What are All-On-4 dental implants and how do they work?
A few decades ago, about 34 years ago, a lot of information and research was done on dental implants. They studied how we could replace someone's missing teeth with implants and how to replace someone who's missing all their teeth with implants. That's where All-On-4 started being developed.
Do we have to put an implant at every single spot where there's a missing tooth, or can we space out these implants and create enough stability to support a full set of teeth?
They discovered that as long as there are four implants spaced equally apart, it is stable and strong enough to support a full mouth of new teeth. All-On-4 specifically refers to teeth that are screwed in and never come out. There are dentures that you can pop into implants and pop out, but All-On-4 means these are teeth that are screwed in. It is a type of denture called a hybrid overdenture and hybrid implant denture. That exactly is what an All-On-4 is.
Who is a good candidate for All-On-4 dental implants?
I would say the best candidates are those who have lost their teeth due to cavities and wear and broken down teeth because implant-supported teeth cannot decay like our natural teeth can. Natural teeth can get cavities even if they have a cap, crown, or filling. Even those, because they're still attached to your natural tooth, can decay. All-On-4 is not made of natural teeth. It's based on implants, and the teeth are made of porcelain. Those teeth cannot decay. That's why those are the best candidates: people who have lost their teeth through wear, fractures, cavities, and things like that.
Another good set of candidates are people who have had trauma or something where the bone itself is not diseased. If someone has a disease of the bone, it doesn't completely eliminate them from being a candidate, but there are many factors we have to consider. Individuals with severe, uncontrolled diabetes or heavy smokers who don't plan to quit are not the best candidates for this type of dentistry.
Also, individuals who lost their teeth due to severe periodontal disease are not the best candidates. If someone lost their teeth due to severe periodontal disease, we want to get their teeth cleaned up. If we get their teeth cleaned up and rid of the disease, we know the teeth are still going to be lost, but then we remove the teeth. When we remove the teeth, it's being done in a healthier environment because things have been cleaned up. Then we place implants in a healthy environment, so our healing and survival of those implants are usually about the same. Those are the examples of who are good candidates and who are not the best candidates.
Are All-On-4 dental implants a good option for seniors?
I would say the age population most commonly losing their teeth are usually individuals in the senior category, a little more mature in age. Just the wear and tear of life, things breaking down over time. A lot of times, you see older individuals losing their teeth. This type of dentistry is good for all ages. There's not an age limitation except that you can actually be too young, but you can never be too old for this type of dentistry. Your body is going to heal. It might take a little longer than someone who is younger, but it still is a great option.
I find it's actually the best option for seniors. As someone gets older, they start to lose some of their faculties, ability, and dexterity. Having a denture to take in and out every day can be a challenge as someone gets older, especially if you're depending on a caregiver to take care of you and perform these actions. That can be unreliable sometimes. What's nice about the all-in-one dentistry is that it's screwed in; it does not come out, and maintenance and cleaning are much easier than a traditional type of denture. It's also more comfortable and feels more like natural teeth. Because it feels that way, seniors have a much better time tolerating this type of teeth than someone who is wearing a denture. It is good for all ages, especially those in the senior category.
Are All-On-4 implants suitable for patients with bone loss in the jaw?
Very commonly, people will tell me, "Well, Dr. Jones, I've been told that I have too much bone loss. I guess I'm not suitable for implants." Not true. Even if you've experienced lots of bone loss, you could still be suitable. There have been so many advancements in implant technology that our implants are getting smaller and integrating into the bone better. Because of these advancements, people can have a lot of bone loss and still be good candidates. In the past, we had to put in larger screws and implants. Now that's not the case. It's rare that we absolutely cannot put an implant in. In most situations, we can customize an implant size to fit the person's bone available and still have the same long-term outcome.
What does the All-On-4 dental implant process involve?
