All on 4: Everything You Need to Know But Were Afraid to Ask

10 Dec 2018

If you are reading this you or somebody you know has heard about the All On 4 procedure as an option to wearing dentures. Unfortunately we are seeing more and more patients that are coming to see us because they have been dissatisfied with treatment that has been carried out elsewhere. If you are keen to avoid these pitfalls please read on.


What are All-on-4 Dental Implants?

All on 4 is a protocol for replacing teeth on people who have previously lost all of their teeth and are unhappy with wearing dentures or whose teeth are so badly damaged that they cannot be saved. It uses dental implants to anchor artificial teeth that are fixed.


Who invented All-on-4?

It was first presented by Dr Paulo Malo in Portugal in conjunction with implant manufacturer Nobel Biocare.

What makes All-on-4 different to other implant treatments?

Professor Per Igmar Branemark first began implanting artificial teeth in the 1970s and this treatment became available in Australia in the late 1980’s. From then until about 10 years ago this was complicated, expensive treatment that was only suitable for a small number of patients. Often treatment would take up to a year during which time it was almost impossible to function normally.

All on 4 uses specially positioned implants that we designed so that treatment can be completed within 3 days. Instead of eating mush for months on end patients can be chewing all but very hard food within a few days. As the name suggests a full set of upper or lower teeth can be anchored on 4 implants in most cases.

A welcome benefit is that this helps keeps the costs down as compared with previous protocols.


How is an All-on-4 treatment performed?

The dentist first carries out a designing process that involves taking impressions, taking special x-rays and taking photographs. The teeth are then designed and can be temporarily tried in to make sure the patient will be happy with how the new teeth will look.

Once the patient and dentist is happy with design an appointment is made to remove any hopeless teeth and then place 4 small titanium screws carefully in the jaw where the teeth used to be. At the same appointment further impressions and measurements are taken. Over the following 24 hours a dental technician makes the new teeth and the dentist places them on the following day.


What are the benefits of All-on-4 Implant?

In short it provides you with most of the same benefits of have a healthy set of natural teeth. There is substantial evidence that having poor teeth does much more than make it more difficult to eat and embarrassing to smile. Lost or unhealthy teeth have been linked with the following:


  1. Heart disease.
  2. Stroke.
  3. Diabetes.
  4. Dementia.
  5. Pneumonia.
  6. Depression and reduces self esteem.


All On 4 provides you with an opportunity to start over with something that feels very similar to having healthy natural teeth again including hopefully improving length and quality of your life.


Does the treatment hurt?

Many patients who are reasonably comfortable having dental treatment done will be fine having All on 4 done with similar local anaesthetic that is used  for simple fillings or extractions. When carried out properly there is almost no discomfort during the procedure.


For a few days after the procedure there can be some swelling and bruising but only mild discomfort for most people. This can be easily controlled using simple painkillers such as Panadol or Nurofen.


I hate going to the dentist. Can I be asleep for the procedure? .

Like all dental procedures you have a general anaesthetic or sedation. When this is done you have no awareness that the procedure is being done.


Do I need after care?

Careful after care is essential. You need to visit the dentist 3 times in the first 6 weeks and then 4-6 monthly indefinitely. This after care is critical to the success of the treatment.


How long will my new teeth last?

The implants that anchor your new teeth should last indefinitely if properly cared for.  The life span of the actual teeth is variable as some people are much harder on their teeth the others. This is also true of natural teeth and explains why some people can keep their teeth for a lifetime and others not.

Another variable is the technique used to make the teeth. At some practices the initial teeth are made to last no longer than a year and a second set of teeth have to made during that time. The teeth that we make at  DentalFresh are designed to last a minimum of 5 years. We also provide options for second set of teeth that can last a lifetime under most circumstances.


Do all dentists perform the All-on-4 technique?

Definitely not, although there are more and more dentists are offering this treatment without the necessary training and experience.

The All on 4 procedure is carried out by highly trained team that will include 1 or 2 dentists, dental technicians, dental chair side assistants and support staff. If you choose a general anaesthetic or sedation there will be a doctor to administer it and keep you safe during the procedure. The dentist who heads the team should have a university qualification related to dental implants and has plenty of experience in implant surgery.


Do I have to go to hospital?

If you have a general anaesthetic in is much safer if this is done in a private hospital or an accredited day surgery.


How much does it cost?

There is no standard fee and prices vary widely. There is also a big variation in what the fee covers so it is quite hard to compare between practices. In Sydney you can expect to pay between $20,000.00 and $30,000.00 for a standard All on 4 for an upper or lower jaw. This should cover all of the treatment with the exception of ongoing cleaning appointments.

