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All-on-4 (CONTENT WARNING: contains explicit images)

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Paw10

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I'm searching for a qualified dentist to do this in my area and do not know where to start. I don't want to do the TV commercial places. This is a very expensive procedure so, I'm going to have to feel confident and comfortable with my dental team.

Also, how long is recovery time? I have several teeth that will need to be removed can the procedure still be done all in one day like some commercials state?

Thank you for any recommendations and advice!
 
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comfortdentist

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Focus on the outcome and not the process. In order to accomplish all on 4 quickly the dentist must remove a considerable amount of bone in many cases. While this is reasonable if you are old and don't have high risk factors for periodontal disease if you are middle aged the problem you might run into is needing to replace some lost implants in the future and you might not have good conditions anymore.
Take you time in figuring out the reason for the steps that will be done.
 
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Paw10

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Thank you for your response.

I'm in my mid 30s and due to a childhood eating disorder I've already spent a large amount of money on dental work (over the amount of the All-on-4). It is a never ending cycle and bottomless pit. This is the best option for me due to amount of work and rework I need done. Also, even with all of the work I've had done I still haven't really smiled in over 15yrs and I'm ready to do that again.
 
drhirst

drhirst

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Hi Paw10,

I feel your pain in trying to get good advice. You are right to be wary of the dentists who indulge in fancy TV advertising. They are often high pressure and may not be fully focused on what is best for you long term. If you were here in the UK I would advise getting an opinion from one of the top guys in a teaching hospital. Even if they were not going to personally do the work they could guide you as to what is the best technique to be looking into. Even then, implant dentistry is very much an evolving science and there is still varying opinions on the best solutions.

I do share Comfortdentist's concerns over removing bone at your age. This bone removal is what allows the new "teeth" to be provided so efficiently. At your age, I would be very concerned about this aspect as each time you have a problem you lose bone and this makes replacing them more complex, and if your all on four implants last 15 to 20 years then most dentists would say they have done very well. A friend of mine who is an expert refers to bone as "the precious" and is always looking to preserve it. Sometimes you just have to sacrifice it but in your case I would be cautious.
I hope this makes sense

Lincoln
 
letsconnect

letsconnect

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Why does All-on-4 involve more bone removal than other techniques :unsure:? Just curious...
 
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comfortdentist

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In your forties and thirties I personally wouldn't recommend the typical teeth in a day situation. I assume your dental problems are due to caries and erosion which ultimately presents as multiple fractures and even abscesses. This is actually one of the best situations for implants as compared to severe periodontal disease. I assume you don't smoke.
Sometimes I will restore a person where the implants serve simply as tooth replacements for bridges. The abutments that go into the implants are custom milled to have the right shapes while the actual teeth are either a milled zirconia or a metal based with porcelain on top. Depending on a patient's need and desired outcome. This type of a case is more difficult but it leaves you the patient with a higher level of bone.
When you look at pictures from most dentists who perform all on four you will be able to see two things. First is that all their patients look about the same when they are finished from tooth size to tooth color while secondly their gums are all fake. The fake gums are there because the interface between crowns or any prosthetics and natural tissues is always a challenge aesthetically. So the dentist removes about 1/4" or so of bone so that when you smile without replacements you don't see anything. Also in these immediate cases you must use long implants to gain stability. If you have a problem with a long implant then either you have a deep problem or a difficult implant to remove with a resulting deep defect. Typically these cases depend on plastic gums with plastic denture teeth which look nice when they are new but wear too fast for many people. Zirconia cases don't wear out but the gums don't look good unless you go to the time and expense to bake low firing temperature pink porcelain over the zirconia then etch the pink porcelain and bond pink composite on top of that layer. This will give nice aesthetic results but at a higher cost.

I realize that this post has a lot of explanation that may be difficult to understand but that is the nature of modern implant dentistry and why most dentists don't get involved with these cases.
 
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Paw10

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North Carolina
Thank you "comfortdentist" this was exactly the detailed information I needed. Now, I won't go in clueless and can weigh all of my options going forward.
 
drhirst

drhirst

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Why does All-on-4 involve more bone removal than other techniques :unsure:? Just curious...
It is so the join between the false gum and the real gum does not show when smiling. This is known as the transition zone or transition line and it needs to be high enough to be hidden by the lip when smiling.download_LI.jpg
 
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letsconnect

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Thanks that makes sense! I did some googling earlier, and thought that might be the case.

So you basically need to create extra space between the upper and lower teeth to accommodate the framework/false gum part by removing some of the bone, like that:

17Nov2BChodges-p04.jpg.scale.LARGE.jpg

(permanently fixed hybrid dentures such as All-on-4 or All-on-6)

VS this:

17Nov2BChodges-p05.jpg.scale.LARGE.jpg

(permanently fixed full-arch implant supported bridges which require 6-8 implants)

Is that what you're saying? (apart from the other issue of when an implant fails and has to be removed, and the longer implant causing a greater defect in the bone)
 
drhirst

drhirst

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Yup, that's about it. It is generally more difficult to clean the implants involved in all on four when compared to implant retained bridge. In fact, the early designs were most unhygienic. These days the designs have improved, but cleaning is still more tricky. This could make some cases fail more rapidly, which is why they are more suited to those who think all current music sounds the same.
 
Gordon

Gordon

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That'd be me then :)
 
letsconnect

letsconnect

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I don't even know what the current music is, never mind what it sounds like... just like the ASMR for dental fear thread! Good to know that @drhirst aka Lincoln can keep us in the loop though!
 
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