ALL-ON 4: COMPREHENSIVE PATIENT GUIDE

All-On-4 Dental Implants: Explained

All-on-4 is a dental implant treatment for people who have lost or are about to lose all of their teeth in their upper or lower jaw (or both) and don't want removable dentures.

It involves the placement of at least 4 (but sometimes up to 6) titanium dental implants into the jaw to secure a tooth bridge of up to 12 teeth in place.

In most cases, the teeth can be fitted to the dental implants in as little as 3 days after surgery. For most patients, this means they don’t have to be without their teeth for months or even weeks — they can have their smile back and restore complete function in just a few days.

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1. The All-on-4 technique places two straight front implants and two back implants at a 45-degree angle to help overcome any bone deficiencies and utilise more bone density to support the tooth bridge
2. The specialised multi-unit abutments enable the tilted implant placement and provide the stability needed to connect the teeth soon after surgery
3. A reinforced tooth bridge is fixed onto the titanium implants with special screws

Learn more about All-on-4 dental implants in this article here or see how we deliver this treatment at our All-on-4 clinic in Sydney here.

What is the success rate of All on 4 dental implants?

When planned and performed by an experienced dentist, All-on-4 is one of the most successful dental procedures available.

95-97% SUCCESS*

The documented success rate of dental implants.

*across numerous studies in dental journals

98% SATISFACTION*

the number of All-on-4 patients who would recommend it to a friend.

*according to

this 2012 study

25+ YEARS

our experience in restoring smiles with dental implants.

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ALL-ON-4 PROS AND CONS

All-on-4 revolutionised dental implant treatment for edentulous patients (i.e. those without any teeth).

The specialised components (made by Nobel Biocare) and the innovative angled placement of the back dental implants mean more people can receive this treatment — even those experiencing jaw bone loss.

Before All-on-4, dental implant treatment for patients who had lost all or most of their teeth would often require more implants, more time and sometimes complicated bone grafting, adding more costs too. 

Without All-on-4’s advancements, dentists were unable to place teeth on the implants for months (sometimes up to 12 months) after surgery. This meant patients would still need to wear a removable denture during this time.

Today, the advanced technology and technique of All-on-4 allows us to place a full arch of up to 12 teeth in the majority of patients. We no longer need to place as many implants and we rarely need to graft bone to the jaw to support placement. For patients, this means a quicker and more cost-effective treatment.

In dentistry, there is no one-size-fits-all approach. However, All on 4 has proven to be an excellent option for patients who have loose dentures and struggle to eat or those with failing teeth that wish to completely bypass wearing dentures.

Still, there are no perfect treatments and it’s important to remember that all procedures carry small risks. We’ll discuss these in another section of this patient guide.

ALTERNATIVE TREATMENTS

While All-on-4 is an extremely effective treatment, it’s not the only treatment option available for patients looking to replace all of their teeth.

The table below outlines some of the main alternative treatments to All-on-4, as well as their suitability for tooth replacement in the upper jaw, lower jaw or both. We’ll explore each alternative treatment option in detail in the following sections of this guide.

ALTERNATIVE TREATMENT	SUITABLE FOR UPPER JAW	SUITABLE FOR LOWER JAW
Dentures
Standard full mouth implants Dentures
Combination treatment (e.g. single implants, crowns, bridges)
Overdenture

DENTURES

Removable dentures are one of the more affordable tooth replacement options. And often, cost is the main reason why patients choose this option over All on 4 dental implant treatment.

However, it’s important to note that dentures are not an effective long-term solution for edentulous patients. Though they may replace the missing teeth, dentures do not replace the missing tooth roots. This means further jaw bone loss (and the complications associated with this) is inevitable.

STANDARD FULL MOUTH DENTAL IMPLANTS

Standard full mouth dental implants involve the placement of up to 8 straight implants in the jaw to hold a tooth bridge in place. Since the implants are placed straight, this treatment is only suitable for patients that have enough bone height and density to support the implants and tooth bridge.

