All-on-4 and Teeth-in-a-day have become familiar terms that refer to the replacement of all of the teeth in the upper or lower jaws. These treatments involve a 2-stage process. The first stage involves surgical placement of dental implants with an adequate healing period. Four or more implants can be placed during this stage depending on the clinical situation. Immediately after the dental implants are placed, a temporary implant bridge is screwed into the implants. This provides immediate function and replacement of teeth after the surgery. After a healing period of approximately 3-6 months, a permanent, final implant bridge of teeth is inserted into the implants.
Before spending thousands of dollars, the most important question to ask is how successful is this treatment? Two questions need to be asked regarding success. How successful are the dental implants and how successful is the implant bridge, which is inserted into the implants? The answer to the first question is straightforward – modern dental implants integrate very well into bone and demonstrate success rates above 90% at 10 years. The answer to the second question is more complicated. Large companies promoting All-on-4 as well as different private practice clinicians will use very different materials to construct the final dental implant bridge. Just like in any industry, there are cheaper materials and more expensive materials. The diagram above shows a hierarchy of dental implant bridge materials and the expense associated with each.
Studies have shown that implant bridges constructed with porcelain fused to metal achieve 100% success at up to 4 years. Alternatively, in a recent study from August 2013 in the Journal of Clinical Implant Dentistry and Related Research, investigators found that implant bridges fabricated with metal/titanium and acrylic demonstrate a need for frequent maintenance repairs of five or six times per implant bridge during a 10 year period. From my experience, the upper front acrylic teeth can fracture within the first year of function. Patients who clench or grind their teeth are even more susceptible to fracture and severe wear of the prosthetic teeth. These patients require frequent repairs, which can be inconvenient and costly over time.
Implant bridges milled from zirconia is a new technique to provide patients with a strong yet less expensive option as compared to porcelain fused to metal. Studies with zirconia for full arch restorations are limited, therefore we do not fully know the long-term success.
Prosthodontists are dental specialists uniquely trained in the complex replacement of missing teeth. They are experts in diagnosis and selection of the proper material for your dental implant rehabilitation. Each patient has different requirements to achieve a long-lasting result. No single material is right for everyone.
