The All on 4 Dental Implants Process

This woman came to my office in Burbank, California for all on 4 dental implants (also called all on 4 dental implants, all of four full mouth dental implants and others).  She had severe gum disease leading to bone loss.  All of her teeth were loose and wiggly (you can tell when somebody has gum disease because the teeth look longer than normal).  She lost confidence in herself and did not feel pretty anymore.

Preparation for the All on 4 Dental Implant Surgery Appointment

In my practice I use facial scanning technology to capture all impressions and avoid pulling loose teeth with regular molds.  It is combined with scanning the inside of the jaw to an accurate representation of your face.  A 3D x-ray is also taken.  On my own time I do my “homework” to fuse the face scan, the teeth scan and the 3D x-ray all into one!  This is like having a virtual patient right on my laptop.  It is really incredible, especially for full arch dental implant cases that involve the upper jaw.

Because she has a really big smile it is critical that this case is diagnosed carefully.  What is really important is that the transition where the artificial pink gum meets the natural gum has to be hidden below the lips.  It is very unattractive to see the transition line between the artificial zirconia gum and the patient’s natural gum.

Many large dental implant clinics that provide the all on 4 implant procedure or full arch implant procedure try to cut costs by not doing this workup.  They just chop and level the bone at random without a predetermined workup.  This can lead to implant failure and terrible results!  Beware when the price of dental implant seems to good to be true. Some call this “permanent dentures,” which is not a good term for this since they are not removable.

Most of my patients will complete the full arch replacement procedure in just 4- 5 visits! Done!

face scan of Ramsey Amin DDS
That is my face scan!

An Example of the Upper and Lower All on Four Surgery

The all on 4 surgery and her case was done all at once…I extracted the teeth,  leveled the bone, placed dental implants and did minor bone and gum grafting all at the same time.  She was sedated using an IV, which is included in the price at my office.

I placed four dental implants on the top, but I had room for five on the bottom.  The term “all on 4” does not necessarily mean that just four implants should be used.  In fact, most of my cases have 5 or 6 dental implants. 

I do not charge extra money for extra implants.  I just want the patient to have a great long-term result!

Ramsey Amin DDS

The area is stitched with dissolvable sutures and she went home that night wearing a mask (protection from COVID-19) .  Because of the complexity of her BIG smile it is much better to mill (NOT PRINT) the teeth from the computer overnight.  This avoids the retrofitting process that weakens the temporary bridge and is very inaccurate.

I gave her a special medication in her IV and special long-lasting no pain that takes away all pain.  There is no need for any strong pain medication like Vicodin, Percocet or Norco.

Installing the Prototype All on 4 Implant

The provisional temporary PMMA bridges were put in place the very next day at about 2 PM.  This usually takes about 30 minutes time.  I unscrew the healing abutments and screw in the beautiful prototype bridges that were made overnight in my lab.  I gave the patient a special numbing mouth rinse.

They always say it was easy!

The bone heals for the next 3 or 4 months and the patient is required to be on a soft diet.

The Final All on 4 Dental Bridge

A few months later, the final all on 4 bridges were made.  She wanted them really white!  It is normal to develop a small gap underneath the bridges if healing is going well.  That means the gum is healthy and firm.  I removed the existing prototype bridges and rescanned the gums and implants one more time for accuracy. This will close the gap.

If the patient wants to make any changes to color, shape or bite that can be done in the final zirconia all on 4 bridge. 

Keep in mind that any bridge material you are offered besides zirconia is glorified plastic! Make sure you know what you are getting!  Zirconia is the premium material while everything else is very breakable. 

Ramsey Amin DDS

Many dentists do not feel comfortable with zirconia because it requires a very high level of accuracy and an expert lab.  Zirconia full mouth dental implant bridges have to be done correctly or they can break catastrophically.

So in the span of approximately 4 months, all of the teeth were replaced with full upper and full lower dental implants.

This is a very typical result in my office.  Many of my cases are much more difficult including full uppers with zygomatics and pterygoid dental implants.

Keep in mind that every dentist has a different way.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

9 thoughts on “The All on 4 Dental Implants Process”

  1. Hi there! Love your advice. Does an implant supported overdenture offer better lip support than a fixed bridge? As in, can the pink gum piece of fixed option behave the same as a denture in terms of support in this area? I am considering the treatment but am terrified I will be left with a shrunken top lip. I am currently missing top teeth in front and wear a removable denture that support lip, can a fixed option do the same job? I would appreciate your opinion on this greatly as I can’t seem to get clear info on this anywhere! Thank you!

    Reply
    • This is a great question!

      Honestly I do not do anything removable for at least 15 years now. All of my cases are fixed. This requires a tremendous amount of experience and an extremely skilled lab to pull off perfect lip support when a patient has lack of fullness. This link should help you read some articles that I have written specifically on the topic of lip support.

      Also I think you should check out an article on all on 4 dental implant problems and complications

      Reply
      • Thank you! I am halfway through treatment and am now very worried I have made a huge mistake and maybe should have chosen overdenture. I am in healing phase following full mouth extractions, bone grafts and 12 implants. My temps are terrible, unwearable in terms of fit and aesthetics. This has made me doubt the skill of their lab and doubt they can design a fixed solution that offers lip support. What would you suggest I could do to try and ensure good outcome? I am so lost. Thank you so much

        Reply
      • Can an overdenture be placed on implants that were originally placed with fixed prosthesis in mind? Last question and thanks again!

        Reply
    • The plastic one will be replaced over and over as it breaks and wears down. The long-term cost on plastic is way higher than zirconia because he will replace it. The zirconia is more costly probably by 25% but is way better in the long run

      Reply

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