COMBINATION TREATMENT

If most of a patient’s teeth have a good prognosis, All-on-4 may not be the best solution. This is where a combination of treatments, such as single implants, crowns, bridges or implant-supported bridges may be recommended.

OVERDENTURE

An overdenture is a removable tooth replacement option for those looking to replace the teeth in their lower jaw. Traditional denture wearers often find their lower dentures are more likely to slip and move than their upper dentures. Overdentures provide a more secure solution for the lower jaw.

An overdenture involves the placement of two dental implants at the front of the lower jaw which are topped with magnetic attachments. A denture fitted with locator magnets is then able to be clipped on and off the implants.

DO NOTHING

There is another alternative that we haven’t mentioned yet and that is to do nothing. Some patients with severely broken down or failing teeth may choose not to receive any treatment at all. Yet this option can be detrimental in a number of ways.

There are biological implications, such as losing the ability to eat and speak, and jaw bone loss which can affect your facial structure and cause your lips and cheeks to collapse inwards over time. Additionally, missing teeth can also have a devastating impact on your emotional and social wellbeing.

Patients who choose to do nothing should consider the negative impact of missing teeth and be aware of the complications that can follow this approach.

ARE ALL-ON-4 DENTAL IMPLANTS RIGHT FOR ME?

Most healthy people, no matter their age, will be suitable for All on four dental implants. In fact, there are very few cases where a patient may not be a suitable candidate.

As long as the treatment is carefully planned and performed by an experienced All on 4 dentist, the success rate is also typically very high.

HOW DO I KNOW IF I’M A GOOD CANDIDATE?

All on 4 dental implants are suitable for most patients who have severe tooth loss and want to replace all of their teeth. This includes most cases where the patient has/is:

• Lost all or most of their teeth
• Failing or severely deteriorated teeth that cannot be restored with other treatments
• Severe gum disease
• Extensive bone loss

The best way to determine whether you’re a suitable candidate for All-on-4 is to have a consultation with a qualified All-on-4 dentist. During this appointment, the dentist will examine your mouth and oral health, take x-rays of your teeth and jaw and assess if this treatment is right for you.

Book a free consultation at our Sydney All-on-4 clinic here.

DOES MY MEDICAL HISTORY MATTER?

It does — but don’t be discouraged if you have a chronic illness or long-term health issue. Depending on your circumstances, you may still be able to have dental implant treatment.

It’s important for your dentist to know your complete medical history so they can ensure they’re providing you with the best treatment options for your health. At your consultation, your dentist will ask you whether you have or have had:

• Diabetes
• Osteoporosis
• Cancer
• Stroke
• Heart attack
• Pacemaker surgery
• Organ transplants
• Haemophilia
• Autoimmune conditions
• Drug use
• Psychiatric illnesses

WHAT ABOUT MY MEDICATIONS?

Your dentist must also be aware of any medications you take, including the dosage and how long you’ve taken them. At your consultation, your dentist will ask you whether you take or have taken:

• Bisphosphonates for treatment of osteoporosis
• Nonsteroidal anti-inflammatory drugs prescribed for the management of chronicinflammatory conditions including arthritis & pain
• Immunosuppressive drugs to prevent organ transplant rejection
• Glucocorticoids prescribed to suppress inflammation in chronic diseases likeasthma, rheumatoid arthritis and autoimmune disease
• Chemotherapy agents used to stop cancer cell growth
• Selective Serotonin Reuptake Inhibitors for treating depression or mental healthdisorders

CAN I GET DENTAL IMPLANTS IF I SMOKE?

Technically, yes. But, if you are a smoker, most clinicians will want you to stop smoking before undertaking treatment as it puts you at a higher risk of implant failure. This is because smoking is a vasoconstrictor and decreases the blood supply to the gums, which affects your ability to heal and increases your chance of complications and infections after dental surgery. For implant success, you need healthy gums — and for healthy gums, you need to stop smoking.

WHAT ABOUT ALCOHOL?

