All on 4 implants are very successful in replacing multiple missing teeth in either the upper or lower arch. However, there are several areas where problems can arise, such as poor quality of devices used during surgery or insufficient care before and/or after the surgery.
Due to the complexity of the all-on-four implant treatment, the restorative dentist should be deeply involved in all stages of the surgery, from planning to installation. Otherwise, inadequate care may lead to issues such as device failure, tissue damage, infection, and subsequently, additional costs for the patient.
Problems associated with all-on-four implants
Here are some of the problems associated with dental implants:
Expectations vs. Reality
A patient who has stayed for too long without some teeth may find it difficult to get used to having a full mouth full again. Patients who are ignorant of how differently implants fit compared to natural teeth may be dissatisfied with the results of their implant placement.
In order to ensure that the patient is aware of what to expect from their new dental appliances, it is important that dentists fully explain the benefits and drawbacks of all on 4 implants.
For instance, patients should be informed that the lack of nerve endings (proprioception) in the all-on-4 dental implant arch may lead to bite and chewing problems. To account for this, patients should be advised to chew gently and carefully until they establish a safe chewing muscle memory with their new set of teeth.
Additionally, all-on-4 implants tend to hang above the gums, unlike natural teeth. This may cause them to feel bulky in the mouth at first, but patients soon get used to the new sense of stability offered by the treatment.
The type of anesthesia used for the procedure depends on both what’s available in the dentist’s office, and the patient’s particular needs. For patients who are not very anxious about the treatment, light anesthetic is usually the ideal solutions. Some patients prefer to sleep through the treatment. If so, it’s crucial to have a reliable anesthetist on hand to assist them. There is also a twilight level that falls somewhere in the middle.
Dentists and patients should take the following factors into account when choosing an anesthesia:
- What’s the minimum anesthesia that must be administered in order to keep the patient comfortable?
- Does the patient have any underlying medical issues that would make one type less preferable than another (the less you use, the quicker you recover)?
- What kind of prior anesthesia-related experiences does the patient have?
Anesthesia risks are uncommon and unlikely to occur as long as the patient and dental team are in agreement over the type of care required and is accessible.
As with any other treatment, all-on-4 dental implants could also fail. There’s a 5 percent rate of failure with this procedure, which occurs when implants do not integrate with the bone like they’re supposed to.
This can be frustrating for everyone concerned because the reasons for it happening aren’t always obvious. This problem can only be corrected by getting a new implant.
Since dentists and researchers generally don’t understand why some implants fail while others do not, lowering this risk can be a bit of a challenge. But implant failure is less likely to happen if the patient adheres to all after-care instructions for dental implants. This includes smoking cessation, eating soft meals, and practicing proper dental hygiene.
An infection could happen after any kind of surgery. Experienced dentists take all the necessary precautions to reduce this risk. Infections do, however, happen for a variety of reasons, the most common one being the presence of the peri-implantitis infection.
It’s important that you get treatment as soon as you spot the following signs of infection after all-on-4 implants:
- Dental implants are shaky or unsteady
- Bad breath
- An unpleasant taste in the mouth
- Swelling, redness, and inflammation in the gums around the dental implants
- Gums that harbor pus
- Bleeding when brushing
You can reduce these risks by following the instructions given by your dentist, which typically include abstaining from alcohol and tobacco products, as well as adhering to the dental hygiene instructions given to you.
Improper care post-procedure
Patients need to understand how crucial it is to maintain good oral hygiene practices when caring for their new arch of teeth. To prevent food particles from building up under the implant-supported arc, super floss or water floss should be used at least once per day. Patients who are prone to teeth grinding and jaw clenching should wear a night guard when sleeping to avoid damaging their prosthetic devices.
Additionally, patients should have their all-on-four devices cleaned professionally every four to six months, and the little supporting screws changed every few years. Performing proper preventative maintenance will stop a lot of potential risks in their tracks.
Pre-existing health conditions
Diabetes increases the risk for tooth damage, whereas periodontal disease can harm your teeth, gums, and jawbone. Smoking, on the other hand, can damage every organ in your body and increase the failure rate of your implants to more than 15% (from 5%). If you smoke, you can expect to face a few issues with all on 4 dental implants.
If your diabetes is under control, it shouldn’t pose any issues for all-on-4 dental implants, but you should let your restorative dentist know if you have the condition. If you have periodontal disease, your dentist may recommend additional dental work prior to having the all-on-4 dental implants installed. For instance, you might need a bone graft to provide enough bone tissue to support the posts.
If you don’t have enough jawbone to support the four implants, your restorative dentist will let you know and recommend alternatives tooth replacement treatments.
Additional problems associated with all-on-4 implants
There are a few other problems that may arise when getting all-on-four implants, such as:
- Damage to or breakage of teeth next to the implant that aren’t properly supported: If the teeth next to the implant aren’t properly supported, they may suffer damage. This can have terrible effects on the patient when coupled with any other kind of failure. It may result in increased costs as well as harm to the teeth, gums, and surrounding tissues.
- Lack of preparation before installation of the all-on-four devices: Regardless of how well-made the implants are, the implant installation can be damaged if the restorative dentist does not take the time to prepare properly or communicate with the oral surgeon.
- All-on-four device placement errors: Dental implants used in all-on-four procedures must be positioned correctly and precisely. If not, the implant may rupture or result in bone loss in the patient, especially in patients suffering from bruxism (teeth grinding). Dentists who specialize in restorative dentistry should be well-versed in both the placement process and the issues that might occur with all-on-four dental implants when the protocols aren’t strictly adhered to.
- Lack of proper interactions with the dental lab during the prosthetic appliance construction: The installation process for an all-on-four implant involves numerous steps that must be rigorously followed to guarantee a successful implant surgery. But factors such as skipping patient visits, inadequate device fitting, poor lab communication, unclear or non-specific instructions, and subpar device quality can all increase the likelihood of problems arising for these patients with their all-on-four dental implants.
- Low-quality substitutes: All-On-4® is a trademarked brand, like all dental appliances, however there are several lower-quality alternatives that can be utilized. Problems with all-on-four dental implants might be worsened by inferior implants and other variables.
Find an experienced all-on-four implant dentist
To increase your chances of successful treatment with all-on-four implants, you need to choose a dentist who specializes in placing these dental implants and has a lot of experience doing so. Instead of purchasing this product or “brand,” you should make an investment in a skilled and knowledgeable dentist who provides it.
Keep in mind that some dentists only practice under the All-on-4 name. Although this is not necessarily a bad thing, they might not have as much experience as other dentists. So you need to do your due diligence.