Hello, I am Dr Roman at Pacific Park Family Dental, and I am here today to talk to you about what the heck is all in four is.
What is all on four?
Recently in the field of dentistry everybody is talking about all in four, all in six, blah blah blah. What does that mean? Why do we call it that? Okay, long story short, "all on" is referring to the teeth. So let's say you have an arch of teeth, we call it these are all the teeth. That's how you think about it, all on. So all the teeth on four has to do with implants. We need at least four implants to put all the teeth on them and that's how we designate what the thing is. So all on four simply means all the teeth in an arch placed on four implants or all the teeth in an arch placed on four fixtures.
How does it really work?
Simply put, implants are quite a bit stronger and can take a lot more force than a tooth. So what we need is at least four implants to base the entire arch on. That means you're going to have an entire arch or entire row of teeth placed on four implants and it will be bolted into those implants. That also means that you don't get to take your teeth out. It also means that they look natural, they have to function like a permanent prosthetic, it becomes a part of you. So no longer do you have to remove the old mom and pop dentures with spit stringing out of your mouth. No, it's one thing that stays in there and nobody knows that it's not yours. That's the beautiful part of it.
How is it different?
How is an all on four, all on five, all on six? It still refers to the same concept: the entire arch of teeth based on four implants, that's all on four; or five implants, all on five; or six implants, all on six. Does that make sense? Okay, so simply put, how is that different from just traditional dental implants? The technology of all on fours really came out when we dentists were looking for a much cheaper alternative to placing a bunch of implants into an arch and just restoring them with either bridges or individual implants because it gets expensive. And we don't want expensive; we want as cheap and long-term as possible. So we want to say, okay, this is the expense curve and this is the longevity curve. Where those two meet, and the lower on the expense side and the higher on the longevity curve, that's where we want to be. We want to have the best of both worlds. We want to do it as economically as possible but yet as long-term as possible, and all in four seems to guarantee that for virtually everybody.
Who is a good candidate for all on four?
So a lot of my patients ask me, "Hey, I have a gum problem or my bone has been eroded by periodontal disease, or I have poor quality bone." The beautiful part about all on fours is that we don't place implants in a traditional way. So, for one single implant, I want to place the implant straight because at the end of that implant, we're going to have a tooth. For an all-on-four, the implant goes where the bone is. So if you have a good bridge of bone somewhere, that's where the implant goes. We guarantee that we have good placement because we look for the islands of bone which are really strong within your facial structure. When we find those little islands of bone, we put implants over there at a specific torque that can handle an entire bridge. Basically, once we have four of those, we know that putting an entire bridge of implants is okay and it's going to work just fine.
Is it a good option for older people?
When a 55-year-old comes up and they're like, "Oh, I'm old, my bones are not great, I don't think this is a good option for me," on the contrary, the longer the bone matures, the more solid it is and the better implant hold is. I'm actually able to place wonderful implants for 65, 70, 80-year-olds and it works and it heals just fine and it's there and it does what it's supposed to do. So it's a wonderful procedure; it works nearly all the time. There are a few cases where it's not advisable, but there's so far and few between. For most people, an all-on-four procedure is a reality.
Is all on four suitable for patients with bone loss?
To a point, yes, absolutely. Coincidentally, an all on four is what we suggest when there is no other bone to place implants anywhere else. If we have to do massive bone grafts, we avoid it by placing an all on four.
What does the all on four process involve?
If you have some teeth that are hopeless, it involves getting rid of those teeth. Anything that is old and non-fixable, we have to get rid of it. We have to prepare the bone area to accept the implants by flattening it out and kind of doing our preparations for the implants, placing the implants at the desired torque levels, and then taking an impression and designing the entire prosthesis to be well-fitted for you. That's kind of the large outline of the steps that we do.
How long do these steps typically take?
Step number one, remove and place implants, usually happens in a day for me. This is the fastest step. For the patient, it is the most stressful step; however, it needs to be done only once. When that is done, we wait for the implants to kind of test themselves, make sure everything is fine, nothing is going wrong. During that time, my patients wear a temporary. With the temporary situation, I know a lot of people want to have a quick perfect result, and we can achieve that. But a lot of patients that I work with want very individualized smiles. They don't want a denture look to their smiles; they want something that highlights their personality. And what we do, because at Pacific Park Family Dental we actually have our own in-house lab, we allow people to experiment. We will make them a temporary and see how they like it, see if we got all the parameters correct, see if the speech is right. When the person says, "Oh, I like this," we transfer that to zirconia. If they say, "I'm not really sure about this, can we try making the side teeth a little bit smaller or the canines a little bit more prominent or the teeth bigger," we can do all that because we have full customization of your smile. We allow patients to play around with this, and sometimes, yes, it takes 10 visits to find your perfect smile because we're looking for it, and we take into account what you tell us. So it's not a one-size-fits-all type of a procedure; it's really a bespoke building process to your needs. And this is why sometimes it takes a little bit of time to find this good area where you feel like this is your smile, this is what you've been looking for for the last 10 years or however long. So that searching period, that experimentation period, it can take 3 to 6 months. I have had patients that are coming in every other week, okay, let's try this, let's try that, totally fine, let's try it. This is your smile; you want it to be perfect. So this is why we take care to get everything perfect so you're happy. But let's say everything goes correctly and you're happy with every single step. Within four or five visits, you will have your teeth. However, because we want to offer more, and we want to customize it to what you want, sometimes there is a trial period in which you tell us how you feel speaking, how you feel chewing, how you feel smiling. Is this something you want? What kind of color do you want? How much gum do you want to display when you smile? Those are all tiny things that have to be addressed and asked, because if a dentist doesn't know to ask those questions, you will never think to mention it. So we have done enough of these to ask you all these nitpicky questions and actually sort them out for you so it looks beautiful and the way you want it in the end.
