All-on-4 same-day teeth

Full-arch treatment is a significant decision, and usually one people have been weighing up for some time. We'd rather you came in, asked everything you want to ask, and left with a clear written plan than felt rushed into anything.

What it involves

All-on-4 is a trade name. It stands for all of the teeth in one jaw, on four implants.

In reality the number of implants we use varies between four and eight, depending on the complexity of the case, how much bone is available, the quality of that bone, and where it sits in the mouth. The aim is to place enough implants, stable enough on the day of surgery and spread far enough apart, to support a full set of teeth.

A full set including wisdom teeth would be 16 teeth in each jaw, and it is not necessary to replace all of those. For a normal All-on-4 treatment we aim to replace between 10 and 12 teeth. Where implants can be spread further apart, or additional implants added, that can often be extended to 14.

Whether it's right for you

All-on-4, or same-day teeth, can be an excellent option for people who have no teeth at all, and equally for people who still have a few teeth that are loose, decayed, severely worn down or broken.

Removing the failing teeth gives us a clean slate to work from. It means we are not dictated to or restricted by their colour or position, so we can recreate the optimum result for you.

Zygomatic implants, where bone is limited

Zygomatic implants are a highly specialised implant, placed into the bone of the cheek on one side or both.

They are often needed where there is a significant lack of bone towards the back of the upper jaw. That tends to happen when back teeth have been missing for a very long time and the bone has gradually shrunk away, and also because the sinus air cavity within the jawbone naturally enlarges, reducing the bone available.

They can be used alongside conventional implants at the front of the mouth, so there are still enough stable implants, spread far enough apart, to give a fixed set of teeth on the day of surgery.

How the treatment runs

This is complex, advanced reconstruction, often for people who have had either severe neglect over a long period, or a lot of previous dental work that is now failing and needs replacing.

The consultation has to be thorough, so that you are fully informed about the options and what is involved before anyone commits to All-on-4 treatment. Once the decision is made, we like to schedule it as soon as we can, so you can get on with it and have your new smile sooner. That often means opening up at a weekend and dedicating the day to one patient.

After surgery we review you closely over the first few weeks to make sure healing is going well, before building the definitive bridge. From consultation to final bridge is normally five to six months.

The day itself

This treatment is normally carried out under sedation, for your comfort.

You come in, sign any final consent forms, and sedation is given by our medical doctor. We then numb the area fully, remove any failing or existing teeth, and place the implants where they are needed. Once we have checked their stability is high enough, we move on to creating a set of immediate fixed temporary teeth.

Those temporary teeth are often pre-made from scans taken at your consultation appointment, then converted into a slimline fixed bridge which is screwed directly into place. We have a technician on site making them bespoke for each patient, so there is usually a gap of about an hour and a half in the middle of treatment. Patients tend to relax in a quiet room during that time, read a book or listen to music. Fitting the teeth takes about 10 to 15 minutes, and a final x-ray is taken at the end.

Recovery

This is more involved and more invasive treatment, and it often means removing several teeth at the same time as placing the implants. So some discomfort, swelling and bruising is to be expected afterwards.

The real benefit over fitting removable teeth on the day is not just the bulk of them — it is that fixed teeth do not move. Your gums may be sore and swollen, but there is no pressure or rubbing on them, and that makes recovery considerably more straightforward.

We normally prescribe anti-inflammatory medication and antibiotics, and provide ice packs, to give the body the best chance to heal. Day two or three is usually the worst for swelling, and it settles from there. Most patients feel relatively fully recovered within a couple of weeks.

What you can eat, and when

It matters that the temporary teeth are not put under excess stress while things heal, for the first few weeks after surgery. That protects both the implants themselves and the teeth.

The temporary teeth are normally acrylic, so heavy chewing on hard food could move or crack them. Within reason, though, you can eat most relatively soft things — mashed potato, omelette, fish, soft vegetables, pasta, bolognese, lasagne and the like.

What can go wrong

We treat a wide variety of cases, and the complexity usually comes down to bone: how much is available, its quality, and where it sits around the arch of the jaw relative to where the teeth need to be.

To manage the more complex cases we often add additional implants, or more specialised ones such as zygomatic or pterygoid implants, so there are enough stable implants on the day of surgery for the fixed teeth, and for the definitive bridge in the longer term.

The other factor is medical. Certain conditions and medications — blood thinners and bisphosphonates in particular — need managing very carefully.

Choosing between your options

There is a huge difference between this treatment and dentures.

Dentures are much larger, and therefore bulkier and more cumbersome in the mouth. They significantly affect speech and taste, and your appreciation of the temperature and texture of food. They also tend to move around, and food gets trapped underneath them easily.

Even dentures supported on implants are still removable, and still carry many of those drawbacks, although they are slightly smaller than a conventional full denture.

What happens at your consultation

The first appointment is a conversation, not a sales pitch. We listen to what's bothering you, examine thoroughly, and explain what your options actually are — the pros and cons of each — including the option of doing nothing for now.

After that assessment you get a total cost for the treatment, in writing. Clear pricing up front matters to us: you should know what is involved and what it costs before you decide anything, and it is very rare for that figure to change once treatment is underway.

Then take it away and think about it. There is no deadline and nobody will chase you.

Who you'll be seeing

The same surgeon, the whole way through. Dr Brad carries out your consultation, your treatment and every review afterwards — you won't be handed between clinicians, and you won't have to explain your history twice.

Every treatment plan is built around the individual patient rather than pulled off a shelf, and that runs across the whole team — before, during and after treatment.

Dr Brad qualified at University of Birmingham in 2005, has placed implants since 2007, and holds an MSc in Restorative & Aesthetic Dentistry (2015). He is registered with the General Dental Council, number 85988.

If you've been putting this off

Most people who come to us have been thinking about it for a long time — sometimes years. That is normal here, and nobody will make you feel awkward about it.

It starts before you even get here. When you ring, you will speak to our reception team or to Dr Brad's treatment coordinator, all of whom know the implant process well. They will take the time to understand where you are up to and how you are feeling about it, rather than just putting a date in a diary.

If nerves are the thing holding you back, sedation is worth asking about. The options range from simple oral sedation — a tablet taken beforehand, purely to calm you — through to IV sedation, carried out by a dedicated medical doctor who comes in to assist. For longer and more complex cases Dr Brad will recommend it as a matter of course. With IV sedation you would need someone to bring you in, take you home afterwards and stay with you for a few hours.

Take the appointments at your pace. Ask the same question twice if you want to. If you would rather just find out what is possible and go away and think, that is a perfectly good reason to come in.

What it costs

You are given a total cost for your treatment after your consultation, set out in writing, so you know the full figure rather than a starting price that grows.

Payment is normally spread across the appointments involved, and you will get a breakdown of those appointments, the intervals between them and the cost of each. Longer-term finance through an external provider is also available — we can talk that through at your consultation.