What is a periodontist?

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease (a chronic inflammatory disease that affects the gums and bone supporting the teeth, also known as gum disease), and in the placement of dental implants.

Why would a dentist refer you to a periodontist?

A dentist may recommend a visit to a periodontist if they suspect that the patient has gum disease or if there are signs of inflammation, bleeding, or infections in the gums. A periodontist specializes in the treatment of gum diseases and can provide more specialized care and treatment options. It is important to follow through with the recommendation to prevent further complications and maintain good oral health.

What does a periodontist do?

A periodontist is a dental specialist who focuses on the prevention, diagnosis, and treatment of periodontal disease , also known as gum disease . They also perform procedures such as dental implant placement , gum grafts , and scaling and root planing to help restore and maintain the health of the gums and supporting structures of the teeth.

What is a periodontist vs. dentist?

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of gum diseases and other conditions that affect the supporting structures of the teeth. While dentists focus on the general health and maintenance of teeth, periodontists have additional education and training to handle more complex cases.

Who is better for dental implants, oral surgeon or periodontist?

The choice between an oral surgeon and a periodontist for dental implants involves several factors, including case complexity, patient health, and practitioner expertise for surgery and aesthetics (implants). To make an informed decision, consult with both specialists and consider their recommendations along with personal preferences. I also recommend you review their online case studies and reviews. Crucially, ensure the chosen practitioner is licensed and experienced in dental implant procedures .

All On 4 Dental Implants - Portland Perio Implant Center

The Definitive Guide to All On 4 Dental Implants

This is a guide to All On 4 dental implants.

Some people say that we're in the middle of an All On 4 dental implant revolution.

Is that true... or an exaggeration?

Let's look at some recent stats.

The above chart was obtained from Google Trends. The numbers (hover your cursor over the line chart to reveal numbers) represent search interest relative to the highest point of the chart for the time shown, beginning January 1, 2004, and through today. The value of 100 shown today indicates popularity at its peak.

Since April 2015, searches for All On 4 dental implants (or All On Four dental implants) have more than doubled and are at an ALL-TIME HIGH!

All On 4 Dental Implants Cost

In addition to the extreme popularity of All On 4 dental implants is a related search term that Google Trends finds nearly as popular, and that is the "cost of All On 4 dental implants."

¹Google Trends indicates that the cost of All On 4 dental implants is near an all-time high and has more than doubled in popularity since January 2015!

Thus one of my reasons for wanting to provide a definitive guide for consumers searching for answers about All On 4 dental implants.

The information you find online can be overwhelming. Just search Google for "All On 4 dental implants" and you will find 45,000,000 (yes, that's MILLION) searches!

In my guide, I want to provide you with real answers from my experience as a doctor who specializes in periodontal therapy and implant surgery. It is my hope that I answer your questions and relieve your concerns. Today, the popularity of All On 4 dental implants is no exaggeration. It is truly a special time in cosmetic dentistry where technology, skill, and talent can create the perfect smile of your dreams.

To your success,

Dr. Kamran Haghighat - Portland Perio Implant Center

Kamran Haghighat, B.D.S., M.S., P.C.

All On 4 Dental Implants

The Definitive Guide

All On 4 dental implants are more popular than ever before.

And it's only getting bigger.

The question is:

What are the All On 4 Dental Implants?

What is the cost of All On 4 Dental Implants?

And, Am I A Candidate for All On 4 Dental Implants?

Well, that's what you're going to learn in this guide.

Tom - Before and After Case Study - Patient of Portland Perio Implant Center

Chapter 1
How All On 4 Dental Implants Originated
Chapter 2
What Are All On 4 Dental Implants?
Chapter 3
Steps To The All On 4 Treatment Process

Chapter 4
Am I A Candidate for All On 4 Dental Implants?
Chapter 5
Reasons to Choose All On 4 Dental Implants
Chapter 6
All On 4 Dental Implants vs. Other Tooth Restoration Options

Chapter 7
The Major Influences On Price for All-On-4®¹ Dental Implants
Chapter 8
Case Studies: Patient Experiences with All-On-4 Dental Implants

Chapter 1

How All On 4 Dental Implants Originated

The All-On-4®¹ dental implant concept is far from new. The original technique was pioneered in the late 1970s by Professor P-I Branemark. However, what is relatively new is the widespread proliferation of dental clinics that claim to offer the All On 4 procedure, and other similar implant-supported methods, to consumers. Despite the growth and mainstream adoption of Al On 4 treatment techniques in the dental field, consumer confusion persists.

