All-on-4®

All-on-4®: a screwed bridge on four implants.

It is a procedure used in patients who lost all their teeth, where we make a denture fixed on four specially positioned implants using screws. The implants implanted instead of the incisors are parallels, and the lateral implants are tilted at 45° in the jaw bone. Special abutments are deployed on which a usually 12-tooth bridge made by the dental technician is fixed using screws.

• Patients who lost or who soon will lose their teeth
   
• Patients with whole removable denture
   
• Patients for whom more than 4 implants can be implanted in the jaw bone only after bone graft procedure
   
• Patients who do not want to undergo a bone graft procedure
   
• Patients who cannot undergo several dental implants due to high expenses
   
• Patients for whom the bone graft procedure takes too much time
   
• Patients who want to return home with a new set of fix denture on the same day

• A long-term final and safe solution
   
• You can enjoy again the benefits of the fix crowns and denture
   
• You can smile without fear because your prosthesis will not fall out
   
• You will be able to taste again because the denture does not cover the palate which limits the ability to taste
   
• It always remains stable and will not limit any activity you may undertake
   
• It restores your confidence and you will feel better
   
• Comfortable denture

1. Consultation, status assessment, performing a 3D CT scan and developing a treatment plan. You will be provided with this treatment plan not only verbally, but also in writing within a few days. Our oral surgeon will answer any question you may have during a new consultation.
    
2. If you already have a removable denture, after the anaesthesia of the surgical area in our operating room we will immediately reshape your removable denture so that it can be screwed on the 4 implants.
   • If you do not have a removable denture and/or you have teeth that have to be removed, first we will remove the teeth, and then we will cast an impression for the temporary denture made by the dental technician.
   • Thereafter we will place in the 4 implants and the temporary denture will be reshaped and screwed on as described above.
      
3. 2 days after implantation to help facilitate healing we will conduct a check-up and laser treatment. 
    
4. 1 week after the implantation we will remove the sutures and check the surgical area.
    
5. 4 months after the implantation we will remove the temporary denture and replace it with a final circular bridge which usually comprises 12 teeth. We will explain and show you how to maintain oral hygiene and dental care recommended for this new denture.
    
6. 3 months after applying the final circular bridge you are expected to return for a dental hygiene check-up.
    
7. 1 year after the implantation you are expected to return for a dental hygiene check-up, an X-ray and an oral surgery check-up. Subsequently, at least annual sessions are required for dental check-ups and plaque removal.

During this procedure, your oral surgeon will minimise the pain using local anesthesia and laser treatment.

Since in the case of this All-on-4® procedure fewer implants are placed in without bone graft, this intervention requires less time and it is associated with less discomfort than a multiple phase solution with bone graft. Many of the patients are able to return to work on the next day after the surgery. 

Each case is different and the status of each person is different, so we cannot establish the exact price in advance.

This procedure is considerably more expensive than a simple removable denture, but it is much more affordable and substantially faster than cemented crowns with bone graft and multiple implants.

Please contact our oral surgeon, dr. Gábor Benedek for a personalised quote. Contact us for a consultation appointment at phone: +36/30/206-9532.

1. 8 or more implants with cemented crowns with or without bone graft?

• Without bone graft: If you choose higher expenses and you have enough bone for more than four implants, it is recommended to choose the solution involving 8 or more implants. This is a very safe procedure due to the lower chewing force load per implant and your denture can be longer (in the case of All-on-4® the denture can reach Tooth 6 or sometimes only Tooth 5).
• With bone graft: If you are able to cover the expenses and a series of prolonged treatments associated with the bone graft, it is recommended to start the complex dental rehabilitation procedure involving more than four implants.

The more implants you have, the more parts can the denture be divided, and thus, if there is a problem, not the entire denture, but only a part of it has to be removed. When wearing a circular bridge, there is tension generated in both the denture and the bone because it cannot flexibly follow the mandibular joint movements, and this particularly applies to the mandible. Therefore, a denture divided into multiple pieces should be made instead of a contiguous denture, if possible. If there are not enough teeth and/or implants, as is the case of the All-on-4, the denture cannot be divided.

2. Or four implants with screwed teeth without bone graft?

• If your bone and/or treatment costs render impossible a solution with multiple implants, you should choose the All-on-4® procedure with fix screwed teeth on 4 implants. This is much more stable and comfortable than the removable denture.

There is no need to artificial gingiva for the cemented denture with 8 or more implants; however, an artificial gingiva is required when screwed teeth are used on 4 implants. We will take into account the individual smile line: the limit of the artificial gingiva and the natural gingiva cannot be seen when smiling, and you will have nice and natural smile.

If you do not have teeth in your jaw, but you want a cost-effective yet stable fix denture, in principle there is nothing to prevent the All-on-4® procedure. However, this can be confirmed by your treating physician after a consultation.

If you are interested to undergo this All-on-4® procedure, please ask for an appointment with dr. Gábor Benedek, MD, oral surgeon.

During this consultation a CT scan will be taken, which then will be evaluated by dr. Benedek and, if you are eligible for this procedure, we will provide you with a written treatment plan.

Our practice uses Swiss-Swedish Nobel implants. This manufacturer had developed the implants and accessories necessary for the All-on-4® procedure. This company is long established and reliable, and guarantee excellent quality products.

All implants are made of titanium. Nobel provide a life-time warranty for fracture due to material defect and for implant loss. Our experience of decades shows that implant fractures due to material defect almost never occur. However, the warranty for the material of the implant is not identical to the warranty for the implant staying in position.

The condition of the patient can change, new diseases may occur, or medications may be prescribed which can lead to implant loss. Unfortunately, no warranty can be provided for these cases. If the patient does not smoke, does not have untreated diabetes or other chronic disease, has excellent oral hygiene, regularly undergoes plaque removal and dental check-up, the implants could last for up to several decades.

Our oral surgeon and dental hygienist will teach you to take care of your denture. A key pillar of after-care is to brush your teeth thoroughly several times a day.

There is a very narrow gap between the artificial gum and natural gum that you can clean pulling back and forward a cotton band.

Annual plaque removal and dental check-ups are also essential. During these check-ups the denture will be unscrewed from the four implants, professionally cleaned and fixed back. The screws will be covered by fillings.

The cemented denture cannot be removed without injury.

In case you have several teeth and/or implants, we usually recommend/plan a cemented denture. The denture comprising crowns and/or bridges prepared by the dental technician will be cemented on the teeth or implants prepared.

We try to make the denture from units as small as possible, and whenever possible, from individual crowns. Thus, if there is any problem with the tooth or implant underneath, only one crown or a smaller unit will have to be removed.

If you do not want the implant in order to lower your costs and if several missing teeth have to be bridged, your teeth before and after the gap may have to be ground in order to reach proper stability. If there is any problem, a long, contiguous denture can be removed only by cutting it in several places or destroying it.

Screwed dentures can be fixed only on implants. In this case, other types of abutments, so-called screwed abutments are used. The occlusal part of the crown will be cut out at the screwes in order to allow fixing the denture to the implants; thereafter, these cut-outs will be covered with tooth-coloured filling.