Peter Spanganberg, DDS (in memoriam)

As an Oral and Maxillofacial Surgeon who performs both TMJ surgery and the All-on-4 procedure,  I can say without reservation that you can have the All-on-4 procedure completed.

The various types of implanted supported teeth are like tools in a tool box, each tool serves a purpose..... and I’m serve you’ve heard the adage; “when all you have is a hammer, everything becomes a nail.”

An implant supported bridge is a great option, but only if you have lost teeth only. Once you begin to lose bone, the overlying tissue recedes with bone loss and it becomes what is called a composite defect. In situations where a composite defect exists, you would need to compensate for the lost bone and tissue by either making the teeth longer, or by leaving a gap between the teeth and tissue; either way, it would be an extremely unesthetic look.

In the case of a composite defect, you then consider the All-on-4. The addition of the pink material is designed to bridge the defect between the teeth and the tissue.

A more cost effective fixed option for the lower jaw is called the Trefoil. It is a fixed bridge, similar to the All-on-4, but with only 3 implants. It was designed by Nobel Biocare as a fixed option for those patients who can not afford a more expensive option.

The All-on-4 technique is unquestionably successful. The first research paper describing the All-on-4 was published in 1998 by Dr. Palo Malo. Over the past 20 years the data has repeatedly shown that the long term success rate of the All-on-4 is in the range of 98-99%.

In the early days of the concept, detractors would say “All-on-4, none on 3” to imply that the All-on-4 doesn’t work because you would lose the teeth attached to the implants if one of the implants was lost.... the reality is that there is now an implant procedure for the lower jaw called the Trefoil, that allows for a fixed set of teeth on three implants. This too is proving to be a predictable and highly successful procedure.

The key to a successful outcome is having a surgeon that has the skill set necessary to complete the procedure, a quality implant that provides a high rate of success, and a dental laboratory that understands the concept and refuses to cut corners in the materials they use.

You will find a wide range in pricing being offered for the “All-on-4“.... I would though make a point of clarification. The purpose of the All-on-4 treatment is so that you will not have to ever wear dentures. If a provider uses the term “denture” while discussing the All-on-4 with you, that should be a big red flag that they might not truly understand the concept.

The wide variation in quoted fees for the All-on-4 is due to the fact that there is an equally wide variation in the skill set of the providers completing the procedure, the quality of the implants being used, the type of materials being used for the teeth, etc.

No matter what the product or service is, we are always eager to find the hidden deal.... I’m sure you’ve heard the adage; “If the offer appears too good to be true, then it probably is.”.... this is unquestionably true with implant dentistry.

The All-on-4, when completed correctly, using quality implants, and a dental lab that truly understands the concept is a phenomenal, life changing procedure! Patients are sedated during the procedure so that they don’t feel any discomfort, the procedure is completed and they leave a few hours later with new teeth attached to their implants. It is a highly successful, highly predictable procedure. But when done correctly, it is also expensive. It is going to cost $20-25,000 per arch (upper or lower jaw).

You will absolutely find dentists in the Phoenix area, or in other countries, that are offering treatment for less than this amount.

As an Oral and Maxillofacial Surgeon, I perform the All-on-4 on a regular basis. I also lecture on behalf of the company who developed the All-on-4 concept, Nobel Biocare, teaching other surgeons on how to perform the All-on-4 and Trefoil implant procedures. I am seeing more and more patients who have had this type of procedure completed elsewhere and are now looking for help to correct the problems that exist with they’re outcome. Invariably these patients selected their provider because the price was right and they felt like they were getting a good deal.

Remember; “The bitterness of poor quality remains long after the sweetness of low price is forgotten.”

The scenario that you’ve described certainly points to a lack of professionalism on his part. But of greater concern is your description of continued numbness and the radiographic evidence of the implants being situated too close to the nerve. I would strongly recommend that you obtain another opinion with a Surgeon, and consider using a specialist for any further treatment, or revision of the work that’s already been completed, if in fact it has been completed incorrectly.