Is it a permanent solution to the missing teeth?
Pretty much, pretty much. If you take care of it, you still have to come to your six-month cleaning so we can check the implants, clean the implants, make sure the all-on-fours are doing fine, make sure my work is holding up because I'm responsible for it. And if something goes wrong, I want to be able to fix it. If you're doing all that, I see these things hold up wonderfully year after year after year after year. And patients don't complain about it feeling unnatural or foreign. It's something that becomes a part of you; you don't even notice it.
What are the advantages of an all-on-four dental implants over tooth replacement options?
It really depends what you want. Some of my patients come in, and I ask them, "Do you want to keep these teeth?" and they say yes. Excuse me, when they tell me yes, I will do everything I can to keep the teeth that they have and offer some sort of replacement for what they don't have, either a partial or a bridge, maybe a few implants. If I see that keeping the teeth that are in the mouth right now will cost an arm and a leg and we really are not going to be any better off than just getting rid of it all and starting from scratch, then I just tell that to the patient. I want my patients to have the best treatment, so I'm always honest and transparent to them. So if it's in their best interest to keep their teeth and go with a partial because it's either cheaper or quicker or more comfortable, I will tell them that. If it's in their best interest to start over, throw out the bad teeth and start over with something new and fresh, I will also tell them that. So what are the advantages of replacing teeth with an all on four rather than trying to fix something that's not salvageable? Well, you end up with a wonderful, wonderful project that you can use every day, three times a day, and you can smile with.
How do all on fours improve oral health and quality of life?
This is a very difficult one to explain. So picture this: somebody who has always, let's say, ridden a bike. They've ridden a bike to work, back home. And one day, you tell them about this new invention. It's called the car. And you tell them, "Listen, I have something for you. It will change your life fundamentally. You will never be tired again, you will never come sweaty to work, you will never come sweaty home from commuting, and you'll always be comfortable. How do you like that?" And then they will say, "Oh yeah, that sounds wonderful." And then they start giving you concerns about cost and how are they going to take care of it, and is it going to last a long time, and should they bother with it. It just seems too complex, and they need to put fuel in it and do oil changes, and the bike doesn't require any of that. It's just so much comfortable with the bike. And you have to explain to this person that's ridden a bike all their life and never seen a car that this thing is going to change their life fundamentally. How do you do that? This is what an all on four is. So when a person comes to me, they're having a partial, they're having a denture. I ask them, "Is it comfortable? Are you happy?" A lot of times, people tell me, "Yeah, yeah, I'm happy." Then when I ask them what they eat, a lot of the times, "Oh, you know, I boiled this, over-fried that, yogurt, soup, blah blah blah." And then I ask them when the last time they had steak and whether they chew it okay or they swallow in chunks. I see that they can't give me a straight answer. They actually don't know because they don't pay attention because the last time they actually chewed something was when they had their teeth, and that's been maybe 20 years ago. So they honestly don't remember what it is to chew something completely, to feel the texture, to actually bite into an apple and feel the crunch. That's gone. So as far as they can tell, they're doing totally fine. They're riding their bike back to work, back home, and they don't know anything other than that. So now my job is to tell them about this thing called an all on four that is going to transform their lives, and that's a difficult thing to do because once they get the all on four and we work out all the kinks and it functions, boy, those most people, they come back and they tell me, "Listen, if I had to sell my house to do this again, I would in a heartbeat." And those are the people who start to appreciate this project once it's done. So it's a really tricky thing to tell somebody, "Hey, this is going to change your life. You have to trust me. Now go do this." And it's a scary process, and it's an expensive process, and I can't tell you how much it's worth it until you feel how much it's worth it by wearing it. So it's even more challenging than getting a car, because a car you can take out for a test drive, and an all on four, once you did it, it's yours, it's in your mouth. Luckily, what we do in our clinic is that we have so much customization that you can do that it really becomes a part of you. If you're not happy with something, if you're not quite sure about the color, we can fix all that. We have our own lab, we can change and change and customize to no end so you are happy. That's one of the reasons why we actually started our own lab, and that's wonderful. So how does it impact quality of life? Once you have your teeth, once you're able to bite into the apple or steak or cake or whatever, and you know that your teeth are not going to flip out, they're not going to fall out, you're not swallowing chunks of food, you're actually digesting things in your mouth, you're actually chewing things, then you can experience life to the fullest once again. And that happens three times a day. You eat three times a day, you eat three times a day at least, you smile a bunch of times a day, and when your smile is great and when your eating is great, that's 80% of your life enjoyment right there. I think it's worth it.
