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Alternatives to "All on 4"

The replacement of all of the teeth in an arch can be achived with a complete denture or an over denture or an implant supported bridge. The implant bridge is often considered the ultimate treatment option for a person who has lost all of their teeth. Four (or sometimes more) implants are required, and a fixed bridge is then made and connected to those implants. The resulting prosthesis is secure, functional and aesthetic. 

This form of treatment is sometimes referred to as "All-on-Four" and refers to the fact that all of the missing teeth have been replaced by a bridge attached to four implants. The typical design of the prosthesis sees it screwed into place on the implants. Whilst this creates security for the patient in that they know the bridge can never accidentally come lose, it does also make cleaning underneath the prosthesis quite tricky and sometimes it is nearly impossible. 

An alternative to the All-on-Four concept is for the bridge to be retained by precision attachments instead of by being screwed into place. The precision attachments allow the bridge to be seated very securely, but, once a day, the patient is able to remove the bridge (usually with some effort) for cleaning. They can then clean the bridge out of the mouth, brush their implants, and then replace their bridge back into their mouth. It thus functions as securely as the screw-retained bridges do, but has the unique ability to be removed when desired, for cleaning. 

A failing dentition

A failing dentition

This lady presented with her teeth in very bad condition. She had decay under many of her old crowns and needed multiple root canal treatments and gum surgery in order to keep them. The long term outcome did not sound positive. 

A tough decision

A tough decision

After considering all of her options, she decided that the predictability of keeping her teeth even after all of that treatment, was still going to be low. She decided to replace her teeth with implant bridges.

After implant placement

After implant placement

This photo shows only the lower arch. Her teeth have been replaced with four implants, and small, conical-shaped attachments were connected to the implants. These small attachments are only visible when the bridge is removed (so normally they cannot be seen or felt) and are simple to clean each day.

The upper arch bridge

The upper arch bridge

This photo shows the upper bridge. It also was made to fit over four small conical attachments on four implants. As it can be removed periodically by the patient, cleaning the bridge or cleaning the gum and implants becomes very simple.

The lower arch bridge

The lower arch bridge

The lower bridge was similar in design. The bridges can be quite fine, or they can be thicker with some pink added to them, if the person is needing some additional lip support.

Conical attachments

Conical attachments

This photo nicely shows the undersurface of one of the bridges. The gold caps fit precisely over the titanium cones on the abutments in the mouth, and this 'press-fit' makes a very firm and solid connection. The bridge then feels as tight as if it is screwed into place, and it will not unexpectedly come loose. 

The bridges fitted into place

The bridges fitted into place

A good, solid bite is achieved with these firmly connected bridges in place. They are comfortable, functional, and secure.

The finished smile

The finished smile

The final bridges create a beautiful aesthetic result too !