When you lose all your teeth, your body senses the loss and begins to resorb the jawbone to use those minerals elsewhere in your body. If you then decide that you would like to have your teeth restored with dental implants, the loss of bone is an issue because you need the bone to support the implants. In that situation, a solution is to do a bone graft. Bone grafts, however, add complexity to the procedure as well as several additional months, since the bone grafts have to completely heal before any implants can be placed.
There is another option, and that is All-on-4 dental implants. This is a technique developed in the late 90s by a Portuguese dentist, Dr. Palo Malo, for situations in which there is a loss of bone. This technique uses four implants. Two of them are placed toward the front of the mouth. Two more are placed further back, and those two are angled as shown in the drawing above. The angulation increases the resistance to movement.
Usually, All-on-4 implants are combined with a technique that securely attaches a provisional denture to the implants on the day of surgery, so that the patient can go home from the surgical appointment with functional teeth. This aspect of the treatment is trademarked by the implant company Nobel Biocare as the Teeth-in-a-Day® procedure.
What to Expect with the All-on-4 Dental Implants Procedure
This procedure requires careful diagnosis and planning. A three-dimensional x-ray is required to pinpoint the locations of nerves and blood vessels to make sure that the placement of the implants doesn’t impinge on these. Dr. Steinberg also needs a three-dimensional picture of the contour of your jawbone so that the implants don’t perforate through the bone. The precise placement of the implants is planned before your appointment.
If you wish to have sedation for your surgery, most dentists who do this procedure will be able to provide that for you.
A provisional denture that replaces all of your teeth in the arch is then attached to the four implants with screws and you will go home with those teeth. There will then be a healing period of three months or so, during which time your jawbone will fuse to the titanium implants—a process called osseointegration. When osseointegration is complete, you will return to the office for the placement of the final denture.