I have really failing teeth. My upper front four teeth are loose due to years of neglect. I already have a removal bridge on the lower front four and my dentist recommended the all on-four procedure. I smoke and drink and he has explained the risks and I am going through with it. What really happens if they fail? Am I reduced to dentures?
If the Implants That Support an All-on-four Fail, What Are the Treatment Options?
Doctor Answers (9)
All on Four
If you are going to proceed with the all on four treatment and are concerned of implant failure, just make sure your surgeon does it with a computer guided stent. If an implant fails, it can be placed exactly where is should go under your teeth. I am pretty confident that all your implants are not going to fail. If there is a failure it may just be one implant. It would be beneficial to stop smoking, just for the investment you are placing in your mouth.
All On Four Is a Highly Successful Procedure.
The All on Four Dental impalnt procedure is a highly successful procedure with years of clinical evidence. I will qualify this statement in that you must seek a reputable surgeon to perfom this specialized technique. Make sure they are a Board Certified Oral & Maxillofacial Surgeon. Also the procedure must be done with Nobel Biocare Implants to be called All on Four. The only legitimate research has been done with Nobel Biocare Implants, be very aware of clinicians trying to cut corners with cut rate "cheap" implants. Also, Dr Rega makes a good point, it is easy to replace a failed implant if the procedure is done with a computer generated surgical guide. If one happens to fail it can be replaced in the exact location. You will just have to wear a temporary denture in the interim or the prosthesis you wear during the healing of the implants will have to be adjusted to accommodate the 3 implants (this can only be done in certain situations). I agree with the others in that you need to quit smoking if you are going to make this investment in your future.It is fairly uncommon for one of the implants to fail if placed by a properly trained surgeon, but it does happen to all of us for no apparent reason on rare occasions. All on four is just one treatment option and more implants is most always better if financially feasible, this way if one impalnt fails, there is no problem supporting the prosthesis.
All on 4 and possible implant failures
It's important to realize that all-on-4 treatment, is only one option. Its success depends on many factors that must be properly diagnosed before it is recommended. The fact is, it is not for everyone. In some patients, I might recommend all on 5, all on 6, or all on 8 strategy. Your surgeon can collaborate with your restorative dentist and make a recommendation that is right for you. With proper diagnosis, planning, and appropriate treatment option, the overall success increases significantly. It is best to prevent failure than managing it.
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If One Implant that Supports All-on-Four Fails, What Are The Options?
There is almost always a back up plan if an implant were to fail. You've described some hard conditions in your mouth and that you have already had a number of problems.
A great implant dentist always has an option up their sleeve, so odds are very low that you would have to go to a regular denture.
BUT, only 10% of patients can actually wear a full denture. For most people they can't chew, they can't really smile because the denture will slip, and they feel embarrassed and they think it must be their fault. This is a miserable existence--I would advise you to do EVERYTHING possible to avoid winding up there.
Go in every three months for prevention visits, use Sonicare, have the office apply Prescription strength Fluoride.
All-on-four is a great solution. It can work really well. No replacement can endure tremendous neglect, but there are fall-back options.
Should one or more All-on-four implants fail
Smoking and drinking can certainly increase your risks with implant stability. Even so, probably you would not have all four implants fail all at once. If one did fail, it could probably be replaced based on the available bone to hold an implant.
Board Certified Periodontist and Implant Practitioner
All on four is ideal for some cases but not for all. Should you have failure of an all on four case you probably did not have enough implants to support the biting forces you have. Now your options ( this needed to be backed up with a consulation by as specialist) : place additional implants as more than likely not all four failed. Bone graft as necessary then place implants on a future date. Finally you can always have something removable.
5 Things To Keep In Mind With Your All On Four Case
There are several things to keep in mind as you try to gauge how successful that your All On Four procedure will be. Here is a list of things to consider:
1. Smoking and drinking alcohol does increase the chance that you could have one or more implants fail. You may not have any problems at all, but certainly need to be aware that this could happen.
2. It would be wise to choose a surgeon that will utilize a 3D CBCT (CT Scan) in planning your case to ensure that the dental implants can be positioned appropriately and placed where the bone quantity is good. If the bone is not of good quantity, then a bone grafting procedure may be required prior to placement of the implants.
3. If the implants are spaced evenly it will be easier to keep the occlusal (chewing) forces equal on all implants. You have a higher percentage rate of an implant failing if it is placed under more stress than the others.
4. Should you have an implant fail it does not mean that the others will fail. If one fails a bone grafting procedure can be performed and a new implant placed at a later date.
5. Follow all pre-op and post-op instructions that your surgeon gives you to ensure optimal healing from your surgery.
All on four, none on three
There is a joke amongst dentist, "All on four, none on three.". Most dentists will suggest "whatever needed."
Implants sometimes fail. They can often be replaced, so dentures are not a given should they fail, and normally only one would fail, not all four.
All on four is a very successful treatment.
Failing all on four
I am not a fan of all on four precisely because of that problem but I have referred several patients to clear choice and seen excellent results.
The majority of my patients have snap-in restorations on 4 implants. They feel like fixed resorations but are much easier for patients to care for. Loss of a single implant temporarily decreases stability slightly but is easy to add back an implant. If all on four loses a key implant it can be converted to a snap in prosthesis.
I usually utilize 4 implants with four mini implants which are loaded immediately while the larger implants are left undisturbed during healing. The minis usually remain when the primary implants are loaded giving emergeny back-up if ever needed.
An interim prothesis that looks and feels great is then used as a template for the final work. I find that a high-end esthetic result for the patient is important versus the one size fits all teeth in a day approach. Should the patient decide on fixed work they have an opportunity to try out their new smile prior to finalization
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.