If the Implants That Support an All-on-four Fail, What Are the Treatment Options?

There are several things to keep in mind as you try to gauge how successful that your All On Four procedure will be. Here is a list of things to consider:

1. Smoking and drinking alcohol does increase the chance that you could have one or more implants fail. You may not have any problems at all, but certainly need to be aware that this could happen.  

2.  It would be wise to choose a surgeon that will utilize a 3D CBCT (CT Scan) in planning your case to ensure that the dental implants can be positioned appropriately and placed where the bone quantity is good.  If the bone is not of good quantity, then a bone grafting procedure may be required prior to placement of the implants.  

3.  If the implants are spaced evenly it will be easier to keep the occlusal (chewing) forces equal on all implants.  You have a higher percentage rate of an implant failing if it is placed under more stress than the others.  

4.  Should you have an implant fail it does not mean that the others will fail.  If one fails a bone grafting procedure can be performed and a new implant placed at a later date. 

5.  Follow all pre-op and post-op instructions that your surgeon gives you to ensure optimal healing from your surgery.  

There is a joke amongst dentist, "All on four, none on three.". Most dentists will suggest "whatever needed."

Implants sometimes fail.  They can often be replaced, so dentures are not a given should they fail, and normally only one would fail, not all four.

 

All on four is a very successful treatment.

I am not a fan of all on four precisely because of that problem but I have referred several patients to clear choice and seen excellent results.

 

The majority of my patients have snap-in restorations on 4 implants.  They feel like fixed resorations but are much easier for patients to care for.  Loss of a single implant temporarily decreases stability slightly but is easy to add back an implant.  If all on four loses a key implant it can be converted to a snap in prosthesis.  

I usually utilize 4 implants with four mini implants which are loaded immediately while the larger implants are left undisturbed during healing.  The minis  usually remain when the primary implants are loaded giving emergeny back-up if ever needed.

An interim prothesis that looks and feels great is then used as a template for the final work.  I find that a high-end esthetic result for the patient is important versus the one size fits all teeth in a day approach.  Should the patient decide on fixed work they have an opportunity to try out their new smile prior to finalization

If the teeth could not be saved at any cost . A proper diagnosis and treatment  planning is mandatory in such cases. 
In the scientific literature it is mentioned that if a patient smokes  10-12 cigarettes per day, risk of implants failure would increase upto 70%. A thorough tobacco quitting protocol should be followed at least 2 and if possible for 3 weeks prior to implant surgery and  2-3 weeks post surgery. 
Alcohol has a synergistic effect with smoking and interferes with the medications given for implant healing after surgery. So if someone takes good care of All - on 4 prosthesis. Regular annual visits and check ups and strict oral hygiene practices are followed implant will survive with a 90-95 percent survival rate provided patient is keeping tobacco consumption low. Also apart from this there are other medical situations too like high blood pressure or blood sugar which contributes to bone loss around implants and leads to failure. 
Now answering your question even if an implant fails. Doctor needs to see the possibility of grafting at the place where the implant has failed. 
After grafting the site and few months wait , reimplantation can be made possible and prosthesis can be redone. And thus it is important to practice oral hygiene practices diligently specially with implants as they give way easily than natural teeth. 

All on 4 is one of the most successful procedure(99.6 % success rate),  if performed by an experienced team. Its very very unlikely that all implants fail (never seen till today). If an implant fails, we always can add another one depending on the position. At times we need to graft and wait for 4-6 months, before adding another implant. The prosthesis may need to be repeated / modified after adding a new implant.