All on 4

Tooth loss caused by trauma, periodontitis, tooth extraction or aging can seriously impair your appearance.

Regardless of the reason, a lost tooth must be replaced, and dental implant therapy is a long-lasting, functional and aesthetic solution that improves the quality of life, ensures a proper bite and a beautiful smile.

For completely edentulous patients, who have lost all their teeth in the upper or lower jaw, it is recommended to have an implant-prosthetic solution to edentulism. This involves prosthetic work on 4 implants (so-called ALL ON 4) or 6 implants (so-called ALL ON 6).

Instead of installing an implant in place of each lost tooth, depending on the condition, 4 or 6 implants are installed to which the prosthetic work is fixed with screws.

What is ALL ON 4?

ALL ON 4 is a method of creating a dental prosthesis for an edentulous upper or lower jaw, which is attached with a screw connection to 4 implants. More precisely, ALL ON 4 is a bridge that is fixed with screws to four specially placed implants. The method was created as a response from the profession to the impossibility of directly installing implants in the back parts of the jaw.

After the installation of dental implants, a temporary prosthesis is made, which is given to the patient two to three days after the operation. In most cases, a permanent bridge is made for the patient after 6 months. Namely, this period is necessary for the process of the fusion of the dental implant with the jaw bone, on which permanent work is done.

WHAT IS ALL ON 6?

As the name suggests, ALL ON 6 represents fixed prosthetic work on 6 implants. As a rule, it is always better to have as many supports for prosthetic work as possible, so this method is an excellent solution for edentulous jaws. However, it should be kept in mind that in some situations, due to a small amount or poor quality of bone, there is a limited number of implants that can be placed.

ADVANTAGES OF THE ALL ON 4 METHOD:

• Dental implants are a lifelong solution
• A prosthetic replacement is a long-term solution (on average 10 years)
• Reconstruction of all teeth in one jaw on 4 implants
• Minimal recovery time
• Top quality Straumann implants that we use in our work
• If necessary, tooth extraction and implant installation procedures are performed in one visit
• Improving the quality of life
• Comfort when eating (no dentures falling out when talking, chewing, sneezing)
• Hygiene (food does not fall under the denture)
• Restoring the natural appearance of the face and lost chewing function

• Patients who want fixed prosthetic work and have lost all or most of their teeth
• Patients who have a complete mobile prosthesis
• Patients who have experienced bone loss over time, especially in the back of the jaw
• Patients who have teeth in very poor condition and are scheduled for extraction

The ALL ON 4 or ALL ON 6 method is the most common solution for:

1) patients who already have a toothless jaw and cannot wear a complete prosthesis (stimulation to vomit, movement of the prosthesis).

2) patients whose remaining teeth cannot be repaired and included in prosthetic work. In such cases, the teeth are extracted immediately before the installation of the implant.

Note: For patients who do not have enough bone for ALL ON 6 , i.e. a bridge on 6 implants which is always a better solution, the ALL ON 4 method is used.

The procedure is not recommended in the following situations:

• In advanced osteoporosis
• In patients with uncontrolled diabetes
• Patients who have undergone radiation therapy to the head and neck, who have been treated with chemotherapy or bisphosphonates should consult with an oral surgeon before implant placement to assess whether implant placement is possible for them.

An orthopantomogram and a CBCT scan of the jaw are required to plan the procedure. Such a scan allows for precise planning of the implant position with respect to the volume and density of the jawbone.

Creating temporary work

Depending on the complexity of the surgery and the end result, the oral surgeon will decide at the end of the procedure which type of temporary work is most appropriate for the patient.

If the primary stability of the implant is OK, an impression is taken immediately after installation for the immediate bridge, which is attached to the implants.

If there is not enough primary stability or some additional procedure will be needed during the period of osseointegration, the patient receives a temporary prosthesis.

Permanent prosthetic work

Six to nine months after the implant placement, the permanent prosthetic solution is created. This period is necessary for the hard and soft tissues of the jaw to take on their stable shape. The temporary work is easily and painlessly dismantled by removing the screws, and the first impression is taken at the implant level.

Creating an all-on work takes 10-14 days, and these are the steps:

1. Taking an impression at the implant level, which the technician uses to create a model.
2. According to the model, appropriate multi-units are selected to correct the position and depth of the placed implant to make it optimal for permanent prosthetic work. After their placement, a new impression is taken at the level of the multi-unit.
3. The next step is to determine the intermaxillary relationships. The intermaxillary relationships are determined using bite templates, or acrylic plates with wax walls on them. These are screwed onto the multi-units and with them we determine the height and horizontal dimension of the intermaxillary relationships.
4. Into the wax ramps, the dental technician places try-in teeth to check the height for the titanium framework, which is the next step.
5. Titanium constructions that are screwed onto implants.
6. The next trial is the trial of the prototype, where plastic teeth are used to check whether they match the shape and size. In this step, the plastic teeth do not match the final color.
7. If the shape and size of the tooth is OK, another ceramic trial will follow.
8. With the last test, if there are no more corrections, the work is permanently fixed and an impression is taken for the protective splint.
9. On the day the protective splint is handed over, everything is immediately checked again.

After the implant is placed, the patient takes antibiotics as recommended by the dentist. The stitches are removed 7 days after the implant is placed, unless absorbable stitches are placed. After a minimum of six months, the stability of the implant is checked.

Mild to moderate pain is possible, and analgesics are taken as recommended by the oral surgeon. Swelling is normal, and cold compresses are used to reduce it, according to instructions that the oral surgeon will also explain in detail.

After fixation of the all-on operation, there are no major complications and the patient is able to function normally the entire time.

Since the ALL ON 4 bridge is a one-piece structure with no gaps between individual teeth, the bridge is cleaned as a single unit. Cleaning a bridge on four implants is specific and therefore differs from cleaning techniques for natural teeth.

It is cleaned with a toothbrush and toothpaste, and the areas around the implants need to be additionally cleaned with an interdental brush, which you can discuss with our dental experts. It is also recommended to use an oral irrigator to clean the basal side of the bridge that rests on the gums.

During a regular annual check-up, if necessary, the bridge can be removed and professionally cleaned.

In cooperation with banks, Bagatin Polyclinic provides the option of paying in installments, as well as interest-free payments up to a certain number of installments.

You can check more about payment methods and treatment prices in the current price list of the Bagatin Polyclinic:

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