All-on-4, acrylic or or zirconia porcelain?

I am very confused which is better. I heard that porcelain looks better and acrylic does not chip? But does the acrylic last? What is the life span for these types of arches? I would hope they would not have to be replaced in 10 years. Is All on 4 a lifetime solution? I am 54 and don't want to have this expense again in 10 years.

Doctor Answers 9

Zirconia or Acrylic titanium

There are many options for the restoration

Zirconia - This is the ultimate option where there is a combination of strength and cosmetics. Most patients feel that this is the option that is the closest to the feel of their natural teeth. The material is very rigid and if upper and lower jaw is being done it is recommended to use a material that is not so rigid in the lower jaw.It has been around for approximately 10 years or so. This means the follow up is not as long as other options. 

Acrylic Titanium - This option does have long term follow up, the advantage of this option is that it is easily repaired should you sustain trauma to the teeth. It has some resiliency meaning that with impact the force is not at easily transferred to the implants. It does stain over a period of time but this can be cleaned and polished readily

For a full mouth solution a combination of materials is recommended to have the esthetics of zirconia and the resiliency of acrylic titanium .

Zirconia versus Acrylic Hybrid WILL ANSWER A LOT OF QUESTIONS YOU MAY HAVE

As with any medical/dental procedure, there are pros versus cons for ANY treatment, by ANY clinician. Every option has a "lifespan" or "shelf-life" for how long the restoration should last. Ultimately, the longevity of the restoration heavily relies on patient factors (i.e., genetics, overall systemic health longterm, cleaning recall frequency, home hygiene, clenching/grinding of teeth, smoking, etc. etc.).

Prosthodontic care for missing teeth should be thought of in a “chronic condition” context.  You must recognize that long-term outcome monitoring is necessary.Think of a prosthetic arm or leg: As with any other body part that needs to be replaced as a result of an amputation, there is maintenance!

The overall goal of the All-on-4 (Fixed bridge implant bridge) protocol is to restore a terminal or missing dentition. The dentist/dental specialist restoring the case is giving you a tooth substitute (not replacement).  Since we cannot implant natural teeth, the two most common substitutes are: 1. Acrylic  or 2. Zirconia.

A combination that is used more and more is an upper zirconia bridge opposing a lower acrylic bridge. 

I've seen some patients that come in for second opinions that have very PRETTY Acrylic bridges, but also some with very UGLY Acrylic bridges. Zirconia bridges are the same, some are very esthetic, others are VERY OPAQUE, dead looking, and can look "Less-natural" than an Acrylic bridge. Ask your dentist to show you some ORIGINAL work, not stock photos.

Each have its pros and cons:

ACRYLIC: 
Description: Typically a titanium milled (CAD/CAM) bar connects the four implants. Acrylic denture teeth are set on the bar, tried in for approval of esthetics, and the teeth are processed (connected to the bar) with a pink acrylic. So in essence, there is 3 layers: the bar, the teeth, and the pink acrylic that connects everything.

There needs to be necessary room for all layers (14-16mm), otherwise the bridge will not fit in the space provided.  Many times repairs/breaks on the acrylic hybrid All-on-4 bridge are a result of the minimized space; either the teeth or the acrylic has to be thinned out, weakening the strength. 

PROS: 
Cost is Less (denture teeth come  "stock," mass-fabricated)
Easier to repair 
Acrylic is softer, so there is a "give" to the bite, for grinders they will slowly wear away the acrylic, similar to natural teeth. However, if the material is more stiff (Ceramic) a grinder can chip the restoration (too brittle). 

CONS: 
Staining more frequent
Delamination (Debonding) of tooth from acrylic
Wear is faster
Higher repair; in a study in the Journal of Prosthodontics, 255 patients were followed up for an average of 13 years, and approximately 58% had one or more prosthetic events (i.e, chipped/broken tooth, loose implants screw) during that recall period.  Overall survival rates at 20 years were 86% for prostheses (bridge), 15% survived free of any event, and 92% experienced survival free of biological implant failure. 


ZIRCONIA:
Description: A monolithic, high-strength material that is directly fitted to the 4 implants (without a titanium bar). 

PROS:
Zirconia is Harder than Acrylic (for grinders they will slowly wear away the zirconia compared to acrylic)
Can layer porcelain for more esthetic, natural look (should be as minimal layering as possible)
No chance for tooth delamination/debonding (All one piece)
Can be used in limited space situations (12-16 mm of space)


CONS: 
Cost is Higher (requires expensive milling/sintering machinery, custom hand finishing/detailing)
Very Opaque (porcelain can be layered, or added to improve esthetics, but the porcelain can chip)
Harder to repair (since the material is all one piece, if a "chip" occurs, the entire bridge needs to be replaced, OR a ceramic veneer can be glued to the front surface of the bridge as an alternative)
Too Stiff (because of the incredibly stiff nature of the zirconia there is a potential for catastrophic failure from fracture of the entire zirconia bridge)

As with all comments, ask a professional Prosthodontist in your area what treatment best suites your needs.

