When considering life-changing dental solutions like All-on-4 dental implants, it's easy to get swept away by the promises of a brand new smile and improved functionality. However, beneath the glossy surface lies a more complex reality that potential candidates should be aware of before diving in headfirst.
If you're contemplating this transformative journey, make sure you consult thoroughly with an experienced practitioner who understands and can provide all of the most current treatment options available. This will ensure that you're not being pushed into a treatment option simply because it is all the practitioner knows.
Irreversible Bone and Gum Removal
When you embark on the journey toward an All-on-4 dental implant procedure, one of the most critical yet often overlooked aspects is the irreversible removal of bone and gum tissue. The All-on-4 is effectively a denture that doesn't wrap around the gums but is instead anchored to them. This creates an unsightly transition line from the fake gums to your real gums that must be hidden so that it doesn't show up when smiling or laughing.
The Basics of Bone and Gum Removal
When we smile with our natural teeth, some of us show a lot of gums, some show a little, and some only show teeth. The All-on-4 prosthetic includes fake gums (the denture portion) that will bump up against the patient's natural gums. This creates an unsightly transition line from the fake gums to real gums that ideally is hidden behind the lips so that it doesn't show up when smiling or laughing. In order to hide this line, the dentist must remove a significant amount of healthy bone and tissue from the patient's mouth so that they can place the prosthetic deep enough so as not to show the transition.
Once that bone and the gum tissue is removed, it is gone forever. This may not seem like a big deal, but if an implant fails, the patient has very few options remaining to restore their teeth. If you're considering All-on-4 implants, it's crucial to have an informed discussion with your dentist about these irreversible changes. Understanding what’s at stake will empower you to make a decision that aligns with both your esthetic goals and oral health needs.
Artificial Feeling in the Mouth
One of the most commonly reported issues with All-on-4 dental implants is the artificial feeling they can impart in the mouth. For many, this sensation can be jarring and may detract from the overall experience of having a restored smile.
The Reality of Artificiality
When you first receive your All-on-4 implants, it's normal to expect a seamless transition into normalcy—after all, these are designed to look and function like natural teeth. However, many patients note a persistent sensation that reminds them they are wearing something artificial. Psychological issues of accepting the bulky foreign prosthetic in the mouth can be difficult to manage, but many All-on-4 patients also suffer with physiological issues such as excess drool, decreased taste of food, and difficulty speaking properly.
Why Does This Happen?
Replacing More Than Teeth: Replacing teeth with teeth can already be a significant enough change to require some getting used to. For All-on-4 patients however, they must also get used to having a big portion of their gums replaced with what amounts to a permanent denture.
Lack of Sensation: Unlike natural gums with living nerves, the denture portion of the All-on-4 does not provide sensory feedback. This absence can create an unsettling disconnect between what you see in the mirror and what you feel in your mouth. Eating, kissing, and other activities can feel unnatural.
The Emotional Toll
The psychological aspect should not be overlooked either. Imagine being on a date and anticipating some kissing at the end of the night—certainly could give some concern about what the experience will be like for the other party! For some individuals, this artificial feeling can lead to frustration and dissatisfaction with their new dental arrangement.
Unattractive Esthetics When Lips Are Retracted
While the promise of a radiant smile often drives individuals to consider All-on-4 dental implants, one facet that isn't always discussed is the unattractive esthetics that can emerge when lips are retracted. Picture this: you are at dinner with friends and you are trying not to laugh too hard so you don't show the fake gum line under your lips. That's no way to live.
Hiding The Transition to Fake Gums
Is the transition line really that unsightly? Well, there's a reason that All-on-4 dentists don't show pictures of their patients with their lips pulled back: they don't want you to see what's under the hood! They know that looking at a fake pink denture doesn't get people excited about spending a lot of money, so they hide these images and instead only show images with their patients smiling naturally.
With an ideal All-on-4, the dentist removes enough bone and gum tissue so that even with your biggest smile, it won't show the transition line between the fake and real gums. This is a double edged sword, because you don't want the transition line to show, but you also don't want to remove healthy bone and gum.
In some unfortunate cases, dentists don't remove enough bone, resulting in the unsightly transition to the denture being visible when the patient smiles. This can be extremely embarrassing and disappointing to a patient who has spent tens of thousands of dollars. Beyond the esthetics, this can further increase speech and eating problems for the patient.
The Esthetic Dilemma
When the lips are pulled back, whether for a wide grin or an enthusiastic conversation, the contrast between the artificial materials and natural gum tissue can become glaringly evident. Patient might expect to see:
Visible Gaps: Depending on how well the implants fit and look in relation to your existing gums, there may be noticeable gaps or unevenness that detracts from an overall pleasing appearance. While patients may hope to not have gaps, dentists often create gaps in intentionally to try to make the prosthetic easier to clean.
