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“All-on-Four” and Teeth-in-a Day” Implant Tooth Replacements

What is “Teeth-in Day,” or “All-on Four” Dental Implants?

“All on Four”–There is a considerable amount of literature online about the “All-on Four” or “Teeth-in-a Day” concept. As a dentist with over 30 years of dental implant surgical and restorative experience I can offer a number of practical, and academic observations (no hype).

Who is a candidate for “All on Four” or Teeth-in-a -Day” Dental Implant Therapy?

First we have to describe explicitly what those, often marketing terms, really mean. ‘Teeth-in a Day” means replacing the remaining teeth in a given (upper or lower) arch with a dental implant prosthesis within the period of a single appointment. It is a last resort treatment for what dental professionals call a terminal dentition—where all teeth are hopeless and terminally involved.

In clinical reality, the biomechanics and biological requirement of tooth replacement often (usually) require more than four dental implants for optimal dental implant longevity. This needs to be individually determined by a skilled and experienced dental Implantologists and discussed as an option with the patient.

TO BE ABLE TO DO THIS THOUGH IN A SINGLE VISIT THOUGH—a number of clinical requirements, about 20 criteria, need to be determined (such as bone dentistry, medical requirements, local anatomical needs, etc.) In a course at the California Dental Institute, along with the Nevada School of Dentistry, over 20 clinical criteria were studied that needed to satisfied to have this option feasible and reliable clinically.

In a perfect clinical situation immediate “teeth-in-a day” is a wonderful and optimal option, and Dr. Gibbs at SmileGlenEllyn dentistry has done a number of cases in this fashion. It is a wonderful to see a patient with a “terminal dentition” suddenly be able to smile again!  It is wonderful to eliminate the need for dentures!

(see also our article on the “Hidden Dangers of Dentures” and our  dental implants introduction page)

“Teeth-all-on Four” Dental implants Tooth Replacements

“Teeth-all-on Four” means replacing all of the remaining teeth as above with just four dental implants. In an attempt to maximize the remaining (often minimal) bone the back implants may be angled forward to achieve more bone support (see diagram) and eliminate teeth not supported by dental implants (think poor bio-mechanics.) The best-case scenario with this concept is to maximize the remaining bone to avoid anatomical complications such as the mandibular nerve in the lower jawbone, or the maxillary sinuses in the upper jawbone.

In an ideal situation teeth can be removed, or an existing denture replaced in  a single appointment–commonly called “teeth in a day.”  The doctor works with a dental lab technician to join the dental implants to the dental implant bridge and the patient can leave th office smiling and chewing again!

Options related to Immediate Replacement for Missing teeth and “Teeth in a Day”

As mentioned—about 20 clinical requirements must be satisfied to replace all remaining teeth in a single visit. This is the ideal and is optimal treatment. If bone dentistry, medical health, remaining bone, or adverse biomechanical factors are present the delay may be minimal (usually 3 to 4 months) but the predictably and comfort for the patient may be noticeably improved.

Although clinical criteria are beyond the scope of this short article to place on 4 to 6 implants need to individually prescribed by an experience dental implant dental specialist. The best case often is NOT “all-on-four” or “teeth-in-a day,” but staged treatment with a denture short term (3 to 6 month). This option is NOT what mass marketing recommends, but what is best clinically longer term for the individual patient —again this must be individually determined. The “price point” and time frame should not be determined by marketing objectives, but long-term reliability and outcomes.

In reality—patients should be advised—final determination of the number and time frame may not be accurately determined until the day of surgery.   I have often said (very accurately) that only “one person” can give promises, and “he” is not doing dentistry—we do what is best for the patient!

“Teeth-in-a Day”—Final Restorations

This is one of the most significant misconceptions (I’d say marketing lies) in the “Teeth-in a Day” concept. The restoration placed at the time of surgery is, in the vast majority of cases is NOT the final restoration. Usually the surgical areas need to heal before a long-term tooth replacement can be accurately.  The primary implant bridge is beautiful and functional, but there are more esthetic options once final healing is (biologically) achieved.

So what is the Reality in the ‘Teeth-in-a Day” and “All-on Four” Dilemma?

Individual situations must be accurately assessed per patient. Long-term comfort and reliability must be assessed vs. short-term marketing needs. Accurate pre-clinical diagnosis, using years of experience and advance technology like cone-beam radiography, are required.

The VERY best “All-on-Four”  or “Teeth-in-a Day”Dental Implant Bridge

The esthetics of All-on Four” restorations is changing, and demand the better materials is also increasing.  In the last few years the plastic and denture teeth commonly used in dentures are being replaced with new all ceramic materials made with materials like zincronium.  This are more esthetic, stain resistant, and considerably more resistant to wear and chipping.  There currently only a few dental labs of fabricating these advance esthetic Teeth-in-a Day restorations, and we have made them for many patients in the Glen Ellyn, Wheaton, Lombard, Wheaton, and even patients traveling from far away.

Because of the more demanding laboratory processing these are usually actually placed after adequate healing.

Need for Dental Sedation or Advanced Anesthesia

Although Dr. Gibbs at SmileGlenEllyn in Glen Ellyn has experienced in dental anesthesiology and IV sedation, this is not required for these procedures. The patient comfort level and anticipated difficulty is discussed with the patient and a choice is determined.