Armory Dental Implant & Oral Surgery-Center for Dental Implants, the All-On-4(tm) or All on 4(tm) Treatment

The Upper Jaw

The upper jaw has anatomic variations that require variations in the All-On-4(tm) approach.  Please click HERE for these alternative treatments.

Potential Draw-backs and Risks

It is recommended that in the All-On-4(tm) approach the tips of the implants be placed in the hardest part of the jaw bone and the nasal floor in the upper jaw, and the side walls of the lower jaw bones to maximize mechanical anchorage.  This is to maximize the mechanical anchorage of the implants.  This aspect requires the surgeon to have intimate knowledge of the local anatomy to help avoid surgical complications.  CT scans that are obtained before, during, and/or after surgery are important for this approach in Dr. Woo's opinion.

Longer than usual implants are used when bone is soft to maximize the mechanical anchorge.

It is recommended to go into the front areas of the sinuses to find the locations for the back implants in the upper jaw, and this potentially causes sinus complications.  Dr. Woo routinely uses CT's, relies on his experiences with anatomy and surgery, and most of the time does not have to open the sinuses.

When teeth are removed in the same surgery as the implant placement, the bone may have too much tooth socket spaces to allow for the required implant anchorage.

The fixed dental bridge may not be placed the same time as the dental implant surgery if the implants are not anchored tightly into the bone.

While the approach reduce the risks of surgery compared to the traditional approches, it doesn't not eliminate them.

The All-On-4(tm) concept doesn't require re-building the missing jaw bone that most patient started with.  The missing bone is replaced by the prosthetic materials of the dental prosthesis.  While it is not unique to this approch, it does require the patient and the referring dentist to accept that the dental prosthesis replaces not only the teeth but also the missing gum and jaw bone.

In fact, in the upper jaw, the patient's jaw bone needs to be covered by the upper lip during wide smiling, so that the junction between the healed jaw bone and the prosthesis is covered by the upper lip when the patient smiles.

Due to the above reason, the upper jaw bone is actually sometime reduced to allow the lip to hide the junction between the bone and the prosthesis to provide a superior esthetic result.

On the lower low, the thin top portion of the jaw bone is often removed, so that the implants could go into the thicker basal bone.

Removing bone, sometimes required in this approach, may seem to go against conventional implant dentistry dogma, and it is a non-reversible procedure.

The back tilted implants are so important in this approach that if one of them fails, the surgeon needs to have options.  Most importantly, this needs to be discussed with the patient as part of the risk/benefit analysis before treatment begins.

For many reasons, the bridge placed at the time of implant surgery (immediate prosthesis) is not meant to be permanent.  Some of these reasons are:

1.  It is technically difficult to have the highest quality prosthesis made at this point of treatment.

2.  The shape of the jaw bone and gum will change after surgery, and most of these changes will happen in the first few months.  The permanent bridge will then take into account the healed shape of the jaw to provide the best esthetic, hygiene, and speech results.

3.  Patients want the opportunity to try out the shade, shape, positions, and bite before committing the decisions for the detail of the permanent prosthesis, and this is not possible before treatment begins when most patients still have their own teeth in the way.

The above is not a complete list of potential risks and complications.

As with any dental or surgical treatment, the nature of the problems, options, risks, benefits, prognoses, anesthesia risks, and cost estimates are all need to be considered.  These are complex decisions.  We are here to help you make them.

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