Teeth In A Day | All On Four | Immediate Load

If you are facing the decision to replace some or all of your teeth, you probably have heard about All-on-X, All-on-4, or Teeth in a Day. If you do some research on the web you will find several marketing names which in essence address the same thing – cost-effective, comfortable, and expedient restoration of the one or both jaws with a prosthesis supported by dental implants. Dental implant solutions are becoming increasingly popular, and more people are asking for these treatments by name. But what are they and are they different procedures?

What are the Differences Between these Treatments?
All use similar techniques. All-on-Four or All-on-X, as the names suggest, will use just four dental implants or more to restore a complete arch of teeth. Teeth in a Day is based on the same principle. The technique involves maximizing the use of your jawbone by optimally locating your dental implants in areas where the jawbone is naturally stronger and thicker and teeth may be placed during the same procedure. Hence the term “Teeth-in-a-Day”.

Does the Whole Treatment Process Take One Day to Complete?

That would be great but unfortunately, the answer is No. The most important part of the whole process which is surgery and placement of the temporary bridge does take one day.

Usually, several appointments are required for the fabrication of provisional teeth and pre-surgical preparation. You may also need to come back several times for the follow-up care and adjustments after the surgery. It also takes several appointments to fabricate a final bridge.

All in all, it may take around 9 months or more to complete the whole treatment.

How Does Treatment Work?
Usually, two dental implants are inserted right at the front of the mouth, and at least an additional two are placed further back, providing greater stability. It’s a treatment that is extremely appealing for anyone who has suffered substantial jawbone loss, perhaps because of periodontal disease or because they lost their teeth quite some time ago. It’s a treatment that can help avoid additional bone grafting, can be more cost-effective, and is suitable for people who cannot have a bone graft, perhaps because of medical reasons.

Not surprisingly, the idea of supporting a complete arch of teeth with just four dental implants is very enticing. There might be occasions where four dental implants aren’t sufficient to provide adequate support for a complete arch, and this might be the case when restoring an upper arch with implant teeth. Our dentists will determine how many dental implants are needed to ensure your implant treatment is a long-term success. Hence, the term All-on-X can be referenced in your treatment.

Who is a Candidate for this Procedure?

Patients with hopeless, compromised, and missing teeth, who are in good general health and have adequate jaw bone are candidates for this type of restoration. Factors that are taken into account and which determine if you are a good candidate for this approach include:

State of your general health
Condition and state of your jaw bone
Condition and state of the remaining teeth

What are the Pros and Cons of All-on-Four / Teeth in a Day?

Advantages:

Expedient and comfortable restoration of teeth and oral functions
Minimizes or completely avoids the need for bone grafting
Provisional teeth connected to the dental implants on the same day of surgery
Maintains jaw bone over time
Reduced cost in comparison to some implant options

Disadvantages:

Complex treatment
Risk of surgical complications (see the section below)
Risk of restorative complications (see the section below)
Expensive (much higher cost than dentures and higher cost than some implant options)

Who is a Candidate for this Procedure?

State of your general health
Condition and state of your jaw bone
Condition and state of the remaining teeth

What are the Success Rates with All-on-Four / Teeth in a Day Procedure?

All-on-four / Teeth in a Day procedure is supported by clinical research. For an experienced team success rate of dental implants is in the area of 95%.

After your implant treatment is completed, it’s especially important to maintain excellent oral hygiene and schedule regular dental visits. That way, you can make sure your dental implants last a lifetime.

What is the Treatment Process?

This treatment includes the following steps:

Initial evaluation
Fabrication of provisional teeth and pre-surgical preparation
Surgical procedure and connection of provisional teeth to the dental implants
Fabrication of a final bridge
Maintenance stage

All-on-4 / Teeth in a Day is an interdisciplinary approach and the treatment team typically includes a restorative specialist (prosthodontist), a surgical specialist (oral surgeon, periodontist, anesthesiologist), and a dental technician.

Do Provisional Teeth Always Get Connected to the Dental implants on the Day of Surgery?

It is desirable to connect provisional teeth to the dental implants since fixation of the provisionals provides better comfort for the patient. However, in some instances, it is not always possible to accomplish. For example, the stability of the dental implants in the jaw bone may not be adequate to support provisional teeth. In that case, an immediate removable denture is given to the patient. Although less comfortable it provides a cosmetic and functional replacement for the missing teeth.

What to expect during surgery

Dental implant surgery is an outpatient surgery. Every patient is different and surgical protocols are custom-tailored to your specific needs.

In a typical surgery, bad teeth (if present) are removed with the aid of a local anesthetic, bone grafts are placed as required, and the jawbone is prepared to accept the placement of your dental implant. Then the necessary amount of time is allowed for your implant to integrate or fuse, to your jawbone.

Once healed, your implant dentist will take molds or optical scans of your mouth to custom-make your artificial teeth. In a few short visits, you will enjoy the benefits and comfort of your new teeth.

For those patients undergoing the full arch “teeth in a day” procedures, you can expect to have all diseased teeth removed and leave the office with a temporary version of your new teeth that same day, and return at a later date for placement of the final versions.

Enjoying your new smile

Dental implants look and feel like natural teeth. Compared to dentures, it’s much easier to eat, smile, and talk with dental implants. You won’t have to worry about “clicking noises” or feel anxious about what food is “safe” to eat. You can stop feeling embarrassed by your smile and start living the way you want to.