While the occasional glass of wine isn’t likely to cause any issues, it’s still important to be aware of the effect alcohol can have on your body’s repair processes. Alcohol has been found to slow down bone repair and reduce bone quality. Additionally, this study found that daily alcohol consumption may have a negative influence on predictable long-term implant treatment outcomes.

PROCEDURE STEP-BY-STEP

All-on-4 is a complex treatment that requires a lot of careful planning and precision by your dentist. But for patients, the process is relatively quick and straightforward. Below you’ll find a step-by-step guide to the All on 4 dental implants procedure so you know exactly what to expect from this treatment.

STEP 1: CONSULTATION

All-on-4 treatment should always begin with a comprehensive consultation with your implant dentist. During an initial consultation, the dentist will conduct a clinical examination of your mouth, take x-rays and 3D scans of your teeth and jaw, assess your suitability for treatment and answer all your questions. If applicable, they may discuss alternative treatment options. Some clinics may also give you the opportunity to see their different tooth bridge options.

STEP 2: PLANNING

After your consultation, the dentist will begin planning your implant placement using special implant planning software. This is a very important step in the All-on-4 procedure as it will help your dentist ensure the implants are placed in the ideal position and avoid vital structures. Meanwhile, your new tooth bridge will be expertly crafted to suit your facial structure and symmetry, while ensuring optimal function.

STEP 3: IMPLANT PLACEMENT

On the day of your implant surgery, you will be put under IV sedation (also called twilight sedation — learn more about sedation here) which will help you remain relaxed and free from discomfort during the procedure. The dentist will then surgically place the implants into your jaw. It typically takes between 3 to 4 hours to secure the implants into each jaw. If required, your old teeth will also be completely removed to insert the implants. After surgery, you’ll spend about an hour or two in recovery as you ‘wake up’ from sedation. When ready, a family member or friend will need to escort you home as you won’t be able to drive.

STEP 4: CONNECTING THE IMPLANT TEETH

Most patients can have their All-on-4 tooth bridge connected to their dental implants in as little as 1 to 3 days after surgery. Initially, patients will receive an acrylic tooth bridge to be worn for approximately 3 to 6 months while the jawbone and gums completely heal. Once the tooth bridge is connected, the dentist will advise the correct aftercare and cleaning for the implants and teeth.

STEP 5: TWO-BRIDGE SOLUTION

For patients who have opted for a two-bridge solution, they will receive their final tooth bridge around 3 to 6 months after surgery once healing is complete. The upgraded tooth bridge is typically made with durable materials like titanium or zirconia, providing a lot more strength and a longer lifespan than the acrylic version.

HOW MUCH DO ALL-ON-4 DENTAL IMPLANTS COST IN AUSTRALIA?

A complete All-on-4 treatment with implant placement and tooth bridge will range from $18,000 to $35,000.

This is because there are several key factors that can influence how much a provider will charge for this treatment (which we’ll explore below).

At Dental Implants on Miller, our price starts from $19,500 excluding sedation and you have two different options to choose from — check them out here or download our price guide for more information.

THE FIVE FACTORS THAT CAN AFFECT WHAT YOU PAY

1. Implant and tooth bridge quality
2. One- or two-bridge process
3. The technology your dentist uses
4. The experience and training of your dentist
5. Your oral health

Want to learn more? We cover the above factors in detail in this article here.

REMEMBER: THE CHEAPER OPTION DOES NOT EQUAL THE BETTER OPTION

Some patients may search for the cheapest All on 4 providers. But it’s important to be wary of any cheaper quotes for this type of treatment.

A cheaper quote can mean…

• Less inclusions For example, it may only cover the cost of a one-bridge solution and you may haveto pay for an upgrade to your final tooth bridge after your 3-6 month healingperiod. Likewise, it may not factor in any additional treatments you will requirebefore receiving your implants, such as gum disease treatment or bone grafting.

• A less experienced dentist Dentists who have invested less time and money in additional training for this treatment may offer cheaper All on 4 prices

• Cheaper materials You likely won’t receive genuine Nobel Biocare components (or their lifetime warranty)

For more information, see our in-depth article on why you should avoid a cheaper quote for All on 4 dental implants here.

