April 15, 2020 Tri Le All on 4 is a relatively new way to replace entire arches of missing teeth with dentures. This teeth replacement treatment involves installing 4 implants in the upper or lower jaw, or both, and affixing a denture to those implants. The denture is a full set of false teeth that can either be permanent or removable. The primary benefits include no need for denture adhesives and increased comfort and functionality when compared with traditional dentures. The replacement teeth also look like natural teeth, which can improve your appearance when you smile and prevent your lips from curving inward due to a lack of teeth. All on 4 and Missing Arches Before you contemplate All on 4 treatment, it’s important to understand the definition of a missing arch. The arches in your mouth are the upper and lower jaws where your teeth form a crescent. For example, if you no longer have any natural teeth on your upper jaw, you are missing the entirety of your upper arch. All on 4 dental implants are designed to replace entire arches. All on 4 implants are designed to replace entire arches of teeth with just 4 implants. Good All on 4 Candidates Good candidates for All on 4 dental implants may include: People who have lost numerous teeth due to injury. People who have lost numerous teeth due to tooth decay. People with advanced gum disease. Individuals who are unable to see significant benefits from restoring the teeth or those who cannot have teeth restored. Good candidates don’t necessarily have an entire arch missing, but they do have a significant number of teeth that need replacing. If you are a dental patient who is torn between dental implants or traditional dentures for replacing an entire arch of teeth, All on 4 may be a good choice for you, and you may be a good candidate. However, the criteria for All on 4 is slightly different than for dentures or single or multiple implants. For this reason, candidacy is determined on an individual basis. Determining Candidacy for All on 4 Dental patients who have lost all or most of their teeth will need a dental examination in order to determine if All on 4 would be right for them. The evaluation and examination process takes into consideration the dental and medical history of the individual and involves taking x-rays of the jaw bones and few remaining teeth, if there are any natural teeth remaining. The x-rays and examination along with medical history are used to determine if any underlying health issues may prevent adequate healing after the implants are placed and if there is enough density in the jaw bone and enough gum tissue to support the implants. Since every individual’s mouth and medical history are different, it’s extremely important to get an evaluation so that you can learn if All on 4 is the right choice for you. If it isn’t the right choice, other teeth replacement options can be discussed with our dentist. Individuals Who Wouldn’t make Good Candidates for All on 4 Dental patients who do not make good candidates for All on 4 have a history of poor oral health and have underlying conditions that would make healing after the implant surgery difficult or unusually slow. These would be individuals with a history of uncontrolled diabetes as well as high blood pressure and autoimmune disorders. If you are missing a significant amount of jaw bone or gum tissue, All on 4 typically wouldn’t be a good option. Unfortunately, when individuals have lost a significant number of teeth, the human body tends to reabsorb the jaw bone, causing low bone density in the areas where teeth have been lost. If you’ve had missing teeth for a long period of time, you may not have enough bone density for implants. If you currently have periodontal disease, which causes gum recession, you may not have enough gum tissue to support the implants or the attached denture. In addition, if you still have most of your teeth or have only experienced a few tooth extractions, you wouldn’t be a good candidate for All on 4 as this procedure is designed to replace entire arches, not a few missing teeth. If you are only missing a few teeth, you may be a good candidate for single tooth implants, which look and function just like natural teeth. Bone and Gum Grafting to Increase Candidacy For individuals who are not considered a good initial candidate, gum and bone grafting can help increase candidacy odds. Bone grafting involves taking pieces of bone from other areas of the body, like the hip or another section of the jaw, and grafting it onto the area where more jaw bone density is needed to support the implant. Learn more about bone grafts and understand who make good candidates, the different bone graft procedures, how the procedure works, and its effectiveness. Gum grafting involves taking tissue from the top of the mouth or from areas where gum tissue is healthy and grafting it onto the area that needs more gum tissue. If the grafting procedures are a success, it can increase the likelihood of success with All on 4. However, bone and gum grafting does require more treatment time because you will need to completely heal from your grafts before All on 4 treatment. Is Age a Factor in Candidacy? Age isn’t necessarily a factor in determining All on 4 candidacy. Younger people are just much less likely to have experienced severe deterioration of the the teeth or gums. Most dental patients who need All on 4 are individuals who are middle aged or into their senior years and have experienced multiple extractions and root canals and very few if any natural teeth are left. Alternative Options to All on 4 If you are not considered a good candidate due to oral health issues or still having too many natural teeth, other teeth replacement options may work for you. These options include single dental implants, full and partial bridges and traditional dentures. The good news is that even if All on 4 isn’t right for you, there are still teeth replacement treatments that will work so that you can chew and speak correctly and improve your smile. Tri LeA practicing dentist since 1987, Dr. Le has been running successful dental practices in Texas with his wife Ann since 1990. A member of the ADA, AACD and AADSM, Dr. Le has also contributed to several leading dental journals.