Terms such as "implant-supported dentures" and "smile-in-a-day teeth replacement," while great for marketing, have only exacerbated consumer confusion. Nonetheless, demand for implant-based dental solutions continues to grow, and more and more people are seeking All-On-4 dental implants.

Our goal in this guide is to provide you with the knowledge and information you need to make an informed decision about All-On-4dental implants.

"No one should die with their teeth sitting in a glass of water."

DR. PER-INGAR BRÅNEMARK

All On 4 History

The story of modern All On 4 dental implants begins with a single crucial discovery by Professor Branemark. That discovery was osseointegration.

Osseointegration is a structural bond that forms between living bone tissues and an artificial substrate. In implant therapy, this substrate is typically a metal such as titanium or zirconium.

Branemark’s discovery and subsequent fleshing-out of the underlying mechanics behind osseointegration laid the foundation for all modern perio implant therapy. However, it wouldn’t be until the 1990’s that the field would begin to take off thanks to a pair of critical advances.

Contrary to what some believe, the first instance of modern All-On-4® employed to replace missing teeth is not known. In the 1990’s many clinics around the world were experimenting with novel ways to replace and rehabilitate a full arch with only four implants.

Unlike the original applications of Branemark’s time, dentists and researchers discovered two critical breakthroughs: immediate loading and angled supports. By proving that the implant supports could be immediately loaded with replacement teeth, as opposed to having to wait through a recovery period post-implantation, dentists were able to provide same-day teeth replacement. Meanwhile angled implant supports made implant-supported teeth replacement solutions available to a far wider audience of potential patients.

In the past, patients with inadequate jaw bone depth or bone density were not candidates for All-On-4®¹ and could not receive dental implants. When angled supports arrived, it allowed dentists to bypass areas of low bone depth or thickness and anchor directly into areas of the jaw that naturally had more bone depth and density. In the case of All-On-4®¹ dental implants, that meant that the two rear implants of the four total implants needed to be anchored into each arch at an angle.

The first in-depth study of the efficacy of the modern All-On-4®¹ technique utilizing four implants per arch, angled implants, and capability of immediate loading was funded by implant manufacturer Nobel Biocare and carried out by the renowned dentist, Paulo Malo.

It is important to note, that while Nobel Biocare popularized the technique, dentists and oral surgeons from around the world had already been utilizing many of the methods associated with the current All-On-4®¹ dental implant procedure for dental replacement therapy.

Chapter 1 - Continued

The Modern All On 4 Process

The modern All On 4 procedure as described by Paulo Malo and used in the vast majority of cosmetic dentistry practices today consists of three key components:

1. Four individual implants per arch,

2. Two implants which are angled in the rear,

3. Also, the ability to receive a dental bridge upon which artificial dentition is attached.

The process itself typically begins with an initial consultation and health screening to determine a patient’s suitability for the procedure. This is followed by preparatory work such as the taking of dental impressions and 3D imaging to create a digital model.

Patients may also receive additional prep work on their teeth, including the extraction of existing teeth and elimination of any infections. Once preparations are complete, the patient is ready for the surgical phase of the procedure.

During surgery, four implants are strategically embedded in predetermined locations in the mouth. Typically, two implants are placed in the front of the jaw and two in the rear at an angle between 30 and 45 degrees from the biting plane.

Chapter 2

What Are All On 4 Dental Implants?

As the name of the procedure would suggest, All On 4 Dental Implants is a total teeth replacement solution that relies on only four dental implants.

How does this work?

Similar to conventional individual implants, the implants in an All On 4 solution support a prosthetic dental bridge for an entire arch.

As a result, patients seeking comprehensive full-mouth oral reconstruction can receive a teeth replacement option with fewer dental implants, with four per arch.

Straumann ProArch - Portland Periodontist

In comparison, replacing every single tooth in a patient’s mouth with conventional dental implants would typically require a minimum of 8 implants per arch and involves bone grafting, especially in the posterior segments of the upper jaw where the sinuses limit the volume of available bone. All On 4 dental implants allow the clinician to sidestep the costs and morbidity associated with grafting procedures by the implementation of this “graftless” technique.

Four Parts of an All-On-4 Assembly

While relatively simple in concept, it is needless to say that the manufacturing and fabrication requirements of an All On 4 componentry and assembly necessitate a high degree of quality and strict regulatory requirements. Even the slightest deviation caused by errors in clinical execution may result in an unfavorable outcome and long-term failure.

