Best Way Forward?

All on 4 implants placed in maxilla (7 years) and prosthesis has fractured twice and cracked 3 times necessitating the construction of another one. Had new fixed bridge 3 years (reinforced with metal along back of teeth) which cracked along one side. Found fractured screw when taken off and unable to remove. Advised implant has to be removed and dental specialist says can replace removed implant with immediate placement of another. Says pioneering procedure and ? risks. Opinions please.

Doctor Answers 5

Problems with all-on-4 implants

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This is a great treatment modality for many people. However some people may be better served with a different treatment plan. I am assuming that your prosthesis is a screw retained one-piece appliance that has a metal framework with teeth and gums over it. If you do not have any excessive bite forces or clentching/grinding habits then it should not break so easily or so often. If you do have these issues then you may be better off with an overdenture that clips on the implants but is removable at home to clean and sleep.

There are may reasons that can cause your problems. I mentioned one already. Also: poor quality of lab, poor quality of design, poor quality of materials, poor quality of implant system used, bite not adjusted properly.

The fact that you have broken it several times and broken a screw would lead me to believe the problem might be with your bite.

Many implant companies make fractured screw removal kits. so you may not have to have the implant removed and replaced.

Immediate implants are done all the time by experienced surgeons. I would not consider it a pioneering procedure anymore, but with your bite issues I would be weary of oveloading it, which could lead to non-integration. Many times all-on-4 on the upper arch needs 5 implants.

Good luck

Dr. T

Miami Beach Dentist

Your dental implant treatment..............................

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Dear Jess,

Hello I am Dr. Amit Goswami, from Delhi Dental Center in New Delhi India. the 1st thing is all-on-4 is all-on-4 till the time you have all 4 implants with your self -- if you loose any one on them then it become none-on-3....................

see the best thing you should do is instead of the replacement of your failed implant -- add some more implants to your bone -- see when we take out an implant too much of bone around it will also has to be sacrificed along with the implant ... now even if you place a immediate implant there with bone graft ... the bone will not be strong enough ............. get 2 more implants in your jaw bone  -- now with these new implants you will have 6 implants and the support will be good enough for the prosthesis -- then tendency of further fractures will go down ........

next thing when you will get new set of teeth get a lower night guard made for your self as i think that you might have a clenching habit at night time because of which you had cracks in your prosthesis again and again............



Amit Goswami, DDS
India Dentist

All on 4 implants

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I am not a fan of the all on 4 restorations for the upper, but it does seem to be popular since 4 implants are cheaper then 6. You are experiencing just what most of us dentists try to avoid - not enough implant support or restorative strength to withstand the forces in your mouth. As to the broken implant screw, they are usually easy to retrieve with the right instrument. Removing an implant does destroy a lot of bone around the implant so I would question an immediate replacement. With all the complications you have been through I would recommend seeing another dentist to explore the options that would be right for you. We are all different and a cookie cutter all on 4 does not work for everyone. Best of luck. 

Thomas R. Froning, DDS
Littleton Dentist

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While this is a treatment choice successful in some, in many others, complications are evident. It is always best to stage the treatment and place more implants for adequate support of a prosthesis. I generally place at least 6 implants and a work closely with our prosthodontists to fabricate a balanced and precise prosthetics. I recommend, remove the poorly positioned or poorly healed implants, allow the site to heal or graft if bone is inadequate and place the new implants as second stage.


Dr. Kazemi

H. Ryan Kazemi, DMD
Bethesda Oral & Maxillofacial Surgeon
5.0 out of 5 stars 7 reviews

Best way forward?

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I assume you still have natural teeth on the lower arch? If so, you must start with looking at your bite the way upper and lower teeth come together. If your upper has fractured that many times your bite must be off and that should be address before you start doing everything over again. Good Luck



Kevin Coughlin DMD, MBA, MAGD     CEO Baystate Dental PC

Kevin Coughlin, DMD
Springfield Dentist

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.