THERE ARE SEVERAL WAYS TO COVER THE COST OF ALL-ON-4 TREATMENT

Cost is the number one barrier patients face when deciding to restore their smile with All on 4 dental implants. Before making such a big financial commitment, most patients want to confirm how they will cover the costs of their treatment.

Some of the most common finance options patients use to pay for their treatment include:

• Personal loan
• Specialised medical finance, such as MediPay and DentiCare
• Early release of superannuation

Learn more about All-on-4 finance options in this article here.

DID YOU KNOW YOU MAY BE ABLE TO ACCESS YOUR SUPER TO PAY FOR ALL-ON-4?

Some patients may be eligible to access their super to cover the cost of medical or dental treatments. Check out this article for some handy resources on this option.

WANT TO SEE OUR PRICE LIST?

For more information about the cost of All-on-4 at our Sydney clinic, download our price guide.

BEFORE AND AFTER IMAGES OF ALL-ON-4 DENTAL IMPLANTS

BEFORE

Evgenia

Cost: $19,500 approx.

Time: 3 working days

Evgenia lived with broken down teeth for years. As her teeth were beyond repair she chose full mouth implants on her top and lower jaw.

AFTER

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HOW TO CARE FOR ALL-ON-4 IMPLANTS

Caring for All-on-4 dental implants is much like caring for natural teeth. To ensure the success and longevity of dental implants, patients must follow their dentist’s aftercare instructions carefully and establish a good oral hygiene routine.

POST-OP AFTERCARE

Most patients are surprised at how quick the recovery time is after their dental implant surgery. However, it is still very important to rest and relax for a few days after treatment and follow your All-on-4 post-op aftercare instructions carefully.

While all wounds will be closed and any bleeding will be stopped before you leave the surgery, it’s normal for the surgical site to ‘weep’ a small amount of blood for 2 to 3 days after the procedure. Keep in mind this small amount of blood will mix with saliva and may appear to be a greater volume than it is.

DO	DON'T
Rest	Rush back into your usual routine — allow yourself a few days to rest and recover
Drink plenty of water and other fluids (but avoid hot beverages)	Lie or sleep flat for 48 hours post-op — prop yourself up with an extra pillow
Eat soft, easy-to-swallow, nourishing foods like yoghurt, smoothies or cooled soup for the first 4 weeks after surgery	Do any heavy lifting or exercise
Use OTC pain medication every 4 to 6 hours (or as directed) for the first 2 to 3 days post-op	Eat any hot, hard, crunchy or chewy foods for at least the first 4 weeks after surgery
Use ice packs regularly to help reduce swelling and bruising	Smoke or drink alcohol for at least 7 days after surgery
Follow your dentist’s post-op cleaning instructions	Rinse or spit for 48 hours post-op — swallow your saliva
	Disturb or touch the stitches in your mouth with your tongue or fingers

CLEANING

Maintaining good oral hygiene is essential for the success and longevity of your All-on-4 implants. But cleaning your dental implants doesn’t have to be complicated. By adding a few new steps to your daily oral hygiene routine, you’ll be able to keep your implants and gums healthy.

HOW TO CLEAN ALL-ON-4 DENTAL IMPLANTS AT HOME

• STEP 1: Brush
  Brush your teeth at least twice a day with a small soft manual toothbrush
• STEP 2: Floss
  Use special implant floss to clean under your tooth bridge and behind your backmolars twice a day
• STEP 3: Water flosser
  Use a water flosser to help dislodge any food particles that may be stuck in hard toreach places between the tooth bridge and gums
• STEP 4: Gum stimulator
  Use a rubber tip gum stimulator to further help dislodge any food particles andstimulate blood flow to aid the healing process
• STEP 5: Mouthwash
  Rinse with mouthwash to finish with a fresh, clean feeling

For more tips, detailed advice and specific dental products that can help you keep your All-on-4 smile healthy, check out this article.

CHOOSING YOUR CLINIC

All-on-4 is a life-changing procedure — but it’s also one that is permanent and irreversible. This is why it’s so important to do your research and be very selective when choosing your clinic.