From the dental implant fixture itself to the final retaining prosthetic screws, everything needs to fit together perfectly and integrate seamlessly for a successful outcome.

The 4 Parts to an All On 4 Dental Implant Assembly

1. Dental Implants

The four implants in each arch are the literal foundations of the entire All-On-4®¹ assembly that provide anchorage for the final prosthesis.

Failure of an All-On-4®¹ prosthesis may be related to an implant(s) that has failed or is losing osseointegration to the underlying bone. This could be due to the incorrect initial placement of the implant, infection, or a lack of adequate underlying bone quality or quantity.

No matter the reason, if any implant fails, the entire All-On-4®¹ prosthesis will need to be removed and either refitted after replacement of the failed implant fixture or remade entirely depending on the circumstance.

2. Abutments

While the dental implants are integrated within the jaw bone and are not visible clinically, the abutment `is an intermediary connecting component that protrudes from the implant through the soft tissues and enables the prosthesis to in turn be retained on the implants.

Abutments form a mechanical attachment point between the dental implant and either a crown or a dental bridge. For All-On-4®¹ dental implants, the abutment supports a dental bridge or fixed dentures.

The abutment itself can be one monolithic piece or consist of a number of sub-components. Several types of abutments exist including angulated abutments, castable abutments, multi-unit abutments, preparatory abutments, transmucosal abutments, and many others.

In an All-On-4®¹ application, straight and angled multi-unit abutments are typically utilized which allow for greater flexibility in Implant positioning in the arch that avoids additional grafting and for optimal positioning of prosthesis screw access holes that make an All-On-4®¹ solution retrievable when necessary.

3. Dental Bridge (Fixed Dentures)

The dental bridge, also known as fixed dentures, is the most visible portion of an All-On-4®¹ assembly and often the part that patients and doctors alike tend to pay the most attention in regards to both aesthetics and functionality.

As a result, the dental bridge is often the component of treatment that requires the most number of visits and time to complete. A perfect fit and acceptable visual aesthetics are a must. As a result, most All-On-4®¹ procedures call for a temporary bridge to be produced prior to the fabrication of a final permanent prosthesis. This temporary bridge, while still functional, will be made of a cheaper, less durable material, such as acrylic and is delivered the same day the dental implants are placed, ensuring the patient never goes without teeth.

The surgical team will deliver the temporary prosthesis and ensure the accuracy of fit and functionality. Changes to the esthetics will be assessed throughout the healing phase and addressed in the final permanent prosthesis which will be fabricated from a more durable material.

A permanent dental bridge prosthesis typically consists of replacement teeth attached to a metal framework embedded in a material designed to simulate the gums. Popular materials for All-On-4®¹ bridges may include a titanium framework with overlying acrylic resin, with teeth made from acrylic, porcelain or modern nanocomposites, or made entirely from (metal-free) zirconia through CAD-CAM technology.

4. Prosthetic Fixation Screws (Retaining Screws)

Prosthetic screws hold the entire assembly together as one non-removable unit. They transect the dental bridge through small access holes in the artificial teeth where they are less visible and attach the framework to the abutments.

Prosthetic screws are designed to both accommodate and act as a safety mechanism against the shear stresses applied to All-On-Four¹ prosthesis in function. Remember, the entire assembly must sit passively and rigidly on only four dental implants. As a result, cemented connections are not recommended. These work better for conventional individual implants where only a single tooth sits on its own abutment.

The screw-retained design provides for ease of retrievability of the prosthesis by the clinician when required.

5. Follow-up and Post Operative Care

With the final prosthesis in place, the All-On-4®¹ procedure is complete. However, there is a recovery process that follows.

Swelling, bleeding, and some pain is common after an implantation surgery and can last for several days for some patients. Muscle pain and stiffness are also common. Patients will also likely be limited to a soft diet of foods that do not put undue stress on the mouth. Dietary restriction can last for several weeks to four months. Patients are also restricted from engaging in strenuous activity or exercise such as lifting weights or playing contact sports for the first few weeks following surgery. Finally, proper dental hygiene is a must.

Chapter 3

Steps to The All On 4 Treatment Process

1. Initial Consultation

Every All On 4 procedure begins with an initial consultation with Dr. Haghighat at Portland Perio Implant Center. Even patients who have done their own research and come to the conclusion that an All On 4 procedure is right for them to meet with Dr. Haghighat.

The purpose of the initial evaluation is to determine the best treatment solution and strategy for each patient, evaluate treatment options that should be considered, and determine any risks or potential challenges with the treatment plan.

