Just Had All-on-4 Implants Done - Fairfax, VA

I am in my early 40's and I just had my all-on-4...

I am in my early 40's and I just had my all-on-4 implants procedure done on Wednesday (3 days ago). There were complications during the procedure due to the fact that I'm allergic to sulfites and cannot have local anesthetics containing epinephrine, which are more long lasting and promote vasoconstriction during surgery. Long story short, when I woke up, they gave me the bad news that they could only do the top and had to stop due to risky blood loss. So, what should've been one procedure is now two since I'll have to undergo the whole thing again next week for the bottom!

So, what have I learned so far? Well, I respect all the reviews I've read stating that it was all a breeze and didn't hurt at all but I need to keep it real and tell you that, in my personal experience, this has not been easy breezy! I am on antibiotics as instructed and also on two types of pain management meds, one being a narcotic. The post-op pain has been pretty tough to endure and that's only having had the top done (with only 5 extractions). The day of surgery was manageable, post-op day 1 was pretty bad, and post-op day 2 was really really really bad. I was coughing and spitting up huge blood clots. My entire face swelled up like a balloon, from below my eyes to just under my jaw bone there was huge swelling and it was so black and blue it looked like I was punched in the face in a street fight. My nose swelled up so much I looked like a piggy and it truly felt like the anatomy of the inner nose/sinuses were totally different which is probably from the pressure. My nose hurt from the inside out. My lips also swelled up so much I couldn't close my lips together up until today (post-op day 3). The pressure on the sinuses and the headache from the pressure were also pretty bad.

Today is Saturday (post-op day 3) and the swelling is finally beginning to go down but there is still pain. I have tried to go without pills and it's too much pain to handle. Now, I am not a whimp and can usually toughen things out but this is not a walk in the park. There are so many stitches on the roof of my mouth, way up where the gums meet the new teeth, all the way in the back, and the worst part has been the frenulum (the piece of skin you have that holds your top lip to your gums)... they cut that too to make room for the new teeth and it hurts and burns something crazy. My lips were also pretty torn apart from the surgery.

Funny enough, the teeth themselves feel pretty normal aside from the surgical pain. Of course, since they couldn't do the bottom, I now have top teeth that don't fit the bottom, so that has caused jaw pain and tension that you would not otherwise have.

All in all, I am still on the fence regarding the whole experience and the fact that I am still all black and blue and have to endure this all over again next week probably doesn't help. I am hoping this will all become ok and that it will be just a rough patch that will be worth it in the end.


I'm sorry to hear about the complications you had with the procedure I myself having the exact same procedure on June 18 approximately three weeks from today I asked him straight up to be honest with me how long is it going to hurt how long will it take for most of the pain subsides they told me "there is a little pain if any just a little soreness and swelling "Because the titanium is going straight into the bone and that there is no nerves in the jaw bone itself"'and that a lot of patients are back to work the next day I personally find that hard to believe seeing that I've had two spinal fusions and both times it was torture for the first 2448 hrs. It's somewhat the same kind of procedure titanium being screwed into the bone itself just two different parts of the body. I pray that what they're telling me is right and I'm wrong. I will know soon enough so until then good luck to you hope you heal quickly and I will return hopefully with a positive update! Robert From San Mateo California
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Thank you so much for joining our community!  Your experience is much more difficult than that of most because you have these added complications--I just know there are others out there in your situation (allergic to sulfites and can't use epinephrine) who are wondering how this will be for them.  Unfortunately for you, doctors work very hard to find what works best for the most patients, but are left scrambling when they can't use those methods.  The inability to use epinephrine and minimize bleeding means more swelling, and more pain from swelling.  

But even when things go right, some will have more pain than others.  My mom is built like an ox, strong and seemingly impervious to pain.  She fell down some rickety wooden stairs once, landed flat on her back, and was down for one day.  I think I would have ended up in hospital.  Anyway, when she got her implants, she had a lot of pain and swelling--much worse than most of the people here on RealSelf go through.  So I think that's just variable and some are luckier than others.  The sample size here isn't that big, so you tend to get a lot of extremes :).

Because of your review, I looked up how sulfites and epinephrine are related and it seems like it's a preservative used in the epinephrine preparation, is that right?  I looked it up on the American Academy of Allergy Asthma and Immunology website and it was under a metabisulfite allergy.  It seemed like they were saying sometimes there were metabisulfite-free preparations available, but that also some patients who've reacted with anaphylaxis before tolerate the epinephrine fine even with the metabisulfite.  It's especially interesting as epinephrine is used to treat anaphylaxes in emergency situations.  I'd be extremely interested to hear more about your situation.
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Update on all-on-4 implants

So, as previously explained, the first surgery didn't go well because of excessive blood loss. Less than a week later, I went in for the bottom. This second surgery went much better and I felt like the entire team was ready and on top of things. The recovery was better for the bottom than for the top... less swelling, less bruising, just as much pain though. I took the Motrin 800mg and Percocet more often than prescribed to be able to handle the pain.