What is the cost of an all on four?
Typically, it ranges. It can go anywhere from $30,000 all the way up to $60,000. We like to stay at around the $40,000 range because we need that. Typically, it ranges from $30,000 to $50,000 or even $60,000, depending on what's being done. Most of our cases range at around $40,000. With that, we also guarantee that what you're getting is going to be excellent. If you don't like something, we're always going to change it and take care of you. This is one of those things why people choose to do all on fours with me, because they know I will take care of them. They know I will come out on the weekend and give them a new temporary if their old one broke. That's just the way we treat our patients. We know that this is a very delicate process and they need to be supported through that, and we do what we need to do to get you to perfectly healthy teeth and your happy smile.
What is the recovery process like?
So let's say you get your surgery, you put in your implants, it's a lot and you know, it's not easy getting over a pull too. It hurts, and implants hurt, and surgery hurts; it's all uncomfortable. I typically do a couple of things. I prescribe a lot of medications before you get to the office, and I tell you how to take them. They include an antibiotic, a pain pill, and a little bit of anti-swelling medication so all the swelling goes down quickly. There will be bruising; some people do have a little bit of yellow spots, some people have blue spots, that's okay. It goes away within a week, totally fine. The gums are a little bit annoyed with what we did and a little bit irritated, and that's okay. Typically, the pain subsides within a day or two, and you know, because we manage it so well with pain medication, it's not really the biggest issue. The biggest issue is to kind of get the temporaries into the mouth after the surgery. There can be some discomfort; we try and minimize that as much as we can. If we have to numb the patient the day after or two days after to get the temporary in, we do that too. But we try and be as gentle as possible. That is kind of the biggest discomfort that people have to deal with. Other than that, once the implants are in, everything's healed up, getting a new temporary or getting a new fitment is super easy. The person comes in, five minutes, the old one is out, the new one is in, they fit it, they tell me what they like and dislike, we make any adjustments, and they go on their merry way. So once the healing has happened, it's a relatively easy kind of pleasant process, so to speak. However, the healing process for the implantation and the removal of teeth is anywhere from 3 to 4 days when it is kind of the most sore. After that, things just kind of get back on their own track, and everything works out well. I have had patients who went to work the next day and they were totally fine. I have seen patients who take like three ibuprofen and they were totally fine. So really, the recovery process depends on the person and their tolerance for discomfort, I would say. However, most patients just maybe spend a couple of days at home and then they're fine.
How long does an all on four last?
So this project, all on four, how long does it last? So let's say you got your all on four, all on five, or all on six. How long can you expect this whole thing to be there? Really, it's determined by biology and how well we take care of it. If the care is diligent and the implants are doing well, there's no bone loss, then there's no reason why you can't have this for the rest of your life. I don't see very many breakages in all on fours when they're properly executed. They just work and they just function, and you can expect years and years and years and decades of work out of them. So, typically, I would expect this project to last 20, 30 years would be my honest answer. That's what I expect.
What kind of care and maintenance is required?
We have to remember that all on fours are not natural teeth. All on four is made out of a zirconia material which is extremely tough, so you can't scratch it, you can't stain it. We do ask that people gently brush it just to get the surface plaque off and they use a water pick to clean right under the bridge. Once they do those couple of things, I find that the care is relatively straightforward. Not much food gets trapped in there and people do really well to take care of them. So there really isn't anything to be worried about, just follow a few simple steps and procedures before you go to sleep, and then you're done.
So I hope I was able to answer some questions about all on fours. I know it's a complicated venture and it's a scary one too. However, the entire team is here for you and we will do everything needed to be done that you are comfortable throughout this process. My patients know, once I do an all on four, that patient has my personal cell phone number and if they need to reach me for anything, they reach me for that. They text me, they call me, I call them back, I text them, I make sure that they are taken care of because it's a big step and it's a big procedure and we want this to go well for them. So sometimes my patients need my care and they need my attention even outside of clinic hours. Rarely, but it does happen and I want to be there for them. This is why every single patient that does this, they have my personal cell phone and they're welcome to call and text and ask me questions and kind of banter around and some people do that and that's okay. I'm here for my patients and this is why I'm a doctor, I want you to be healthy. So I hope I've answered everything and if you like what you're hearing and you want to know a little bit more, give me a call at (360) 803-3546. Somebody will put you in touch with me and we'll talk a little bit more about this whole thing. Well, thank you so much and have a good one.