The initial consultation also provides Dr. Haghighat with an opportunity to screen for health considerations such as an allergy to latex, sensitivities to common anesthetics, and preexisting health conditions that could complicate the procedure.

The initial consultation is a separate appointment from the actual treatment procedure date, which is only made once the candidate has been deemed suitable by Dr. Haghighat for All On 4 dental implants.

There are instances where Portland Perio Implant Center also offers same-day fittings from initial consultation to completion of the implantation procedure and immediate loading with just one appointment.

2. Preparatory Work

Once a patient has been deemed a candidate by Dr. Haghighat to receive All On 4 dental implants, preparatory work begins.

Preparation consists of mapping out a patient’s existing oral conditions utilizing a combination of 3D imaging and physical impressions. This information will be used to generate a working digital model.

Portland Perio Implant Center will also use this data to fabricate a mockup of the final prosthetic to help the patient visualize the final results. Once aesthetic details have been finalized with the patient’s approval, including color, quality of material, and overall look, the data is exported for the fabrication process.

Some patients may require specialized surgical preparation by Dr. Haghighat before the actual implantation procedure such as the extraction of existing teeth or the eradication of existing infections. In rare cases, bone grafts may be necessary. Some of these preparatory procedures, such as dental extractions, can be executed in coordination with the implantation procedure while others, such as bone grafts, may require additional appointments.

Compared to conventional dental implants, pre-implantation preparatory work is significantly reduced thanks to the uniquely angled implants characteristic of All On 4 dental implants. Tilting posterior implants in the upper arch allows Dr. Haghighat to achieve stable anchorage in existing bone without having to resort to extensive bone grafting. Tilted implants also help to avoid existing nerves in the lower jaw as well as avoid sinus floor augmentation in the upper jaw.

3. Implant Insertion

With the patient’s mouth adequately cleared of existing teeth or infections, implants can be inserted. In most cases, these steps can be performed simultaneously. The exact location and angle of insertion will be determined by the digital model created by Dr. Haghighat during the preparatory stage.

Generally, two implants per arch will be located near the front of the jaw, and two posterior implants will be inserted at an angle into the rear of the mouth. Once the implants are embedded, abutments are added. These will serve as attachment points for both the temporary and final bridge prosthetics.

Both the implants and abutments are permanent and cannot be easily removed without a skilled dental professional. Because there is generally only one opportunity to execute a flawless operation, it is essential to use the most skilled and experienced dental implant specialist to ensure a seamless procedure.

4. Bridgework Fitting

With the implants in place, a temporary bridge is attached to the abutments. This temporary prosthetic is designed to sustain immediate loading and will provide the patient with adequate functionality until a final, permanent bridge can be fabricated. Portland Perio Implant Center is a highly advanced dental facility and has the latest technology in CAD/CAM equipment, popularly termed chair-side CAD/CAM technology.

Our technology can often have the final prosthetic made and fitted on the same day as the implantation operation. Patients at clinics that utilize third-party fabricators may require a follow-up appointment for the final fitting.

5. Follow-up and Post-operative Care

With the final prosthesis in place, the All On 4 procedure is complete. However, there is a recovery process that follows.
Swelling, bleeding, and some pain are common after an implantation surgery and can last for several days for some patients. Muscle pain and stiffness are also common. Patients will also likely be limited to a soft diet of foods that do not put undue stress on the mouth. Dietary restriction can last for several weeks to four months.
Patients are also restricted from engaging in strenuous activity or exercise, such as lifting weights or playing contact sports, for the first few weeks following surgery.
Finally, proper dental hygiene is a must.

Dr. Haghighat will discuss the potential side effects of an All On4 procedure before and following surgery. Some patients require additional follow-up appointments for either a final fitting or for adjustments to their prosthetics.

While the All On 4 procedure can be done in some cases in a single day, the recovery process may last several months after the surgical process.

At Portland Perio Implant Center our goal is not only to provide a flawless operation but also to guide and support you through the recovery process and long-term maintenance.

Chapter 4

Am I A Candidate for All On 4 Dental Implants?

All On 4 dental implants are highly suitable for a wide range of dental patients. The features and functionality are the primary reasons why All On 4 dental implants, according to Google Trends, are at all-time highs in regard to interest and web search.

While All On 4 dental implants are suitable and available for a wide swath of the general public, each patient must make their own decision about whether or not to undergo the procedure.