Finding a clinic and team that make you feel safe, comfortable and confident is key to ensuring you get an exceptional experience and results.

THE SEVEN FACTORS TO CONSIDER WHEN CHOOSING YOUR CLINIC

1. Is the clinic using genuine Nobel Biocare components and are they recognised asa Centre of Excellence?
2. What training does the dentist have in this procedure?
3. How much experience does the dentist have in this procedure?
4. Does the clinic work with a reputable laboratory and high-quality materials?
5. Does the clinic have a properly qualified medical professional to administer andsupervise sedation?
6. Is the clinic purpose-built for surgical procedures and recovery?
7. Does the clinic offer all options for All-on-4, including various tooth bridgeoptions?

In addition to the above, there are some more essential questions you should ask your potential All-on-4 clinic before making your decision — find them in this article.

POTENTIAL RISKS

All on 4 dental implants come with many life-changing benefits. But like all medical procedures, there are some potential risks and complications that can occur with this type of dental treatment.

WHAT ARE SOME COMMON ISSUES WITH ALL-ON-4 DENTAL IMPLANTS ?

All on four problems are usually very rare so it’s unlikely that you’ll need to worry about any of the below — especially if you’re working with an experienced dental implant dentist.

Some issues that can occur with dental implants include:

• Implant failure
• Infection
• Gum recession
• Nerve damage
• Sinus inflammation

WHO IS MOST AT RISK OF DEVELOPING THESE PROBLEMS?

All on 4 dental implants may have a reduced success rate for those who have/are:

• Smokers
• Poor dental hygiene and maintenance
• Pre-existing gum disease
• Pre-existing medical conditions that may impact healing such as osteoporosis ordiabetes
• Immunocompromised
• Had radiation therapy to the mouth or jaw area

WHAT’S THE BEST WAY TO AVOID THESE ISSUES?

• Work with an experienced All on 4 implants dentist
• Follow your dentist’s aftercare instructions carefully
• Keep up good oral hygiene and cleaning habits
• Avoid smoking

PAST PATIENT REVIEWS: LEARN HOW OTHERS FEEL ABOUT THEIR ALL-ON-4 EXPERIENCE

Finding it hard to track down trustworthy All-on-4 patient reviews online?

This is because, in Australia, dental professionals legally cannot publish any patient testimonials or reviews of their treatments or procedures on their websites.

But that doesn’t mean it’s impossible to learn about other people’s first-hand experience with All on 4 dental implants.

We share some of the best ways to learn how other people felt about their All-on-4 treatment here — but if you’re short on time, you can check out a quick overview below:

ASK YOUR PROVIDER FOR LOTS OF BEFORE AND AFTER PHOTOS

Before and after photos will show you the results your potential All on 4 dentist is capable of achieving, as well as how the final outcome can look on different patients.

SPEAK TO PAST PATIENTS

If your potential All on 4 provider offers you the chance to talk to past patients, this is a great sign. It shows how confident the dentist is in their work and patient relationships. Plus, nothing is more valuable than hearing someone else’s first-hand experience.

CHECK OUT YOUR PROVIDER’S GOOGLE REVIEWS

Patients are allowed to post personal reviews on a dental practice’s Google My Business page so this is a good way to see what other patients are saying about their experience with them. But remember to take everything you read in Google reviews with a grain of salt.

LOOK AT PATIENT SUCCESS AND SATISFACTION STUDIES

Published medical studies on All-on-4 patient success and satisfaction rates are often a great source of truth about this procedure, providing reliable, long-term accounts of real patients.

Here are some key stats from a few recent studies:

• All on 4 has a success rate of 95-97%*
  * according to this 2019 study

• 95% of patients were extremely satisfied or satisfied with their new teeth*
  * according to this 2012 study on patient satisfaction with the All on 4 procedure

• 98% of patients would recommend this treatment to others*
  * according to the same 2019 study

ARE YOU READY TO GET YOUR SMILE AND YOUR LIFE BACK?