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

Question

A person have really failing teeth. Their upper front four teeth are loose due to years of neglect. They already have a removal bridge on the lower front four and the dentist recommended the all on-four procedure. The person smoke and drink and he has explained the risks and their going through with it. What really happens if they fail?  reduced to dentures?

Scott Young, DDS · Answer

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.

Jyoti Singh, MDS · Answer

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.

Dushyanth Paul, MDS · Answer

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.

Ivan Chicchon, DDS · Answer

Although implant "failure" sounds scary, it is usually correctable with a few additional procedures. If one of the implants supporting the all on 4 fails, it usually happens during the healing period. That means that the implant can be removed and a new one can be placed before your final set of teeth are made. This is usually not an issue. 
However, sometimes bone loss can occur gradually over time and can lead to failure many years after the prosthesis is placed. This is less common and can be more difficult to remedy. Still, there are many prosthetic optional for patients for which the All-on-4 treatment did not work. A prosthodontist is a master problem solver so you will be in good hands no troubleshoot things that may come up.

Saj Jivraj, DDS · Answer

Firstly i would definitely concentrate on prevention and hygiene before the procedure is done. The patient has to take some responsibility for the success of the restorationI would also get a medical evaluation just to ensure the overall health is OKIf you have a failure in this procedure it is just like any other implant procedure, we have to wait for healing and replace the implant. I have to date not seen a situation where all of the implants have failed. This procedure with attention to detail is a very successful procedure and the patient enjoys huge benefits by literally getting their life backWe wish you all the best

Tamara Rojas, DMD · Answer

All on four is ideal for some cases but not for all. Should you have failure of an all on four case you probably did not have enough implants to support the biting forces you have. Now your options ( this needed to be backed up with a consulation by as specialist) : place additional implants as more than likely not all four failed. Bone graft as necessary then place implants on a future date. Finally you can always have something removable.

H. Ryan Kazemi, DMD · Answer

It's important to realize that all-on-4 treatment, is only one option. Its success depends on many factors that must be properly diagnosed before it is recommended. The fact is, it is not for everyone. In some patients, I might recommend all on 5, all on 6, or all on 8 strategy. Your surgeon can collaborate with your restorative dentist and make a recommendation that is right for you. With proper diagnosis, planning, and appropriate treatment option, the overall success increases significantly. It is best to prevent failure than managing it.

Scott Greenhalgh, DDS · Answer

There is almost always a back up plan if an implant were to fail. You've described some hard conditions in your mouth and that you have already had a number of problems.

	A great implant dentist always has an option up their sleeve, so odds are very low that you would have to go to a regular denture. 

	BUT, only 10% of patients can actually wear a full denture. For most people they can't chew, they can't really smile because the denture will slip, and they feel embarrassed and they think it must be their fault. This is a miserable existence--I would advise you to do EVERYTHING possible to avoid winding up there.

	Go in every three months for prevention visits, use Sonicare, have the office apply Prescription strength Fluoride. 

	All-on-four is a great solution. It can work really well. No replacement can endure tremendous neglect, but there are fall-back options.

Daniel B. Strader, DDS · Answer

Smoking and drinking can certainly increase your risks with implant stability. Even so, probably you would not have all four implants fail all at once. If one did fail, it could probably be replaced based on the available bone to hold an implant.

Brian Dorfman, MD, DMD · Answer

The All on Four Dental impalnt procedure is a highly successful procedure with years of clinical evidence. I will qualify this statement in that you must seek a reputable surgeon to perfom this specialized technique. Make sure they are a Board Certified Oral & Maxillofacial Surgeon. Also the procedure must be done with Nobel Biocare Implants to be called All on Four. The only legitimate research has been done with Nobel Biocare Implants, be very aware of clinicians trying to cut corners with cut rate "cheap" implants. Also, Dr Rega makes a good point, it is easy to replace a failed implant if the procedure is done with a computer generated surgical guide. If one happens to fail it can be replaced in the exact location. You will just have to wear a temporary denture in the interim or the prosthesis you wear during the healing of the implants will have to be adjusted to accommodate the 3 implants (this can only be done in certain situations). I agree with the others in that you need to quit smoking if you are going to make this investment in your future.It is fairly uncommon for one of the implants to fail if placed by a properly trained surgeon, but it does happen to all of us for no apparent reason on rare occasions. All on four is just one treatment option and more implants is most always better if financially feasible, this way if one impalnt fails, there is no problem supporting the prosthesis.

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

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