Alternatives to All-on-4

Alternatives to All-on-4

Because the popularity of the All-on-4 treatment (a non-removable denture fixed to 4 or more implants replacing all the teeth in one jaw), patients rarely hear of alternatives. There are two implant alternatives to the All-on-4 concept: Fixed Bridges on Implants and Removable Implant Dentures.

If we include the All-on-4 option, there are four total options for patients to replace all the teeth in one jaw. Many dental implant practices propose the extraction of all the teeth to make room for implants, even if there are several perfectly good teeth remaining in an arch. At the Dental Implant Center, we believe that ALL patients should receive ALL viable options. We also believe that good teeth are often still worth keeping. For those patients with no teeth or no good teeth, the four options described below can be considered.

Option 1 – Bridges on Implants

This is the very best option any dentist can offer. This results in 2, 3 or 4 fixed/non-removable bridges attached directly to the implants. Advantages over All-on-4:

  • Requires much less bone removal (often no bone removal)
  • Look, feel and function like natural teeth
  • Very little, if any speech changes
  • Does not cover any part of the palate
  • Can be cleaned just like bridges on teeth
  • Have no unnatural contours or areas that cannot be cleaned
  • Require no special abutments (All-on-4 protocol requires angle correction abutments which are not bone or gum tissue friendly)
  • Usually do not need pink porcelain at the gumline (because aggressive bone removal is not necessary).

Bridges on Implants
Fixed Implant Bridges (non-removable)

Option 2 – All-on-4

The technical names for this prosthesis are “hybrid” or “fixed-detachable”. It can be removed by an implant dentist when/if needed, but not by the patient. The popular names are “All-On-4” or “Teeth-in-a-Day”. These are sometimes done with 5 or 6 implants, depending on varying factors in a given patient’s anatomy.  This is wildly popular, worldwide. Because of its popularity and potential profit margin there are many under-qualified dentists attempting it. These treatments result in a denture-type prosthesis that attaches (is screwed on) to multiple implants. It can be made of titanium/acrylic or zirconium. Tooth breakage is common if the material choice is wrong or if the patient has a strong bite, clenches or grinds. It is a very good option when done properly with the correct combination of materials. The final result is highly aesthetic, functional and comfortable.

All-on-4
Fixed Implant Dentures/All On 4/Hybrid

Option 3 – Removable Implant Denture

This treatment results in a denture that snaps down onto the implants and is removed for daily cleansing.  Four implants are preferred in this situation, but two can be used as well. Each implant and attachment have seven levels of retention so the amount of stability and retention can be adjusted. The decision on how much retention is the correct amount is determined by the dentist and the patient. It is still a very fine option that gives denture wearers exponentially more retention and stability.  It is the least expensive of all implant options.  The downside though is that it is large and requires follow up visits (every 3-18 months) to replace the attachment inserts. The cost for this service is low ($100-200).

Removable Implant Dentures/Overdentures
Removable Implant Dentures/Overdentures

Option 4 – Complete Dentures

Many people remember their grandparents or their parents having dentures in a cup. Most people struggle to use dentures because they move when the patient eats and speaks.  There is nothing to retain it and nothing to keep it in place. People are constantly trying to balance their dentures as they are chewing, as they are speaking, or as they are laughing.  This treatment is an old-fashioned style of tooth replacement. Most people know they don’t want dentures but, due to financial constraints or insufficient bone, they are still an option. Dentures can restore a beautiful smile, but they are not very comfortable, and they are not very functional. So, we call this the least ideal option for people missing all of their teeth.

Dentures

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