ALL ON 4, who's an ideal candidate?

Hi and thank you for your question:
Typically in my office there are two specialist that examine the cases together, my partner (prosthodontist) and my self (Oral Surgeon). Over the year of working together we analyze every case individually and take into account everything from finances to health history:
1- There are cases that have decay in every tooth in their mouth and for this cases, doing an All on four or six vs, restoring every single tooth the way they should , saves them thousands of dollars because it becomes cost prohibitable.
2- Patients  that have been dealing with periodontal disease all their life, spending thousands of dollars only to hear that they need to have more surgery and at the end loose the battle to periodontal disease. We take in consideration the stage of periodontal compromise, degree of bone loss , monies expent by the pt. to help them decide and make a proper decision, before there is no bone left requiring extensive surgery to create the bone in hopes that this would work ( I have seen this too many times).
3- There are cases that loose multiple teeth over the years as well as bone and to be restored to a functional mouth, the amount of bridge work or implants needed, make it financially prohibitable for the pt. as comparared to an All on four or six.
I hope this helps you decide what to do!!
Good Luck to you,
Dr. Arroyo, Oral Surgeon

Some Medical conditions can affect the success of All on four procedure. Conditions such as , Patient under radiotherapy or chemotherapy, Patients with uncontrolled Diabetes, Heavy smokers. Patient under IV fosamax or simillar medications, Patient who are under long term high doses steroids, patient with serious cardiac conditions and under blood thinner and can not stop medication for medical reasons.  Sometimes a combination between these medical condition and Jaw bone condition where extensive jaw construction is needed to perform the case but the medical condition and healing abilities for patient is not ideal. 

An ideal candidate for the All-on-4 procedure is a healthy patient, non smoker, good bone width and height as well as low force factors. Success rates are as high as 95% and can change your life. 

A younger patient, such as in their 20s, 30s, and early 40s, may choose an alternate option if available. This is because the typical All on 4 case requires significant bone reshaping in order to make room for the prosthesis. Once this is done, the bone is reshaped for life. As a periodontist, my main objective is to save teeth whenever possible, unless there are ethical reasons not to. There are extreme cases where so much bone atrophy has taken place, that implants would be risky in terms of nerve damage or even fracture of the jaw. In some of these cases, if the All on 4 procedure does not work, the patient may need to accept a removable full denture as an only alternative. 

The candidates to looking for a all on 4 are patients who seek to have a prothesis that is fixes the patient can not remove by itself, this increases the confidence, security and self-esteem of the patient that the prosthesis will not fall.
Talking about the need to make a bone graft or not depends on the need whether the bone is adequate in quality and quantity.
Potencial candidates are those who have total prostheses that fall and patients in which the remaining teeth are very deteriordos and the cost-final result does not provide the expectations of a satisfactory aesthetic change.