I would like some clarification regarding dental implants? (Photo)

After some research, my choices are an "all-on-4" solution or 6 implants in each jaw with either crowns or bridges. My concerns are regarding food becoming lodged under the screwed on dentures and if the same problem would occur with crowns or bridges. Could you please explain the difference in my two options and which option limits food entrapment and provides a greater level of comfort with less required maintenance. Also, what are the chances of a periodontal disease problem with implants?

Doctor Answers 5

Prosthetic options for implants

All on four and other implant retained full fixed bridges requires same or more care than natural teeth. Success of implant osseointegration does not make them last forever. Some infections (Peri-implantitis) could arise on patients with poor oral care. Regular check ups are required, professional cleaning and other specific at home care are required for example the use of waterfloss (waterpick) to avoid food underneath the bridge.Between all on four and 6 implants holding a full arch bridge is exaclty the same. full arch fixed bridges (a bridge is crowns fused between them) requires a titanium frame holding a denture made with different materials (acrylic, composite, porcelain, porcelain fused to metal, or zirconium).
It is important that prosthetic options for edentulous patients that want implant retained dentures are:OverdenturesAll on Four, all on six and all on eight.Full Fixed arch bridgeHybrid dentures 

Dominican Republic Dentist
4.8 out of 5 stars 34 reviews

All-on-4 vs All-on-6

While food entrapment can occur with any of these two options, I follow a protocol for All-on-4 or All-on-6 where temporary teeth are connected to the implants the same day of surgery and then allow 6 months of healing to take place. At 6 months a final impression for a second set of teeth is taken capturing a more matured healed anatomy. This allows for less likelihood for food entrapment due to a more stable adaptation of prosthetic teeth to natural gum. The chances of peri-implantitis is greater with cement retained teeth vs screw retained. Also, the way your teeth fit together is critical in preventing excess forces that can traumatize or overload the bone.

John Paul Gallardo, DDS
Miami Periodontist
5.0 out of 5 stars 30 reviews

"All on 4"

No matter which option you choose, meticulous, daily oral hygiene is going to be essential.  It is always better to go with 5 or 6 implants instead of just 4. " All on 4" could turn into "None on Three" if even one of the implants fails.Fixed bridges retained on implants can be even more difficult to clean than a Hybrid Titanium bar / acrylic implant retained denture. Fixed bridges will cost more than the hybrid denture option.   I will say again that 5 or 6 implants will be best to consider.

Food trapping under prosthetics

The more implants the better for support and restorative options.  Properly fabricated restorations will minimize collection of food, however maintaining good oral hygiene will always be essential.

Joel Klasfeld, DDS
New York Dentist
5.0 out of 5 stars 3 reviews

Clarification regarding dental implants

The problem with all on 4 is that if one implant ever fails and needs to be removed, you will have a major problem and major additional expense.  It would be much better to have 6 implants upper and 6 implants lower if you can afford it.  Then you could have "all on 6" or fixed bridgework.  Either of these will require diligent daily home care and regular 3 month maintenance visits for cleaning by your dental hygienist or dentist.  This will be your best way to prevent periodontal disease around your implants.   For easier maintenance, a removeable implant supported locator retained prosthesis would be a good alternative. This prosthesis can be removed daily or more frequently if necessary, giving you direct access to clean around the implants and remove any food or debris that may have gotten under it.

Gary Braunstein, DDS
Encinitas Dentist
5.0 out of 5 stars 6 reviews

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.