Is “All-On-4” procedure a good treatment?

BY DR. JAMES KHAZIAN DMD. AFAAID.FICOI.

I have been asked this question many times and there is no simple yes/no answer for that. Here I am briefly examining this treatment approach and explaining my opinion.

There has been significant advances in dentistry during the past 20 years. We are very rapidly moving towards an era of super modern dental treatments that focuses on comfort, pain-free approach, and highly esthetic and functional concepts.

Replacement of lost teeth has always been a major challenge in dentistry and conventional solutions for tooth replacement were removable dentures and dental bridges. These solution had major drawbacks.

Removable dentures were bulky and fake looking and did not provide a solid foundation for effective chewing. It was a major compromise and patients had to adopt to them and learn how to live with them. They required a modified diet of softer food and some patients could never learn to chew with confidence.

Dental bridges, although had more esthetic appearance and provided better function, they required shaving off big portion of remaining natural teeth, which was very destructive to natural dentition. Besides, A dental bridge was only indicated for missing teeth or spaces which had adjacent natural teeth on both sides.

Implant dentistry offered excellent solutions to all these problems and provided tooth replacement options that were more natural. Implant teeth look, feel, and function like natural teeth. Dental implants offer many different treatment options and can replace one, several or a full mouth of natural teeth.

One of these procedures is called “All-On-4”. This procedure is indicated for patients who have lost all their teeth in upper or lower or both jaws. Proponents of this treatment claim that by surgical placement of just 4 implants in each jaw they can replace 12 teeth. This means that someone who has lost all her/his teeth can have 12 upper and 12 lower teeth with just 8 implants.

There is quite a lot of doubt and opposition to this concept and many high profile dental experts do not quite agree with this and believe 6 implants or more may be needed to support 12 teeth in each jaw. They think 4 implants do not provide a structurally sound foundation for supporting 12 teeth. They also say if for any reasons 1 of those 4 implants fail the entire treatment plan is compromised.

I personally share this belief and strongly recommend at least 6 implants in each jaw. The goal of such treatment is to have strong and esthetically pleasing replacement teeth that provide peace of mind for the patient for many years. Such treatment will definitely enhance one’s lifestyle and improve overall physical and mental health.