol for patients experiencing the most severe instances of bone loss, which does not require a patient to go without their teeth.

The only way to accurately estimate the cost for an individual patient is to have an examination and consultation with a dental specialist.

Q. Why does my dentist recommend the All-on-4 Procedure but said I will have a denture for awhile?

A. Dentists that are familiar with the All-on-4 procedure realize that they do not have the facility that will allow both the surgical and the prosthetic (restorative) aspects of the AO4 to be performed in one day, in one place. Therefore the surgical aspect of the AO4 is performed at one appointment in the surgeon's office, but it is not practical to have a patient then moved to the general dentist's dental office the same day after surgery in order to secure the new teeth to the implants.

Therefore, the surgeon installs a removable denture to the patient to wear for several weeks to a month so that adequate healing of the gums can occur. The general dentist can then start to make the non-removable teeth.

We at Dallas Dental Arts have both the surgical and restorative suites, an on-site dental laboratory and technological advances under one roof, and performed in one day. The discomfort of wearing a denture that moves over newly placed implants is eliminated.

Q. What can I eat following the procedure?

A. A modified diet is required until you receive your final fixed titanium reinforced framework. The time line will be determined by your clinician, but is normally about 6 months. In the mean time, 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.

A modified diet is required until you receive your final fixed titanium reinforced framework. The time line will be determined by your clinician, but is normally about 6 months. In the mean time, 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.

Q. Recommended follow up visits and examinations?

A. The AO4 procedure calls for the implants and provisional restorations to be done in the same day. Your first check up will be in about one week's time, with follow up appointments monthly for 4 months. Then, the procedure for your final restorations will begin with 2 or so more appointments necessary for the fabrication and try ins. Your clinician will control the time line which may differ for each patient depending on healing and other possible issues

Q. 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.

A. We've heard this statement often, and can assure you it is not accurate. 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.

Q. Are any General Dentists recommending the All-on-4 Procedure?

A. We currently have many 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 believe in the benefits of the AO4. They also realize that a specially designed dental facility is necessary to efficiently provide the best possible environment to perform these procedures. Dallas Dental Arts has all of the necessary components in one place - oral surgeons, dental implant laboratory with master technicians, and progressive instrumentation and technologies (including in-house dental CT imaging machines), along with surgical and restorative suites. We even provide facilities for your family and friends to wait in comfort.

Q. Why don't all dentists recommend the AO4 for people with missing and compromised teeth?

A. Most dental implant specialists (oral surgeons and periodontists) lack the experience and the facilities, including an in-house AO4 trained dentist, dedicated dental implant lab, or the high end technological advances needed to perform the AO4 in one facility in one day. In addition, Dallas Dental Arts has a complete team of surgical and restorative assistants, implant coordinators and a customer service team ready to help your experiences with us be as comfortable and rewarding as possible.

Q. What is the overall success rate of the AO4 technique?

A. 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 falter when only 4 strategically implants are used vs. 6 or more. In extremely rare cases an implant may fail. If so, and in all likelihood it will fail within the first two months of the procedure, and because we guarantee our implants for the life of the patient, we will replace the implant and rework the implant-supported bridge whenever there is a less than desirable occurrence.

Q. What is the difference between a "provisional" and "final" restoration?

A. A provisional restoration, commonly referred to as the implant-supported bridge is fabricated using acrylic resin, at our in-house dental lab, the day of implant placement. Acrylic resin is a soft material which will not harm your implants nor cause any irritation to your jaw bone while the healing process is taking place. It is strong enough for you to start your active life again. Don't hold back, but just watch what you eat - keeping to a soft diet until directed otherwise by your clinician. The provisional is designed to last 6 solid months, and we guarantee the workmanship during that time.

Your final restoration is made using a titanium framework for strength, and is placed after sufficient healing, about 6 months post op. This restoration allows for extra support and long-term form and function for your permanent teeth. The teeth themselves are made from acrylic or porcelain but it is the 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, and we guarantee that too.