It is possible to see fees a lower than this but it is likely that they are using materials and components, which are not accredited for this use.

You should receive the cost in writing including exactly what is included.


That is out of my price range. Are there other options?

There are several options for treating people that have lost all of their teeth some of which are much less expensive. You should be told about all of your treatment options so you can decide on something that suits your budget.

Is All on 4 suitable for every patient who has or is going to lose all of their teeth?

When teeth are lost or diseased the patient often loses the bone that holds them. To place implants we need to have bone in the right areas so there are some patients who are not suitable for a standard All on 4 procedures. For those patients there are now some great techniques to either grow new bone or place special implants called Zygomatic implants. DentalFresh are one of a small number of practices in Australia that are regularly placing Zygomatic implants in conjunction with our preferred specialist. Zygomatic Implants fall within a Specialist’s scope of practice.


What about having the treatment done overseas?

There are properly trained dentists who provide good treatment in many countries in the world. It is also possible to have poor treatment in Australia.

The cost of a properly carried out All on 4 procedure will be as low as you might expect in countries like Thailand mainly because they have to pay the same amount for genuine components as we do in Australia. The downside of having treatment overseas include:

  1. You will have limited time to choose the right practice.
  2. Unless you stay overseas for an extended period you will need to find a dentist who is prepared to do this in Australia. This will add a cost that would have been included if done in Australia in the first place.
  3. You will need to travel overseas if anything goes wrong.
  4. It is unsafe to fly home straight away after surgery.
  5. Many countries overseas to do not regulate infection control procedures as they do in Australia.


It is our experience that with all of this factored in there is little or no cost saving and a substantial increase in risk.

While all of this may be a little overwhelming, All on 4 is an amazing treatment that can change people lives. At the DentalFresh we are proud of not only the quality of treatment we provide but how often patient tell us that the process is much easier than they had expected.


How to Choose the Right Practice for Your All-on-4 Treatment?

As we mentioned above it is quite difficult to compare practices due to the range options available. The following is a checklist that may help you:

  1. When you make the first phone call does receptionist have a good understanding of what treatment the practice offers? Quite simply if they cannot answer your questions about All-on-4 then it is unlikely that the practice is regularly carrying it out.
  2. How long is the first appointment and what does it cost? There are some practices that offer short free consultations. We feel strongly that we should provide as much consultation time that is required for our patients to make a decision. It is rare that we would spend less than 11/2 hours. Our policy that our initial fee of $250.00 covers all consultation time and x-rays.
  3. Do you need to go elsewhere for x-rays? This varies from Practice to Practice.  In order to obtain the most accurate x-rays our practice has the latest in high quality cone beam CT scans on site, others may need to refer to an outsourced Radiography Centre..
  4. What qualifications does the dentist have? A dentist that has the appropriate formal university qualifications for doing implant treatment will always make these available to you.
  5. How much experience does the dentist have? Do not be afraid to ask this question. To do All-on-4 well a dentist should be doing implants on a daily basis.
  6. At the first appointment does the dentist listen to your requirements, perform a thorough examination and tell you all of your options including all advantages, disadvantages and possible risks?
  7. What is the cost and what exactly does the fee include? This should be in writing before the surgical appointment.
  8. Are genuine Nobel Biocare components used? Beware of cheap implants!
  9. Who is the dental technician? This is a very important consideration as poor technical work is the major cause of complications. We are in partnership with RWD Dental Image who are the premier providers of All on 4 in Australia and amongst the best in the world.
  10. What is the cost of ongoing maintenance?
  11. Who provides the ongoing maintenance? This may seem a strange question but at some practises the surgeon attends only to do the procedure and has other less experienced staff in charge of the maintenance. We are seeing many patients who come to us because of poor after care.
  12. What happens if there are complications? All on 4 is generally a very safe procedure but there are occasionally some hiccups as there is with any surgical procedure. You need to know if the dentist knows how to deal with this and if there are any additional costs. At Dental Fresh there are no additional costs as long as you follow our instructions.
  13. Do you feel pressured into making an immediate decision?
  14. Does the practice look clean and well organised? To do implant surgery a dental practice needs to provide service at the same level as a hospital operating theatre.
  15. And finally do you feel at ease? It might sound a little corny but we like to treat every patient the same as we would our own family.

We wish you all the best on your journey to a having a beautiful smile.


Want to learn more or book a consultation? Visit our Contact Us page and complete our enquiry form or call us on 02 9389 3656, we’ll be happy to help answer your questions.

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