All on 4 dental implants – prices, cost, problems – everything you need to know
All On 4 dental implants
What are All On 4 implants? The shortest answer is – a permanent dental prosthesis fitted on four titanium implants. It is a great solution for all the patients without any remaining teeth, with badly broken or decayed teeth or teeth compromised by a gum disease. The procedure done in two stages consist of installation of four or more implants in maxilla and/or mandible where the bone is the densest, and after the implants are healed, the full bridge of porcelain crowns (10 to 14 teeth) is fitted on the implants.
One of implant manufactures, Nobel Biocare, was among the first to identify All On 4 technique as an alternative to conventional implant techniques available at the time. Portuguese dentist Paulo Maló researched All On 4 for Nobel Biocare, however it is an Australian dentist Alex Fibishenko who became famous because of it. He takes credit as the pioneer of All On 4 in Australia. Dr Fibishenko is the head of purpose built All On 4 clinics around Australia and applied as first for the registration of the technique as a protected trademark. Nowadays Dr Fibishenko is a lecturer for Nobel Biocare and the company has all the trademark rights to Allon 4.
All on 4 procedure has evolved over time:
- four dental implants supporting full permanent bridge (documented since 1977)
- the use of angulated implants in the back of the jaw (documented since 1990)
- immediate loading of implants (documented since 1990) 
All on 4 step by step:
There are three stages of the procedure:
- Examination – the dentist makes a CT scan to examine and determine the best possible options for the patients
- Extractions of the remaining teeth if needed
- Bone augmentation by using bone grafts to ensure that the implants will fit properly in the jaw; due to the recession of the bone this step is obligatory for patients who lost teeth long time ago
- Implantation – installation of four or more titanium implants in the jaw
- Fitting of temporary acrylic denture
In between the first and the second stage of the procedure, the dentist will remove the stiches up to two weeks after implantation. The jaw and gums need to heal and it takes from three to six months before the permanent denture is fitted. Healing period involves the process of osseointegrtion, where the implants are integrating and fusing to the living bone in the patient’s jaw.
- Uncovering of the implants – the temporary denture is removed and the implants are uncovered by the dentist. The abutments (implants connectors) are installed on top of the implants.
- Taking the impressions of the teeth for the permanent porcelain denture, which is prepared in the laboratory.
- Installation of the permanent denture of porcelain crowns by screwing it into place or by using dental cement.
All on 4 cost
All on 4 procedure is performed in three stages and below you will find the basic treatment plan:
|CBCT scan (3D Cone Beam Computed Tomography)||included|
|Teeth extractions, if needed||included|
|4 x Astra Tech / Ankylos implant (titanium post) Lifetime guarantee||included|
Total cost: 18 000 PLN / 3853 GBP
* If you need bone graft / sinus lift, the total cost is 22 000 PLN / 4710 GBP.
|4 x Astra Tech / Ankylos titanium abutment (standard implant connector)||included|
|Taking teeth impressions||included|
Total cost: 10 000 PLN / 2140 GBP
|Cemented overdenture based on implants||included|
Total price for the whole treatment is 28 000 PLN / 5993 GBP for 1 jaw
Problems with All On 4
Although the average success rate of implantation is extremely impressive – from 95% to 98% – there are some rare cases of failure.
Loose or falling out implant
Amongst the problems with All On 4 dental implants, this seems to be the most common. It usually occurs when the osseointegration process fails and the implant does not fuse with the living bone. The implant will then become loose and may fall out completely. Another reason for that may be progressing bone loss when more than 0.2 mm of depletion a year will cause loss of implants.
Overloading is a result of too much pressure put on the implanted area of the jaw. It occurs most commonly when the implants and abutments are installed during one procedure. Abutments protruding from the gums are easily disturbed and patient may accidently exert unnecessary pressure on them on a daily basis. As the abutments are connected to the implants beneath, the extra pressure may cause injury and disruption in proper osseointegration of the implants and the bone and result in loss of implants.
Use of medication for osteoporosis
In general, medications for osteoporosis increase done density and thickness. When installing the implants, the dentist will make holes in your jaw bone which later should fuse with the implant while healing. Bisphosphonates in anti-osteoporosis medication inhibit the bone’s resorption phase preventing the bone to heal normally. This may later lead to jaw osteonecrosis, a painful process where the bone is exposed and the gum does not heal over it.
Dental implant infection (peri-implantitis) is an infectious disease that leads to inflammation of the gum and bone resulting in the loss of bone and therefore the implant. It can be contracted due to pre-existing and non-treated bacterial infection, infection during the implantation (use of non-sterile technique or use of a contaminated implant), or due to lack of proper dental hygiene after the procedure.
Nerve and tissue damage
Damage to surrounding tissues or nerves are caused mainly by the lack of experience or skill of the implantologist.
Nerve damage occurs mostly in the lower jaw to inferior alveolar nerve when the implant is installed too close to it or when the nerve is hit during the procedure. The signs of nerve damage is numbness or tingling in the gums, cheek, chin, lips or tongue. The damage may be permanent or only temporary, but in some cases extraction of the implant is required.
Another thing that can happen is perforation of the sinus in the upper jaw which results in feeling of pressure or stuffy nose. That may also require removal of the implant, fixing and lifting of the sinus and installation of the new implant.
The rarest that can occur is breaking of the jawbone due to low bone density or bone deficiency. It may happen while drilling the holes in the jaw or installing the implants.
Rejection of the Implant
There are very rare cases of rejection of titanium implants which results in the loss of implants. As titanium is a biocompatible material, there are arguments among dentists if the dental implants can be rejected at all or if the loss of implant is rather the case of infection or failed osseointegration.
Breaking or bending of implant
This was often observed in the past with the old generation of implants, the risk reduced greatly with the advancement of technology. As mentioned earlier, titanium alloy used in implants is biocompatible. Another merit of this metal is its strength and durability, and in fact it is almost impossible to break the implant itself. The weak point is the abutment screw which is the main cause of breaking or bending the implant. Abutment is a connector between the dental crown and the implant and being a small piece, it is quite vulnerable to forces.
Allergic reaction to titanium
The biggest All on 4 advantage is the materials used in procedure – they are biocompatible and durable. However, there are very few patients with the allergy to titanium and they may experience adverse reaction to implants or inflammation. Among the symptoms of adverse reaction to implants are burning or tingling of the mouth, swelling, dryness in mouth or loss of taste. As implants are made from titanium alloy, the allergy may be caused by traces of nickel, vanadium or aluminium added to improve the material. If the patient suffer from allergy to any of the above, he should inform the dentist. Yet, with the advancement of technology, it is still possible to have implants, as the new generation of zirconia dental implants is the best solution for patients looking for the metal-free implants.