Ace Jovanovski, DMD
Round Rock Prosthodontist

Zirconium or Acrylic: All on 4?

You are definitely making a sound decision in considering the All on 4 Hybrid Denture. The process will include placing the implants and depending on the clinician or the patient's finances, the prosthesis could be supported by the bar or not. There is a temporary prosthesis that is fabricated initially. This prosthesis is normally made in acrylic. Now aesthetically, it looks good, but you are right-- there is wear, which will result in breaking and/or chipping of material over time. So the acrylic denture maybe a questionable option, if you are looking for durability and longevity.
Porcelain zirconium provides the durability and longevity, and also the aesthetics. This is becoming the more popular material used in fabricating this prosthesis. Labs are becoming more innovative with processing this material too make it more life-like. This could be the ideal choice for someone looking for aesthetics as well as longevity for the All on 4 Hybrid Denture. 

James Magee, DDS
Altamonte Springs Dentist

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All on 4 acrylic or zirconia

Acrylic teeth on an all on 4 look better than zirconia . However the zirconia companies are getting better but I feel they are not there as far as esthetics .  You can have them layered with porcelain but this can fracture .
As far as durability zirconia will be more durable and will last and not chip.
if you do chose acrylic teeth they have the longest trac record they will wear and will chip but they are easily repaired . The teeth can be replaced easily in a few days . 
Remember this technique is relatively new less 11 years in the US.

some doctors have concerns about zirconia against zirconia and are not recommending it this product is very new (a few years )so the jury is still out

Thomas R. Gonzales, DDS
Las Vegas Dentist
5.0 out of 5 stars 1 review

Material for the All-on-4 teeth.

There is nothing that will be implanted or placed in your body that will last a lifetime.  No procedure can ever be guaranteed.  That being said the replacement of all your teeth is one of the procedures that will last a very long time if taken care of and managed properly.  If you are 54 chances are you have 30-50+ years of maintenance and possible replacement.
Materials do break and need maintenance. Acrylic does wear and the teeth may break off.  If using Zirconia ceramic monolithic teeth, there is no fear of wear or breakage.  If you choose to use any porcelain (glass) there may be more fractures over time.

Good luck.

Longevity and Aesthetics Make The Decision

Acrylic is generally cheaper and lighter, but won't last as long as zirconia and will not look as realistic. So, if money is not the driving force in the decision, then Zirconia is the way to go. "Lifetime" is a tough expectation to put on the longevity of any dentistry because materials aren't indestructible. It also depends on the bite that the all-on-4 is set to. If it's a proper, neuromuscular bite, then there's less stress on the arch, but there are also things like your eating habits, proper care of the dentures and implants, regular hygiene appointments, etc that will all affect how long the dentures last. Zirconia ultimately will last longer because it's a stronger material. Also, depending on the restoration such as a denture or bridge, even though the technique is called 'All-On-4', you will likely need more than 4 implants if you opt for Zirconia because it's a heavier material and will require more support.

George Sepiashvili, DDS
Westchester Dentist

Acrylic versus zirconia teeth for the All on 4 procedure

Your question is a great one!

One of the biggest factors in determining which type of teeth would be best for you is to know what the opposing arch has.
If you're All on 4 prosthesis will be opposing acrylic denture teeth, then you should go with acrylic teeth.
If however you're posing arch has porcelain or zirconia, then you should go with a zirconia All on 4 prosthesis because it will wear much better.

I hope you found this information to be helpful,
Dr. Champagne

Prettau Zironia is the strongest material in Dentistry

Gone are the days of sacrificing top-tier beauty, precision, and price in order to gain the strength offered from full-contour Zirconia restorations. We’d like to introduce you to the future of highly aesthetic Zirconia bridges, The Zirkonzahn Prettau bridge. Prettau Zirconia is far more translucent than Zirconias of the past. Combine this with staining techniques applied by world class dental technicians, and you’ll see a bridge the likes of which were unimaginable in regards to strength and aesthetics. By eliminating veneered porcelain, you are not only sure to avoid chipping, but also eliminating wear on opposing teeth. Whether you opt for the Prettau bridge or our in-house milled PMMA/Titanium bridge, our experience allows for an even higher level of predictability for your restoration.

Zirconia dental bridges are more durable than acrylic

The acrylic option is usually for a more budget conscious person, but what isn't often discussed is durability.  Monolithic zirconium doesn't chip like a layered feldspathic porcelain but also is not porous like acrylic.  After 8-10 years, the acrylic tends to harbor a smell/taste that requires replacement in order to remove.  Zirconium does not.  Also, the acrylic will wear out over time, faster if chewing against porcelain or natural teeth.  Some places design the case with porcelain on top teeth and acrylic on the lowers, knowing that in 10 years the lowers will be replaced due to wearing out (similar to how tires become "bald" the teeth become very smooth and worn down).

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.