The decision-making process should take many factors into consideration, including personal health, existing oral conditions, budget, aesthetic goals, durability, quality, and other important considerations. That is why it is helpful to consult with a surgeon or prosthodontist who is qualified in identifying potential issues and can provide you with valuable insights.

4 Steps to Determine If All On 4 Dental Implants Are Right For You

To determine suitability for an All On 4 treatment plan, it will be helpful to complete this preliminary checklist. There are four critical questions that will not only help you process your thoughts and establish priorities but will also help in your initial consultation with Dr. Haghighat at Portland Perio Implant Center.

There are many dental clinics that will often have potential All On 4 candidates undergo an initial evaluation to determine their suitability and to set treatment plans and expectations. The more explicit and well-developed your goals and expectations are, the better we can tailor your treatment plan to meet your desires.

When it comes to communicating your vision for your smile, it is better to over-communicate.

Following are four questions to help you process your thoughts and treatment priorities.

Step 1: What Are My Goals?

What are you trying to achieve with dental implants?

Dental implants are an excellent solution for total arch replacement. However, they aren’t useful or practical for patients who only need to replace one or two teeth. That can be better accomplished with conventional dental implants which we can also help you with at Portland Perio Implant Center.

Likewise, if your goal is aesthetic perfection, conventional individual dental implants might be a better option. By establishing what your vision and goals are for pursuing cosmetic dentistry, you can better determine the most appropriate procedure or set of treatment procedures that are best for you.

Step 2: What Is My Overall Health and Tolerance for Surgery?

Thanks to dental implants, patients can now receive a total arch replacement with only four dental implants. However, inserting and embedding dental implants will require some surgery. Anesthetics will be necessary in the majority of patient cases and requires a recovery period during which swelling, bruising, and some bleeding is expected. As a result, dental implants would likely be ruled out for patients with fragile health conditions that make surgery a potential risk.

Step 3: What Is My Timeline?

Dental implants are ideal for patients who desire a condensed timeline from surgery to the completion of the recovery process. Immediate loading technology has made it possible for a patient to receive a brand new set of teeth with just a single appointment and in a single day.

Granted, additional follow up appointments are often necessary to adjust for fit and replace temporary prosthetics with permanent ones. However, compared to the old process of replacing a whole set of teeth with conventional dental implants, the All-On-4®¹ process is considerably faster and more efficient, both in terms of time and cost.

Timeline considerations also go beyond the length of time for the procedure and the recovery period. Another consideration is how long you plan to keep your teeth. While this may seem like a silly question (of course everyone wants something to last as long as possible) it is important for determining suitability and durability. With proper care and maintenance, dental implants can last decades or a lifetime. However, for very elderly patients a permanent fixed solution might not make sense when much less expensive but less resilient alternatives, such as denture implants, can function well for the period of time.

Step 4: What Is My Budget?

The primary benefit of dental implants over conventional full-mouth dental implant reconstruction and other teeth replacement alternatives is the cost. Dental implants provide most if not all of the benefits of a conventional implant-based solution but at a lower cost. This makes dental implants highly attractive to consumers looking to replace one or both of their dental arches. It is also why the search trend for dental implants, in particular, All-On-4®¹ dental implants, is at an all-time high.

Determining your budget will help Dr. Haghighat provide you with the best treatment options available for you.

When making your budget calculations, devote some thought towards how you will pay for your dental procedures. If you need financing, our office can assist and help you secure financing. If you have dental insurance or supplemental health insurance be sure to inform our office when scheduling your consultation so we can help get the right paperwork necessary to your insurance provider.

Step 5: What Are My Expectations?

A successful treatment plan is one that makes you happy with what you see in the mirror and how you feel and function.

It is also important to understand how dental implants will improve your overall look and in what areas dental implants will have an impact. It is important to have the right expectations; this will also be discussed in your initial consultation with Dr. Haghighat.

Dental implants often have a transformative effect on your smile and reduce the visible signs of aging on your face. They also impact your lifestyle. You will no longer have to worry about embarrassment or fear in public situations or have pain when eating.

The ideal candidate is that person looking for a highly aesthetic and permanent complete arch replacement solution.

Physiological Considerations

The underlying physiological condition of a patient’s bone structures in the mouth also plays a critical role in determining a patient’s suitability for an All On 4 treatment procedure.

Patients who lack adequate jaw bone volume and density in certain areas may have no choice but to opt for All On 4 dental implants. By supporting an entire arch replacement with only four dental implants total (two in the front and two placed at angles in the rear of the mouth), the implant treatment procedure is often able to avoid areas of low bone volume and density, such as the sinuses. This will eliminate the need for bone grafting and that is why it is often referred to as a graftless solution. However, the solution is not a cure-all.