The first step is to schedule an appointment with me. You can call (210) 972-0768 and schedule that consult! You will then come in for a visit that will be about 2 hours long. During that visit, we're taking bone scans, digital scans of your teeth and gums, and looking at your medical history and any diseases. We're creating a plan for you, planning out where these implants would go and what this final smile would look like. I want your opinion. I know something like this could be really life-changing for somebody. That's why we invest the time in you. When you choose my practice, you're not just investing in your health or care; we are investing in you as well. I'm investing in an outcome. I want you to have the best quality of life. That's how the first visit goes.
Once we have a solid plan in place and we've worked out everything, we schedule your actual procedure date. Usually, it takes about a 4-week turnaround to get a person scheduled. The reason for that is because we are creating a design. There are many factors to consider if we're recreating someone's smile, bite, function, and speech. That requires a lot of planning. Because this is custom-made for you, it's not one-size-fits-all. That takes a couple of weeks to develop.
After those four weeks, you come in for your procedure. We have you go to sleep. The best time to work on somebody is when they're asleep and relaxed. This process takes about 4 to 6 hours. I want it to feel like a blink for you. You come in, go to sleep, I'm working for 4 to 6 hours, and you're dreaming and napping. After that, you wake up with your new smile. It's pretty spectacular.
The smile you're left with at that time is actually a temporary smile. That's what a lot of people don't know. We see lots of commercials and ads about this, and everyone's like, "Oh, it's a smile in a day." Yes, you leave with your smile in a day, but that smile is temporary for a couple of months. The reason we do that is because as things heal, gums can shrink, and things can shift. We want everything to heal because once it's all done and healed, we want to make sure that we have the final placement of your implants and the final position of your gums. That way, the final teeth are a perfect adaptation to your gums, implants, and everything else. That's why there is a temporary stage to work out all the adjustments. That way, when we get to the final stage, no adjustments are needed. You walk out with your beautiful, perfect smile.
How long does the All-On-4 procedure take from start to finish?
The whole process takes about four to six hours. Occasionally, depending on the person, it might take a little longer, but I would say plan for a whole day where you're either in the office or just relaxing at home. That's about how long the procedure takes.
How many visits are required for the All-On-4 dental implant procedure?
I would say in most cases, in a six-month period, it's probably going to be somewhere from six to eight visits, depending on how many adjustments are needed. That's including your very first visit as well. There are different checkpoints along the way where I will see you as the patient to make sure healing is normal. We make any adjustments needed because, ultimately, while you're walking through your temporary stage, we want to ensure things are healing perfectly and that all adjustments are being made while you're in your temporary stage.
When it comes time to make your final teeth, we have the perfect product that you desire and can recreate that for you. Once you get that final product, that's it. You're done. After everything is said and done, we see you back once every 6 months to make sure your implants and teeth are being kept clean.
Are All-On-4 implants a permanent solution for missing teeth?
In most situations, yes. What I always educate my patients on is you get what you buy. There are many places trying to cut costs and make this type of dentistry less expensive for people. That's great because it makes it more accessible, but the issue is when they do that, they are substituting the product. You're not getting the same product as you would in my practice or some other places. You're getting a lesser product, which means it's cheaper and not going to last your lifetime.
In my office, when I do this dentistry, it is there to last a person a lifetime. When I say lifetime, that means it's going to outlive you. Depending on the type of implant you get and where you go, I've seen it where things only last about 10 years. You make this investment and go through all the pain and recovery for it to last only 10 years. That's not worth it to me. That's why where you go is very important.
Also, knowing the credentials of the doctor matters. What people don't realize is that for me, I had to attend a residency where I spent a year just learning this, while there are doctors who can take a course over a weekend and start doing the same thing on Monday. Which do you think is better? That's why where you go matters and the expertise and experience of the doctor also matter.