Does the Whole Treatment Process Take One Day to Complete?

That would be great but unfortunately, the answer is No. The most important part of the whole process which is surgery and placement of the temporary bridge does take one day.

All in all, it may take around 9 months or more to complete the whole treatment.

Although dentures are a common choice for missing teeth because of their affordability, they aren’t without faults. If you’re tired of shifting and slipping dentures, irritated and pinched gums, not being able to eat the foods you want, but want to prevent bone loss in your jaw, you can opt for a better way to replace your missing teeth.

How Dentures and Bridges Impact your Dental and Mental Health

Dentures do more than harm your confidence in social settings. They may also speed up the rate at which you lose bone tissue in your jawbone.

When dental roots are missing, the jawbone is no longer stimulated enough to create new bone tissue. Within the first year, approximately 25% of the bone density is lost in the areas where there are no dental roots in the gumline. Dentures and crowns may mask the cosmetic issue, but they don’t address bone loss in the jaw, which ultimately leads to a weaker jaw bone.

Description of Treatment

Most simply stated, this treatment describes the process of receiving a temporary acrylic (esthetic resin) set of teeth that screw onto four to six implants on the same day that the implants are inserted. The concept allows people to avoid experiencing a removable denture and the inherent difficulties of dentures.
What is the process?
It is a miss conception that it only takes one day to get your new implant teeth. The most important and critical part of this treatment is the planning and preparation process. It cannot be stressed enough that this treatment needs to be planned and performed by well informed and highly trained dentists. The process includes these main steps:
1. Initial consultation and examination
2. Diagnostic records: impressions, photos, bite registration, and Conebeam CT Scan
3. Discussion and presentation of plan:
  – Review risks of proposed plan
  – Review sequence and guidelines
  – Arrange surgery and teeth delivery
4. Surgery:
  – Remove teeth
  – Insert implants same day
  – Insertion of immediate/temporary acrylic teeth
5. 24 hour evaluation
6. 1 week evaluation
7. 8 to 12 weeks healing (more time may be needed)
8. Fabrication of final prostheses (4 to 6 visits)
Treatment Dilemma

Implant companies are encouraging Dentists everywhere to offer this treatment to their patients because they know the value dental implants can be for so many people. The dilemma lies in the fact that many Dentists want to provide this treatment for their patients, but may not have received the proper training to adequately do so. In attempts to get some form of training, they attend weekend courses that provide various degrees of information regarding the process. The only formal education and training available regarding the history, techniques, literature, research, and clinical experience are found in advanced dental specialty residency programs. The most highly trained dentists with respect to this type of treatment are generally Prosthodontists.
Advantages
The major advantages are related to avoidance of a denture. As a result, most people experiences consists of less discomfort immediately following the implant surgery. There is less pain and an easier transition to the loss of their teeth and the addition of new artificial teeth.
- Improved comfort
- Non-removable
- Better function
- Provides a future back up interim prosthesis when repairs may be needed
- Preservation of bone around the implants during healing
- Predictable
- Provides a trial run with new teeth (aesthetics and function) prior to fabricating the final teeth
Who qualifies for this Treatment?

This treatment is a great option for anyone who desires a highly functional and aesthetic option to replace all their teeth. Candidates may include those who have already lost all their teeth or those who are going to lose all their teeth in the future. With proper planning, most people have adequate bone for the use of strong quality implants of regular size. Again, the importance of proper planning and understanding of success and failure of implants is critical. In some situations, one’s bone may not be adequate for implants. In many instances, success can be obtained by augmenting the bone (grafting of the jaw or in the sinuses) or through the use of more advanced implant techniques and procedures (zygoma or trans-sinus implants).
What are the disadvantages?
- Added cost
- Possibility that the implants may not be stable enough to immediately load
- Greater chance that people will overuse/abuse their implants during healing
What are the possible complications?
Sometimes the implants are not be sufficiently tight in the bone as needed in order to screw a temporary bridge onto them the same day. If this happens, you’ll be required to use a temporary denture while the implants heal (about 3 months).
- The all acrylic bridges may break during the healing time
- The screws that hold the temporary bridge may loosen or break
- The abutments that screw into the implants may loosen
- Implants may fail
The above listed complications may be minimized, and in most cases avoided, if proper planning and guidelines are followed. If the listed complications occur, most are correctable with minimal affects to the outcome of the treatment. Screws can be tightened and replaced and breaks in the acrylic can be repaired. If an implant fails early on, a new one can be placed and the prosthesis adjusted.

One thing that is important to state is trying to avoid repairs during the critical healing that occurs 2-4 weeks after the initial implant surgery. At weeks 2-4, the bone is actually weaker adjacent to the implants as a result of the natural healing process and as such any unnecessary movement or torquing of the healing implants should be avoided.
What are the final teeth like?

There are various options available to restore ones teeth with a final definitive prosthesis. The final prosthetic teeth should be discussed prior to starting as the different options have different requirements for proper aesthetics, strength, implants, and function. The basic options include but are not limited to:

Hybrid
Metal framework screwed to the implants with denture teeth

Zirconia Pratau Bridge
Dense strong full zirconia one piece bridge

Zurick, Promax, or Component Bridge
One-piece framework screwed to the implants with individual aesthetic crowns cemented to the framework

Bridges or Implant FPD’s
Three separate implant bridges of metal and porcelain, zirconia, or zirconia and porcelain