Patients with inadequate bone depth in the front of the jaw may not be suitable candidates for any implant-based solution without preliminary reconstructive bone grafting procedures. This will also be assessed in your initial consultation with Dr. Haghighat. Fortunately, the condition of lacking adequate bone structure in the front of the mouth is exceedingly rare and is usually found only in patients who have been edentulous, or toothless, for quite some time.

Trust All On 4 Dental Implants by Portland Perio Implant Center

Dr. Haghighat will discuss every aspect of an All On 4 procedure before, during, and following surgery. Some patients may require additional follow-up appointments for adjustments to their prosthetics. While the implant procedure can be done in some cases in a single day, the recovery process often lasts longer after the surgical process.

At Portland Perio Implant Center our goal is not only to craft you a picture-perfect smile but also to guide and support you through the recovery process and long-term maintenance of your beautiful new teeth.

Chapter 5

Reasons to Choose All On 4 Dental Implants

The All On 4 dental implant procedure has gained immense popularity as a treatment modality for the management of full arch reconstruction in edentulous patients or those with terminal dentition.

When factors such as affordability, aesthetic outcomes, functionality, and long-term survival and success of treatment are taken into consideration, the All On 4 dental implant treatment weighs very favorably in comparison to other options. Compared to conventional, more traditional full-arch implant reconstruction therapies, All On 4 dental implants typically have a lower cost, a reduced surgical footprint are less invasive, are quicker to perform, and yet provide the same benefits associated with traditional implant-based treatments.

In comparison to traditional removable dentures, the benefits of dental implants are starkly apparent. They are different in almost every way except for the purpose. Everything accomplished by traditional removable dentures can be easily done, and done better with dental implants, with the notable exception of higher upfront costs. In every other aspect, from aesthetics to functionality to longevity, dental implants are by far the clear winner.

All On 4 dental implants look better, feel better in the mouth, are much more durable, and last longer. They are also what we at Portland Perio Implant Center recommend to our patients for a brilliant new and beautiful smile.

8 Reasons to Choose All On 4 Dental Implants

1. Cost Effectiveness

When taking life cycle costs into account, All-On-4®¹ dental implants are often significantly cheaper than individual dental implants and are even cost-competitive with mid to high-end removable dentures. Although All-On-4®¹ dental implants command higher upfront investment, they are well worth the initial expenditure. Even the best traditional dentures require replacement every 5 years or, as is often the case, even sooner. Quality dental implants properly installed can usually last decades with proper care and maintenance.

2. Immediate Loading

One of the primary benefits of dental implants is the ability of the prosthetic to sustain immediate loading. This means once the implants are set in place and the preliminary dental bridgework is fitted, patients can immediately begin experiencing their new smile and, better yet, they can even eat (with some limitations) with the temporary prosthetics. There’s no waiting for the implants to integrate, which is a process that often takes several months to complete.

3. Drastically Reduced Invasiveness

Compared to conventional dental implants, All-On-4®¹ dental implants require significantly less invasive surgery. Each arch for a full-mouth dental replacement procedure utilizing All-On-4®¹ implants only needs 8 implants or 4 implants per arch. In comparison, conventional dental implants would require 32 implants total which translates to four times as many implants and incisions, and, four times as much surgery time as well as 24 more opportunities for complications to occur in the implants.

4. No Bone Grafts

As a result of a natural process known as bone resorption, many formerly edentulous patients don’t have adequate jaw bone depth to receive implants. The historical remedy for this has been to replace some of the missing bone with a graft that is typically taken from the hip bones. However, thanks to the innovative employment of implants with the All-On-4®¹ treatment, many of these formerly ineligible patients can now receive brand new teeth with All-On-4®¹ dental implants without prerequisite painful and costly bone grafting procedures.

5. Exquisite Aesthetics

6. Natural Tooth-like Feel

Implant-based solutions simply can’t be beaten when it comes to the mouthfeel. Traditional removable dentures don’t replicate the feel of natural teeth. That’s because they don’t replicate the internal structure of natural dental systems.

Dental implants mimic the roots of teeth. They transfer the load of biting and chewing, as well as physical sensations into the jaw. Thanks to osseointegration, implants become an anatomical extension of your natural bone that functions just as you would expect natural teeth to function.