When you are going in, interview your doctor. Don't just trust anybody; interview them. Find out their credentials, how many cases they've done, and how they manage complications, because there can be complications. Something to know about me and my practice is that because I do this type of dentistry and the way I was trained, I'm kind of known for being the guy who fixes things when they go wrong in San Antonio, Texas. I get a lot of cases where things were done by someone inexperienced or not done correctly, and I have to fix those problems. What's nice is because I am the guy that fixes the problems, I know how to avoid those problems. That's the difference because this should be something that lasts your lifetime. So, how long should this last? It should be your lifetime.
What is the difference between full arch implants and the All-On-4 procedure?
The difference really comes down to how many implants are being placed. A full arch implant means you're pretty much replacing every single tooth with an implant. Like I mentioned earlier, that's not always necessary. Research shows if you have at least four implants, that is enough to stabilize a set of teeth for a person's lifetime. One for every tooth is not necessary. It becomes extremely expensive to do it that way. Doing full arch implants is more than double the expense of All-On-4.
On top of that, full arch implants mean the implants are closer together, and hygiene is very difficult. A lot of times, we start to see bone loss in full arch cases because it's very difficult and hard to clean. One reason we space implants out for All-On-4 is to create space for cleaning. We use a water pick to clean, and it allows the water to get underneath, so things are not too tight and you can keep everything properly clean. That's the difference between full arch implants and All-On-4.
What are the advantages of All-On-4 dental implants over other tooth replacement options?
If you're looking into this, you're probably investigating options. What is the advantage of All-On-4 implants versus other implant options? The advantage is really the long-term survival, comfort, and natural feel of it. That's kind of the advantage, and really just the timing. You get teeth right away. You can go with dentures that snap in, but because these dentures snap in and out, that force to snap in and out means you don't get teeth right away. It's really the only option where we can replace someone's missing teeth and get them teeth within 24 hours, within one day. That's really the advantage of the All-on-4: the long-term survival, level of comfort, natural feel, and the turnaround of getting teeth. That's the advantage.
What do the before and after results of All-On-4 dental implants look like?
Our goal is to replicate a natural set of teeth. I'm sure you've been places where you see super white, chiclet-like, artificial-looking teeth, right? That's not here in my office. You're going to get something that not only feels natural, but it's also going to look natural. I want to give you a beautiful smile, but I don't want someone to look at you and think, "Oh, those are fake." Part of this is also not just returning function and improving your health; it's also boosting confidence. That's what it's meant to do.
In this process, you get to design this. The smile you've always dreamed of, the smile you've always wanted, you get to create that. That's really cool and exciting. The final result is a combination of my expert opinion and your opinion of what you've always wanted and desired for your smile. The end result is a confident smile that looks beautiful, feels beautiful, and functions beautifully. That's what the final look is like. In most situations, when it's done right, people can never even tell that anything was ever done. That's what's cool about this: how customizable it can be as a final result.
How do All-On-4 implants improve oral health and quality of life?
If you're someone who hasn't had teeth for a long time or has been missing teeth, how hard has it been chewing? Have you been avoiding foods you wish you could enjoy? Are you having to cover your face while eating with family or hide your smile when laughing or taking a picture? How does that feel when you're in that position? As far as quality of life goes, that boost of confidence improves mental state, fellowship, and overall quality of life. Research shows that people missing a lot of teeth and avoiding foods aren't eating a balanced diet, affecting overall health.
On average, people missing more than a third of their teeth live seven years less than the rest of the population. Seven years is a long time. If oral health is deteriorating, overall health is deteriorating. People tend to transition to softer foods, which contain lots of carbohydrates, making it hard to stay healthy. Not only does it boost confidence, but it improves a person's overall quality of life by allowing better eating, greater variety, more comfortable eating, and getting rid of disease. If teeth are being removed, there's disease present. That bacteria and disease enter the bloodstream and are swallowed, creating disease elsewhere in the body. That's not just my opinion; there's much research on that.
