All on 4 or Denture Stabilisation?
The All on 4 system is an affordable and minimally invasive solution for people with no teeth. Although the dentist will refer to each arch as a denture it is not like a traditional denture at all. It does not have a plastic plate and they are permanently bonded. This means that they are much more comfortable and you are able to eat what you want again and be able to taste the food and chew properly with no chance of your teeth falling out. The teeth are made of acrylic and sit on a plastic gum, this is then screwed onto a metal supporting plate and then . The teeth can be made of acrylic or more recently, Gradia. Gradia is an extremely strong hybrid resin composite which can be highly polished to achieve a realistic effect. It also has a ‘chameleon property’ whereby it can blend into its surroundings.
In the late 80’s Dr Paola Malo of Nobel BioCare discovered that if a full arch was required, rather than using one implant per tooth the whole arch could rest on just 4 implants . The All on 4 system was born.
In this system the 2 front implants are straight and the 2 back one are tilted to up to 45 degrees. Using a 45 angle means that some people with reduced bone quantity or quality can also get their teeth without waiting for a bone graft. In addition to trying to access better bone through the angeled placement of implants, it is also possible to use 6 implants. When this is done it is called an All on 6 System.
To have an All on 4 System in the correct sense means that all the parts are made by Nobel Biocare but over the last three decades or so other companies have made their own systems . With these other systems, sometimes called denture stabilization, Implant overdentures or bar retained dentures, different lengths and angles of implants as well as different attachment systems are now available. Which ones are available to you depends on your budget and also where your good bone is located.
One attachment system one of our dentists uses is a metal bar which links the implants together and stops them drifting apart. The denture is then screwed onto this bar. This system removes the need for cement.
A huge bonus to this system is that not only is it much cheaper than 16 implants but also that the temporary arch can be fitted on the same day and only a few will need bone augmentation first. Some dentist will give an all inclusive price with the sinus lift and bone augmentation included and others don’t . The temporary arches are always an extra and prices start from 800 Euros (around 940 USD) an arch. If you are having both jaws this will therefore cost 1600 Euros ($1880) in addition to the price of the All on 4.
An added advantage of the All on 4 System is that the implants used are made of titanium which is a biocompatible material. This means that the body reacts as if the implant is another part of the body and the natural bone and the titanium will fuse together or osseointegrate. This not only good news for your teeth, it also prevents further bone loss in the area ands to the volume around your jaw giving a youthful appearance.
Although the All on 4 is a hugely popular treatment the reality is that the system is quite inflexible and most people end up having denture stabilisation tailored to suit them. Many people also end up having some kind of bone grafting and if their sinuses sit further into their mouths a sinus lift is also usually indicated. Contrary to popular belief it is also usual for the All on 4 not to be completed in just one day. This is because as much time as is necessary should be taken to ensure the denture fits correctly so in reality it take 2 – 3 days. Having denture stabilisation means that there is no cement to introduce infection into the bone and also that a Gradia or zirconium arch can be used. The teeth are therefore more durable and look more realistic.
The system to be used should really be decided upon by the dentist after examining your X ray and listening to what your expectations and requirements are. A provisional treatment plan will then be sent to you. When the dentist does a physical examination and does the 3D CT scan the plan will either be confirmed or, in around 10% of cases, the plan may be changed after a discussion between you and the dentist.
How can I increase the lifespan of my All on 4?
- Stop smoking 8 days before surgery This is because smoking reduces the blood supply to the implants and reduces the chance of successful osseointegration.
- Practice good oral hygiene. Plaque build up can lead to periodontal disease, bone loss and implant failure.
- Eat soft food for three months to prevent pressure on the implants.
- Reduce alcohol consumption. Alcohol causes a dry mouth, without saliva’s antiseptic properties oral bacteria can thrive and interfere with healing.
- If you have diabetes keep your blood sugar levels under control. Diabetics have an increased healing time and are also more prone to infection. Using a chlorhexidine mouthwash may help.
- Bruxism or teeth grinding puts pressure on the teeth and implants and reduces their longevity. You may not be able to control this.
All on 4 Advantages
- Minimally invasive
- High success rate
- Low cost
- Get teeth in a day
- Available to people with reduced bone density
- No plastic plate
- Permanently bonded
- No diet restrictions
- Implants help to maintain the bone structure which improves facial appearance
- Can be done straight after extractions
All on 4 Disadvantages
- The teeth are made from acrylic so do not have the longevity or natural look of zirconium or Emax crowns.
- As the teeth are fitted on the same day you will not get an opportunity to try them on for fit and feel before they are permanently bonded.
- Food may get stuck under the artificial gum and cause infection.
- As the implants are placed towards the front of the jaw you will get bone mass reduction at the back of the jaw over time.
- If there is a problem with just one of the implants then the whole denture still has to be removed to solve it.
- Attached to 8-10 implants
- May require a bone graft
- Act like natural teeth, few eating restrictions once healed
- Can last 10-15 years
- Implants help maintain the bone
- Crowns attached directly to existing gums
- Look like natural teeth, no artificial gum
- Cleaned like normal teeth
All on Four/Six
- Fixed to 4-6 implants in the jaw bone
- Suitable for patients with bone loss
- Few eating restrictions once healed
- Last 10+ years
- Implants help maintain the bone
- Look like natural teeth – gum join hidden behind lips
- Cleaned like normal teeth
- Not fixed – rest on the gums, can need adhesive
- Can move when eating so certain foods must be avoided
- Need to be replaced as gums change shape
- Further bone loss is inevitable – shape of face will change over time
- Acrylic plate covers much of the gums and roof of the mouth
- Can look like natural teeth
- Must be removed for regular cleaning
Hungarian Dental Travel has been helping patients find the best possible treatment in Hungary since 2004. Now part of Hand Picked Clinics, we are expanding our country coverage with the aim of helping more people from all over the globe.
We can introduce you to some of the best dental clinics in Hungary (and beyond). We know the ins and outs of travelling abroad for treatment. We are not tied to one clinic and we are not dentists, just normal humans.
Every treatment plan is as individual as you are. You will get world class treatment at an affordable price. Our dentists are skilled at designing solutions that both save you money and focus on your long term oral health.
Send us a short message outlining what you want to acheive - restore your self-esteem, a perfect smile, being able to chew properly, your objective will be our aim as we do our best to guide you through.
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