7. Total Functionality

Thanks to osseointegration, All-On-4®¹ dental implants not only feel like natural teeth, but they also work like natural teeth. Once fitted and integrated into the jaw bone, you can use your dental implants just like natural teeth. You won’t have to leave them in a cup of warm water overnight either. Instead, normal, natural hygiene routines, such as regular brushing and flossing will work just fine. If you are looking for a complete restoration of dental functionality, All-On-4®¹ dental implants may be the right solution for you.

8. Longevity

Chapter 6

All On 4 Dental Implants vs. Other Dental Restoration Options

All On 4 Dental Implants are a great solution for patients looking for a cost-effective, aesthetic, and resilient whole-mouth solution. In fact, we recommend All-On-4® implants precisely for our patients seeking whole mouth reconstruction or total dental replacement therapy.

In some cases, All-On-4®¹ Dental Implants aren’t always the best solution for every single patient. Those with plenty of healthy, salvageable teeth, for example, wouldn’t require All-On-4 dental implants at all. Instead, clients looking to replace a limited number of teeth may be better served with other dental restoration options such as individual implants or partial dentures.

When it comes to cosmetic dentistry there is no one-size-fits-all solution. Every smile is unique and it’ is our goal at the Portland Perio Implant Center to provide for each of our patients the best possible solutions for the best possible outcomes.

Total Versus Partial Restoration Alternatives

If you are looking for a comprehensive cosmetic solution or a complete smile makeover then a total restoration solution such as All-On-4®¹ dental implants may be the perfect solution for you.

However, there are other options for consideration.

Other total teeth replacement solutions include variations of the All-On-4®¹ treatment concept, which uses a combination of implant-supported bridges, or conventional individual implants. Patients can also opt for old-fashioned removable dentures if budget is the most important consideration.

Total dental restoration solutions include:

All-On-4®¹ dental implants
Implant-supported bridges variations
Conventional individual dental implants
Traditional dentures

Partial dental restoration solutions include:

Dental veneers
Partial dental bridges
Partial dentures
Individual dental crowns
Individual dental implants or single implants

Chapter 6 - Continued

Alternative Total Teeth Replacement Options to All On 4 Dental Implants?

All On 4 Dental Implants vs. Implants-supported Bridges (Implant-supported Dentures)

All On 4 dental implants are a type of implant-supported bridge solution. However, not all implant-supported bridge solutions are considered to be All On 4 The All-On-4 concept calls for a maximum of four dental implants per arch, which support a full dental bridge upon which replacement teeth are attached. Variations of this concept include solutions with 6, 8, or even more implants that support an intermediary dental bridge. Solutions that employ more than four implants are not considered All On 4 dental implants. Instead, they are often called “All On 6” or "All On X" dental implants and so forth, or, they are simply termed implant-supported dentures.

Consumers should note that as more implants are added to an implant-supported solution, the fewer the advantages of such a system. The brilliance and appeal of the All On 4 concept is based on reducing the number of dental implants necessary to replace an entire arch of teeth. When you reduce the number of implants, surgical time, recovery time, cost, and inconvenience can all be significantly reduced as well.

All On 4 Dental Implants vs. Conventional Individual Implants

All On 4 dental implants were conceived precisely to address the problems and perceived shortcomings associated with conventional individual implants. With conventional dental implants, each replacement tooth requires its own implant. The process of inserting 32 individual implants is difficult, tedious, time-consuming, and expensive.

Another reason to opt for All On 4 instead of individual dental implants is that it may be the only viable total teeth replacement solution, particularly for previously edentulous patients or the elderly. Conventional individual implants require substantial existing jaw bone structure in order to osseointegrate and properly achieve lateral stability. What that means is many patients simply are not candidates for conventional implants because they don't have enough bone depth to support all the implants required.

Patients who have been previously toothless, or edentulous, are particularly susceptible to a process known as bone resorption wherein jaw bone is naturally reabsorbed into the body resulting in reduced bone mass and density. For these patients, All On 4 implants may be their only option for total dental restoration.

Conventional individual implants provide the highest level of structural stability and mouthfeel. Unfortunately, for a total mouth restoration, conventional implants are the most costly solution and require the most extensive surgery. Additionally, many people simply aren’t candidates for total teeth replacement with conventional dental implants because of their lack of bone density. Lack of underlying jawbone depth can often be addressed with bone grafts. However, this adds additional surgical time, recovery time, and cost.

All On 4 Dental Implants vs. Traditional Dentures

Dentures have been around for centuries and are the traditional, tried-and-true solution for replacing missing teeth. Unfortunately, dentures aren’t the sexiest solution out there, nor are they the prettiest. In fact, dentures aren’t even the most functional solution.