One of the greatest complications of oral disease is cardiovascular disease, neuro disease like dementia and Alzheimer's, and stroke. All those are present when someone has disease in their mouth. It's important to get healthy, and that's part of what this option does. It doesn't just remove decayed teeth but provides a solution for replacing them.
A common cause of esophageal cancer is individuals without teeth. How does not having teeth cause esophageal cancer? Without properly chewing food, larger chunks or whole foods are swallowed. The mouth is the first step of digestion. Saliva contains enzymes that break down food, so when swallowed, the stomach can convert it into nutrients. If not properly chewed, the stomach produces more acid, causing heartburn and worsening to vomiting. Older people without teeth often vomit after meals because they can't break down food. Acid damages the esophagus, leading to cancer. Here we have someone developing cancer late in life, which could have been avoided if teeth were replaced at an earlier stage.
Lastly, when acid comes up, it can enter the lungs. The epiglottis closes off our airway when swallowing, but it doesn't work in reverse. So when something comes up, it can enter the lungs. Stomach acid in the lungs is a life-threatening situation, and most people die when that happens. We're lucky if we get to the hospital in time. It's a matter of life and death to replace your teeth, not just immediately but long-term. People missing a majority of their teeth will have their life shortened by at least seven years. That's how an All-On-4 procedure can improve health and quality of life.
What are the potential problems or complications with All-On-4 implants?
I'm not going to pretend that All-On-4 is just this perfect, god-given treatment. It's amazing, but just like anything else, it's man-made, so things can go wrong. The most common complication is the temporary set of teeth breaking while you're healing. You start with a temporary set, and if something overloads them, they're designed to break to protect the teeth. If that happens, no big deal. You just come in, we unscrew the broken set, and make you a new one right then.
What's cool at Inspire Dental is that we make the teeth in-house. We can get you a set in 30 minutes. You call in advance, we fabricate it, you show up, and we take out the old one and put in a new one. It's an easy complication to manage.
The second complication is healing complications, which happen when people don't follow instructions. There needs to be a soft diet initially, which is hard for people because who wants to be stuck with soft foods? People try to cheat and eat firmer foods, affecting healing or causing a healing issue. Not following the diet is the number one reason teeth break. If you stick with the hygiene and diet, complications are unlikely, especially with my planning. I put a lot of planning into place, preventing complications. It's rare that I run into issues because of how much I plan. I've never had a case where we couldn't get to the desirable outcome at some point in the process.
What is the cost of All-On-4 dental implants?
Brace yourself; it can be pricey. It varies in range. It depends on whether you have existing implants, your bone level, and the type of teeth we want to use. The range can be from $20,000 to $50,000, starting fresh with someone who's never had implants. That's the range.
Now, there are different types of teeth, materials, and even numbers of implants. I know we said All-On-4, but there are times we'll put six implants. It depends on the person's bone type and how much bone they have, which determines the overall cost. It also depends on what type of teeth we want to choose because you'll help customize these teeth. Ultimately, depending on what we settle on, that can affect the overall cost.
What is the recovery process like after getting All-On-4 dental implants?
Normally, it's about 3 days. It's 3 days where you're a bit sore, and things are swollen. After 3 days, it starts to go down, and things are pretty smooth in recovery after that. At most, the soreness can last about two weeks, but that doesn't mean you're on pain medicine the entire time. That's usually the turnaround time for initial recovery.
What type of care and maintenance do All-On-4 implants require?
You need a water pick and use it at least twice a day, like you would brush your teeth. Food can get underneath, but it's easily removed and washed out with a water pick. In conjunction with home care, we will see you twice a year in my office to clean your All-On-4. Once a year, we will unscrew it, clean the implants underneath, and put your teeth in a special sterilizer that cleans them. That way, they're good as new. We put them back in, screw them back in, and you're set for another year. That's what the maintenance looks like for an All-On-4.
If you’re ready to schedule an exam or would like to learn more about our services, we’d love to hear from you. Call us at (210) 972-0768 or email [email protected]. We look forward to caring for your smile.