By James Ford
What are All-on-4, All-on-6, and even All-on-8 dental implants? The "All-On Implants Procedure" roughly refers to the process of using multiple implant posts to permanently create fixed points to attach a denture or false teeth, rather than an implant post for each tooth. This can be a permanent fixture or a snap on and off denture. This technology is used in Implant Supported Dentures, Snap On Dentures, Overdenture, Bridges etc.. and is a wonderful alternative to traditional dentures, which move around, require adhesive, contribute to bone loss and cover the roof of the patent's mouth. This can also offer a much faster healing time and lower cost than implanting each tooth separately. The implant posts are made from titanium, which graft very well to bone, and act like the roots of a tooth. When our jaw bones no longer have teeth, they begin to deteriorate. So, implants actually work to preserve and repair your jaw bone and ultimately your entire mouth's structure, health and appearance.
Who needs "Dental Implants or Dentures"
Dental implants, dentures, implant supported dentures etc. are all solutions for patients with all or most of their teeth missing or in need of extraction. If the patient has only 1 or just a few teeth missing, individual implants or bridges are most commonly utilized in order to preserve existing healthy teeth.
What is the difference between "All On 4, All On 6 and All On 8 etc. Dental Implants?
The main difference is quite literally in the name, or rather the number within the name. All on 4 is supporting the denture on only 4 posts, all on 6 uses 6 posts etc.
How long has All-On-4 been around for?
All-On-4 and All-On-6 etc are just terms used to describe how many implant posts were used. The concept of using implant posts to anchor a denture is nothing new, this was the first method implants were utilized with titanium posts in the 1970s. That technology is now used with All-On-4,5,6,7,8..., Implant Supported Dentures, Snap On Dentures, Overdentures, bridges etc. The phrase "All-on-4® treatment concept" is now a registered trademark by a company called Nobel Biocare which has their own particular product line that utilizes only 4 posts by supporting all posterior teeth on only 2 angled posts. The attraction to this product is less posts, it's little required training, easy installation, quicker healing times and lower cost etc..
What is better "All-On-4, All-On-6" or more or less?
There is no real correct answer to this question. In short, more implant posts equal more structural stability. Less implant posts usually equal less healing time and lower cost. The amount of posts used by your physician should not be predetermined before examination and does not have to be an even number at all. No 2 people are the same and neither are their physical conditions. A good physician should never push a 1 size fits all product on their patients just for their own convenience and profit. Each patient should be examined carefully through the use of a CT machine and the doctor, depending on the outcome of that examination, should then recommend how many and where they should be placed. It is ultimately up to the patient whether or not to agree with the doctor's recommendation though. The All-on-4® treatment concept was developed to be less invasive and cheaper, not necessarily stronger. Implant posts and jaw bones are strongest when being pressed down on from a straight up and down angle, like our natural teeth. By having all posterior teeth, the teeth we do all of our chewing with, supported by only 2 angled posts is definitely not ideal from a strength point of view.
What factors play a role in deciding how many, if any, implant posts should be used?
1. How many teeth does the patient have or need to replace?
If the patient is only missing 1 to a few teeth, they should utilize single implants or bridges.
If the patient is only missing front or back teeth, they should utilize single implants or bridges.
If the patient is missing all or most teeth on either top or bottom, many more implant posts are needed to support a full replacement dental prosthesis.
2. What is the patient's bone density?
This is probably the most important factor when it comes to dental implants. A patient who does not have enough bone density to properly hold implant posts might not be a candidate for implant dentistry at all. As soon as we lose teeth, our jawbone begins to deteriorate in those areas. If there isn't enough bone density to support implant posts, bone grafting can sometimes be completed before implant surgery. This obviously extends the amount of time to perform the procedure, increases the healing time and overall cost to the patient.
If the patient has good bone density, then the physician should use as many that is needed to securely place the denture. The denture should not rock, it should not move at all. The vast majority of pressure applied by chewing is directed to our posterior teeth, our molars. This is a crucial place to have the most support possible, which the "All-On-4" system typically fails to address.
3. What can the patient comfortably afford?
Unfortunately, cost is always a factor in everything we do. Less implant posts tend to yield inferior results, but cost less. More implant posts will yield a better result, but has a higher cost. Still, the cost of an all-on-5, 6, 7, 8 etc.. will be much lower and heal time faster than a full mouth of traditional single implants.
In conclusion:
All-On-4 is a term used by physicians to describe the use of 4 implant posts to anchor an entire screw in or snap on prosthesis. All-on-4® treatment concept is a branded product, not necessarily a medical procedure. This has become very popular, but is not always the best fit for everyone. We are all unique individuals and should be treated as such. Just because only 4 posts worked well in one situation, it doesn't mean it will in others. Through my research, I would not recommend less than 5 posts and highly recommend using 7 or more, if possible. I have found many reports of patients who have had only 4 implant posts used on their full top or bottom denture and have experienced serious issues with their denture rocking back and forth, jaw pain, continued deterioration of bone and in some cases, implants failing or breaking the jaw bone due to the inadequate support of their posterior teeth. If they had only used just a couple more implant posts to spread out the load more evenly, they might have never experienced any of these issues.
"In short: Strong homes begin with a strong foundation"