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All on 4

The All on 4 implant procedure is now a well-established treatment concept with more than 15 years of published research. 

It involves placing a minimum of 4 implants, as the name suggests, and using these to support a bridge carrying 12 or more teeth. The number depends on the size of the jaw and positioning of the implants, but 12 teeth on a bridge will meet all functional and aesthetic needs for most of our patients.

The All-on-4 treatment is well supported by the literature and clinical evidence, and we offer this treatment with confidence for our patients. Success rates above 96% are reported, and we confidently offer free replacement in the unlikely event of a failed implant.

Implant treatment 

Implant surgery is usually performed under a local anaesthetic, although some anxious patients prefer to have sedation to make the procedure more comfortable.

On the day of surgery any remaining teeth will be removed and the bone shaped before implants are placed. The gum is stitched closed but this is all usually tucked away under the bridge once it is fitted. The stitches dissolve in about 3 weeks of the surgery and do not need to be removed.

The first bridge to be fitted is a temporary, prototype bridge – in effect our best guess on the day of surgery following our detailed preparation with the technician. This bridge can be modified over the following months, with decisions being made ahead of making the final bridge about tooth colour, shape and position, ensuring that you end up with the best possible look and feel for your new teeth.

After 6 months the final bridge is made following a series of appointments at which your dentist will remove the temporary bridge, take impressions and other records so that the final bridge can be made to the ideal design for you.

After implant placement surgery

After Implant surgery, some discomfort and swelling is quite normal and to be expected. It varies widely from person to person, but you will need to be prepared for 5-10 days recuperation and we would suggest you avoid any important diary commitments during that time.

The degree of swelling will vary between patients and may also depend on the number of implants placed and whether or not additional surgical procedures were carried out. Occasionally, along with the swelling, there may also be bruising of the skin overlying the area, although this should fade over a week. If you are a smoker or have a pre-existing medical condition that affects soft tissue healing, the amount of swelling may be greater. You may also experience some nasal and/or sinus stuffiness.

In the majority of cases the surgery element of the treatment is completed at this first stage, and no further surgery is required. Occasionally, depending on circumstances discovered at the time of surgery, it may be necessary to modify the plan, and secondary surgical procedures may then be necessary. You will be kept advised of any changes to the plan and how these will affect the progress of your treatment, but remember this is a relatively rare occurrence and surgery is completed in one visit in the majority of cases without complication.

If there are concerns about the healing and integration of one or more of the implants a minor procedure may be required to expose and check for firm, bony attachment. Recovery from these minor procedures is usually uneventful, but you will be advised what to expect in your case should this procedure be necessary.

Potential risks of implant surgery

As with all types of surgery, there are risks involved with implant surgery, both during the procedure and the recovery period. While most of these risks are minor, it is important to consider them before opting for surgery. Some, but by no means all of the possible risks are explained below.

Some risks are entirely beyond our control and as with any other surgical procedure an element of risk cannot be avoided completely. The risks of complications are carefully assessed and weighed against the potential benefits of successful treatment in each case. The decision to proceed with the treatment is made by you, taking into account all of the advice and information we provide to assist you in making your decision. If you have any queries or concerns, or feel that you need further explanations or information it is essential that you discuss this at the earliest stage with your dentist. Our experience is that a well-informed patient copes better with the treatment and any minor complications as they occur, so please feel free to ask any questions, no matter how trivial you may feel they are.

Below are listed some of the most common risks associated with implants. It is important to follow carefully the advice in any Pre-Operative and Post-Operative Instructions to be given in order to decrease the chances of these risks occurring.

Failed Integration

A vital part of receiving Implants is that the bone fuses with the implant – a process called osseo-integration. One of the major risks of implant surgery is that the implants fail to fuse correctly with the bone. If osseo-integration does not occur, the implants will not function properly and can be uncomfortable, become loose or fall out.

All possible steps are taken prior to surgery to assess the quality and volume of bone present, and to plan the placement of the implants by using the CT scan. Despite this careful preparation however, some implants will fail to heal as intended and the integration with the bone will fail. This is a relatively rare occurrence and most times when it occurs we cannot explain why it has happened.

In the event that integration fails in this way, the implant will be removed and surgery may be attempted again once the area has healed. In most cases the temporary bridge can remain in place, perhaps with some modification depending on which implant has failed. Our experience is that failed implants result in a delayed outcome rather than a complete failure of the intended result. No further charges will be made in the event of implant failure as we recover the clinical situation, but if the overall plan is affected you will be kept advised of any changes and the cost implications attached to those changes.

Infection at the Implant Site

Infection is an ever-present risk associated with surgery of any kind. If the infection becomes sufficiently severe, it can lead to implant failure. We routinely take steps to minimise the risk of infection during and after the surgical procedure with antibiotic cover, and it is important that you follow the post-operative instructions and complete the course of antibiotics if these are given in your case.

Damage to Existing Teeth

If implants are being placed between or next to existing teeth there is always a slight risk of damage to the natural tooth, its root or supporting bone during the placement procedure. This is more likely to occur if the teeth are very close together or their roots are badly angled, thereby reducing the space available to accommodate the implant. If this is the case, this will be identified during your assessment and discussed with you prior to surgery. In most All-on-4 procedures all remaining teeth in the jaw are removed, but this may apply if the decision is made to keep any teeth.

Surgery requires the use of instruments and retraction, which are different to those used in routine dentistry. Minor damage can occur to any teeth or restorations in the opposite jaw during the procedure. This is very rare indeed, but in any event will be corrected at the time, or at a later date if necessary, free of charge.

Nerve and Tissue Damage

In extremely rare cases, placement of implants can lead to injury to blood vessels or nerves underlying the teeth. This can lead to pain, swelling, numbness and/or a tingling sensation in the teeth, gums, lips, chin, cheek, and/or tongue which, whilst very rare, can be permanent. In most cases the nerve injury is limited to stretching and bruising caused by the surgical process and the nerve recovers in time with sensation returning to normal. This recovery can take a number of months to achieve in full.

Sinus Problems

Implant placement in the upper jaw frequently involves placing implants close to the maxillary sinus, the naturally occurring air box contained within the cheek bone. Complications can arise with the closeness of surgery to the sinus as already explained as a short-term cold-like stuffiness and congestion in the sinus.

 Very rarely surgery close to the sinus, especially where the bone may be very thin as often found to the back of the jaw, can lead to an opening occurring between the mouth and the sinus. This isn’t always apparent at the time of surgery and can arise during the healing process as the thin wall between the sinus and the mouth breaks down. If this should occur it can be repaired with a relatively minor surgical procedure and no further charge will be made.