Modern dentures can be made to mimic the aesthetics of natural teeth. A well-made custom piece may even look like the real thing from afar. However, they will never look as natural as the real thing. More importantly, traditional dentures will never feel as good or behave as naturally as an implant-based solution such as All-On-4 dental implants. Dentures do not provide the important bite force necessary to keep jaw bone from resorption. Eventually, dentures will need to be refitted as the jaw bone and shape of the face changes.

Thanks to osseointegration, dental implants are physiologically integrated into the bone structure of the mouth itself. This provides a level of mechanical stability, functional usability, and mouthfeel that traditional dentures can never match, no matter what anyone tells you. In essence, the implant becomes a physical extension of your mouth and functions just like natural teeth.

All On 4 Dental Implants vs. All-the-Rest

All On 4 Dental Implants offer significant advantages over other total dental restoration alternatives such as conventional individual dental implants and traditional dentures.

Compared to Conventional Individual Dentures:

Cost-effective (less expensive)
Reduced surgery scope
Reduced surgery time
Reduced recovery period
Immediate loading

Compared to Traditional Dentures:

Benefits of an implant-based solution
Improved functionality
Permanent solution
Better aesthetics
Natural mouthfeel

Chapter 7

Factors That Influence All On4 Dental Implant Prices

When comparing pricing for All-On-4 dental implants, it is good to know the factors that can influence pricing. The following are the items that impact the overall price of your procedure:

1. Newest Technology

Choose an implant surgeon who practices in the most technologically advanced facility. The surgical facility should have 3D digital dental radiography equipment that enable precise and clear images of the jaws that need treatment. Dental cone beam imaging provides the doctor with more accurate information and 10 times less radiation to the patient than the machines traditionally used in medicine. What this means to patients who have chosen to replace missing teeth, is that now the doctor can examine, diagnose and plan treatment with a level of precision not possible in the past. This more exact approach using dental cone beam imaging means fewer complications, less invasive therapy, and quicker healing times for the patient. But technology alone is not enough. Using the information obtained and translating it into treatment goes hand in hand with the need for knowledge and skill.

At Portland Perio Implant Center we offer the most proven and precise treatment in the profession. You can feel at ease in our state-of-the-art dental facility. We want to ensure excellence and quality care while having your procedure done. Our well-equipped surgical facility and a team of specialists provide you with the care and safety that you need so you can relax and know with confidence that you are in great hands.

2. Adequate Bone Depth

About 85 percent of patients have adequate bone in their jaw to support implants and won't require additional treatment in preparation for implants.

About 10 percent of patients have inadequate bone volume for various reasons such as the presence of large sinuses, which will require bone grafting or other surgical processes in preparation for dental implants. This will increase the price of implants depending on the severity and additional procedures necessary.

In about 5 percent of patients who opt to receive all-on-four implant restoration in the upper jaw may require special dental implants designed to be placed in the cheekbone due to an inadequate amount of bone density in the jawbone. This level of implant surgery will impact price considerably.

3. Extractions

4. CT Scans and 3D digital dental and panoramic x-rays

3 Reasons CT Scans Are Essential for Dental Implant Treatment

1
Provides an in-depth assessment of dental implant suitability.
2
Provides an accurate jaw bone analysis, accurately measuring bone volume and most optimal location for implant placement, and identifying anatomical structures as well as pathology within that bone that should be taken into consideration for the proposed treatment.
3
Provides precise placement for dental implants. The information provided by a CT scan translate into more accurate treatment execution through fabrication of special guides for implant placement.

5. Type of Anesthesia

For some procedures, you may require treatment in a hospital or day-surgery facility (surgery center), so find out in advance what type of anesthesia you will need for your procedure.

The type of anesthesia required for your procedure will affect the cost incurred. Depending on the level of anesthesia, such and the need for an anesthesiologist to better manage some medically compromising patients, costs may slightly vary.

6. Type of Final Restorations

There are several choices when it comes to the quality of your final restorations. The most common final restoration is fabricated out of titanium and acrylic resin. This is the most cost-effective and affordable option and provides highly esthetic outcomes and manageable prosthesis.

A more recent option is a metal-free prosthetic option that is made of Zirconia. Zirconia provides a combination of strength and aesthetics. Most patients find this option to be the closest to the feel of their natural teeth. The material is very durable and if cared for properly, does not require the changing of the teeth due to wear and tear as one would with the acrylic action.

Other options may include a combination of materials, including titanium and zirconia.