"ALL-ON-4" OR "TEETH IN A DAY"
The term All-on-4, also known as All‐on‐Four and All‐in‐Four, refers to 'all' teeth being supported 'on four' dental implants, a surgical and technique prosthodontics procedure for total rehabilitation of the edentulous (toothless) patient, or for patients with badly broken down teeth, decayed teeth, or compromised teeth due to gum disease. It consists of the rehabilitation of either edentulous or dentate maxilla and / or mandible with fixed prosthesis by placing four implants in the anterior maxilla, where bone density is higher. The four implants support a fixed prosthesis with 10 to 14 teeth, and it is placed immediately, typically within 24 hours of surgery.
ALL-ON-4 TREATMENT CONCEPT
The All-on-4 treatment concept is a prosthodontic procedure (i.e replacement of missing teeth) that provides a permanent, screw-retained, same-day replacement for the entire upper and / or lower set of teeth with a bridge or denture. The procedure is best for patients with significant tooth loss or decay, and for people whose bone loss in the jaw area prevents them from getting conventionally oriented (vertical) dental implants. Often, tooth loss is accompanied by loss of the jaw bone, which poses the problem of reconstruction of the jaw bone requiring bone grafting. The All-on-4 technique takes advantage of the dense bone that remains in the front part of the jaws, and by placing the two posterior implants on an angle to avoid the sinus cavities in the upper jaw and the nerve canal in the lower jaw. For the implementation to be successful a careful analysis of the bone structure needs to be made. The most ideal way to evaluate the bone is by a cone beam computed tomography (CBCT) scan. The All-on-4 protocol is for at least four implants to be placed in a jaw. The back implants are typically angled approximately 30 to 45 degrees from the occlusion (biting plane). The implant is placed in front of the maxillary sinus in the upper jaw (maxilla), and in front of the mental nerve in the lower jaw (mandible). The head of the implant emerges in approximately the second premolar position. This will allow a molar tooth to be cantilevered posterior, resulting in a denture or bridge with approximately twelve teeth.
ALL ON 4 POST-OP INSTRUCTIONS
Standards of good oral hygiene are critical for the success and functionality of the implants and restoration. The best way to prevent infection and ensure healing is to keep your mouth clean. Clean your mouth thoroughly after each meal beginning the day after surgery. Use a soft bristle toothbrush and toothpaste after meals and at bedtime. Use of a dental waterpik is highly recommended to irrigate underneath the denture to flush out debris. DO NOT begin use of the dental waterpik until you are directed by your surgeon to do so.
Minimal bleeding is expected after this implant procedure. The best way to stop bleeding is to place a damp piece of gauze in the mouth and gently bite for 30 minutes. Rest quietly with your head elevated. If bleeding continues, use gauze for an additional 30 minutes. Pink or blood-tinged All On 4 Post-Op Instructions saliva may be seen for 2-3 days following the surgery and does not indicate a problem. Suture material may last 2 to 3 weeks and should be left alone.
Swelling is the body’s normal reaction to surgery and healing. The swelling will not become apparent until 24 hours after surgery and will not reach its peak for 2-3 days. After this time, the swelling should decrease but may persist for 7-10 days. Swelling may be minimized by the immediate use of ice packs. Apply the ice packs to the outside of the face 20 minutes on and then 20 minutes off while awake for the first 24 hours. After 48 hours, begin use of a warm, moist compress to the cheek.
MEDICATION / PAIN
Unfortunately, most oral surgery is accompanied by some degree of discomfort. If you do not have an allergy to nonsteroidal anti-inflammatory medications (Ibuprofen, Motrin, Advil) we recommend taking this prior to the local anesthetic wearing off. More severe pain may require a narcotic pain medication. Narcotic pain medication will make you drowsy, do not drive or operate mechanical machinery while taking the prescription. Alternate Ibuprofen (2 tablets / 200mg each) and the narcotic medication every two hours if needed. Once you feel like you can stop the narcotic, use Ibuprofen or Tylenol. You may also be prescribed an antibacterial mouth rinse which should be used twice daily in the first two weeks following implant surgery. Post-operative antibiotics should be taken as directed and always take entire course of the prescription. All medications should not exceed the recommended dosage. *NOTE: If you are taking PLAVIX or COUMADIN, do NOT take Ibuprofen or Aspirin products.
After General anesthetic or I.V. sedation, start with liquids. While numb, patients should avoid hot liquids or foods. Your food intake will be limited for the first few days, compensate for this by increasing your fluid intake. We recommend high protein shakes/smoothies as meal replacement supplements. Patients are restricted to a SOFT CHEW diet for the first 6 weeks….if food cannot be easily cut with a fork…DO NOT eat it!
Rest and relax with no physical activity for the first 3 to 4 days after surgery. After 4 days, you may resume activity as tolerated.
FOOD SUGGESTIONS FOR FIRST 6 WEEKS
Drink (NO STRAWS):
• Ice Chips
• Smoothies / Protein Shakes
FOOD SUGGESTIONS FOR FIRST 6 WEEKS
• Ice Cream
• Scrambled Eggs
• Cream of Wheat / Oatmeal
• Mashed Potatoes
• Cottage Cheese
• If the corners of your mouth are stretched, they may dry and crack. Your lips should be kept moist with an ointment such as Vaseline
• Sore throats and pain when swallowing are not uncommon. The muscles get swollen and the normal act of swallowing can become painful. This will typically subside in 2 to 3 days
• Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days. Do not force your mouth open. Massage the muscles and apply moist heat
• With upper jaw implant treatment, you may develop bleeding from the nose. This is usually a temporary finding and typically will not persist past 2 to 3 days. Follow sinus precautions supplied to you if applicable.
• An appointment with your general dentist may be needed within a few days of surgery to make any adjustments to your temporary denture. You will be asked to return to your general dentist for a 48 hour follow up to adjust the bite. Then in 1 week, 1 month and 3 months follow-up appointments. Any sutures remaining at that time may be removed at the surgeon’s discretion. Do not pull or cut the sutures yourself.
• Your case is individual as no two mouths are alike. Discuss all questions or concerns with your oral surgeon or implant coordinator.