So, what is happening now? Well, it's been 19 days since the top was done and 13 days since the bottom surgery. I was pretty uncomfortable most of the time, couldn't eat, couldn't sleep because the bite was off, felt like the teeth were too big on the bottom and too small on the top, etc. I just went in for my first post-op appointment today and they adjusted things and I am pretty comfortable now. So today is actually the first day that I'm feeling like this was actually the right decision. It's not perfect yet but these are temporary teeth and they tell me that all my esthetic and functional concerns will be resolved with the permanents. So right now, I'm feeling pretty good about the whole thing and I'm beginning to feel like I may just have a whole new life ahead of me :)

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After pic


I had the procedure done back in Feb 2014. My pain wasn't super bad, but still took meds. I had to get all my teeth pulled bc of a blood disorder that affected blood flow to my teeth causing infections which would cause me endocarditis bc of avms in my lungs, almost died a few times, so it was time. The only place I had a ton of swelling was the lips. I am gonna be honest, it's been awesome to be able to eat food without wondering if my teeth will break but at the same time these temporary implants turned out horrible. My friends and family told me I looked jacked up..which I agreed. It changed the whole shape of my face and I can't talk without a lisp now. I finally get my permanent ones next month and we are praying they make me look normal again. At least my Dr did admit to saying the shape and size was all wrong and when he took my temps out to make the permanent mold this wk, he actually found out one of my screws was placed in the wrong spot so it was extremely painful for him to try to fix that. He didn't know what went wrong. The temp teeth were not even the same shape as my original teeth and the gum part was so thick and crooked. These last 5 months have been hard. I won't let people take pictures of me, I try not to leave the house much bc embarrassed by the way I look and talk. The Dr promised me my permanent implants will be perfect and I will be 100 percent satisfied! I better be for the amount of money this cost us. So I can keep u all updated on how things turn out next month. But I want to say everybody was super nice, apologetic for the mistake and I do feel more confident that they will not let me leave the clinic till I am in LOVE with my new smile! So in the end I think this will all be worth it.....I hope!!!
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How are you doing? Are you going in on the 18th?
@drummerrob, don't forget that there's a huge amount of nerves in the spinal column, which is pretty unique.  I hope that means you have less pain for this as well!  Have you started a review already?

Any regrets?

Once you get over the weirdness of the whole thing, no regrets. It is not a natural anatomical or physiological process though... none of this is! So you have to fully understand that you are doing this because you have to and because other alternatives would be worse. But don't fool yourself into thinking you'll be "normal" because it is not the normal human state to have a mouth full of foreign objects. So, if you can wrap your head around this fact and get over the mental and physical shock, you will be fine. The process was not easy for me, physically or psychologically but... it's now been just over 2 months since my surgeries and it has been better and better as time goes by. I truly think that the adjustment period is the tricky part but functionally, I can eat and chew almost normally except I have to be careful not to strain the implants. I can smile and they look great even-though they are not the permanents yet. I have no pain now. I have gotten used to sleeping with the mouth guard in my mouth. I can brush normally. Having to use a water pick all the time is odd to me but, as I said, you must understand why you're doing this and that it's better than the alternatives.

Let me know if you have questions.


Had all on 4 here in the UK in February (top) and 3 weeks later (lower). Pain was worse than I expected (had 4 extractions from each) and I didn't get on with Co-Codamol prescribed. Also had steroids for a week but can't remember name. Period between upper and lower being done was awkward eating as new teeth and old partial plate & wobbly own teeth just didn't meet properly. Surgeon tried her best to adjust the bite but as the bottom teeth and plate were going shortly I just put up with the condition. Having said that, walking out of the surgery on day 1 with a solid, fixed set of lovely looking upper teeth felt exhilarating. Had 1 hour train journey home and couldn't stop smiling to myself in the train window, laptop screen and even beamed to myself taking my first ever selfie. Went on holiday to the Amalfi Coast a week later and I have so many holiday pics of me grinning away at the loveliness of it all. The man who never smiled to camera. 4 months on am about to start getting ready for the final set. Have been religious with water pik and have had the occasional whistle from uppers where gum is shrinking - hope that is solved with permanents. Yes it's painful in the beginning, there's a lot to take away and then put in in a single session where a team are working quickly. The mouth, lips and gum (with cavities as well as new implants) are bound to suffer and need time to heal but my advice is go to the bathroom, smile at yourself with your temporary but oh so realistic teeth and think that this winter will pass like all the rest. It does. Good luck to anyone about to go in for all on 4. How amazing it is not to be trying out different chemically fixatives (powder work? paste any better? mint flavoured or natural?), soaking dentures, worrying about smiling, not to mention having to avoid no end of foodstuffs. I heartily recommend it and only wish I'd done it years ago.
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Thank you for that wonderfully honest update.  I think it's so helpful for others.  Sometimes people are so desperate for the implants, they just so happy about it when they finally get them.  But some people need to hear the other side of the story, get the full pictures, so they don't expect perfection.  If I had to choose between implants and dentures, I'd choose implants in a heartbeat, but only because of everything I've learned on here, the good and the bad.

Thank you again!  Your smile looks youthful and natural, even before the perms!
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Personally, I think lisps are so endearing. I wish you the absolute best and I have a feeling that your perms will be worth everything you have gone through!

5 month update

So far so good! Just went in for a pretty awful 6-hour appointment to make the molds for the permanent teeth last week. The implants have healed well and are solidly in the bone. In 2 weeks I go in for the first try-out. If I like it, then they'll make the permanent ones with the titanium bar. If I still want further changes, then there'll be a few more try-outs. I'm aiming to have it all completed by year's end. In the interim, I can eat almost like a normal person, I have a pretty nice smile already, and for the most part, it feels like my own teeth! I am happy I did this!!

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5 months


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Super exciting!!!!!  I hope they do a great job with the perms the first time out.  It can be so tiring, having to keep sending things back!  Thank you for updating us :).
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Clear Choice Dental Implant Center

Great experience so far except for some minor things. I would recommend this center at Tyson's Corner in Fairfax, VA.

4 out of 5 stars Overall rating
4 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
4 out of 5 stars Staff professionalism & courtesy
4 out of 5 stars Payment process
4 out of 5 stars Wait times
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