Color Mismatches: Many patients find that their prosthetic does not perfectly match the color of their existing gums. This increases the self-consciousness of the patient and their hope to hide their smile from those around them.
Challenges in Proper Cleaning at Home
One of the most significant hurdles that All-on-4 patients face is accessing the areas that need to be cleaned. Because bone and gums are removed, the area that needs to be cleaned is much higher in the upper jaw and lower in the lower jaw. Patients often have difficulty maneuvering their hands with enough dexterity to floss or brush in these areas. These pesky areas can harbor debris and bacteria, leading to complications if not addressed properly.
Food Traps
One of the biggest complaints of having any type of denture product in the mouth is food traps. These are areas where the denture portion of the All-on-4 collect food that is difficult to remove. The food traps can present a number of problems:
Irritation: Having food lodged in your mouth can be uncomfortable and even cause pain and inflamation.
Bad Odors: Food that doesn't get removed will quickly begin to breed bacteria. All-on-4 patients often complain of bad odors and a bad taste in their mouth and this is due to bacteria growth on food particles that hasn't been properly cleaned and removed from the All-on-4.
Peri-Implantitis: If not cleaned quickly and thoroughly, trapped food can cause infection of the area surrounding the implant, also known as peri-implantitis. If not treated quickly, this will eventually cause the implant to fail, an expensive and painful price to pay.
The Dentist's Role
It is important to have regular visits with your dentist for proper cleaning of an All-on-4. The dentist can remove the appliance and clean areas that can't be accessed at home. While the recommended frequency of removal may vary, most dentists recommend removing an All-on-4 appliance at least once per year for cleaning. These cleanings are far more expensive than a standard cleaning, often over $500, and usually require replacing the connecting screws that hold the appliance in place.
Continued Bone Loss Due to Insufficient Stimulation
The irony of dental innovation often lies in its unintended consequences. All-on-4 dental implants offer an impressive solution for restoring smiles, but one of the hidden pitfalls is the potential for continued bone loss due to insufficient stimulation. All-on-4 bone loss is a topic that doesn't always make it into the glossy brochures but is crucial to understand.
How Bone Health Works
Your jawbone thrives on stimulation—much like a muscle needs exercise to maintain it's strength and mass. When you chew, your teeth exert pressure on the jawbone, which signals it to maintain strength and density. However, when natural teeth are lost, the lack of stimulation can lead to accelerated bone loss.
As an example, consider what happens to an arm that has been in a cast for a few weeks. When the cast is removed, the arm is slender and without muscle tone compared to the arm that wasn't in a cast. We see similar phenomenon with astronauts in low gravity for extended periods. Scientific study has demonstrated that our bones need to experience significant enough forces in order to maintain their density.
The Consequences of Insufficient Stimulation
Let's do an experiment. Try to apply pressure to the ligaments in your wrist using the palm of your other hand. Now apply pressure this time using your pointer finger. You'll notice that you can create stronger and more isolated forces with a finger than you can with your palm.
The All-on-4 prosthetic is a long, u-shaped denture that acts like the palm of your hand on your wrist. The All-on-4 distributes and reduces the total bone stimulation in the jaw, much like a cast that protects a broken arm from receiving any stimulation. This lack of proper stimulation is called suboptimal loading and can lead to a series of adverse outcomes:
Bone Resorption: When your jawbone doesn’t receive adequate stimulus, it tends to undergo resorption—meaning it starts breaking down and losing density. This process can lead to further complications down the road.
Esthetic Deformities: Continued bone loss can create gaps under your prosthetic, revealing the implants and abutments. Not only do these gaps not look great, but they can make eating, speaking, and other activities awkward.
Implant Stability Risks: Insufficient bone density can potentially jeopardize the stability and longevity of your All-on-4 implants. Imagine investing in a luxury car only for the engine to start to fall apart—frustrating, right?
The Bottom Line
The bottom line is straightforward: while All-on-4 dental implants may seem like an easy fix for missing teeth, they come with a myriad of downsides that must be considered. Understanding these dynamics empowers you as a patient—making it easier to navigate this complex landscape while keeping both your smile and jawbone happy!
The Good News
While the drawbacks and problems of the All-on-4 can feel disheartening, the good news is that All-on-4 isn't the only option for permanent teeth replacement. There are other options available such as the 3 on 6™ developed by Dr. Randy Roberts of Smile Clinic that offer teeth replacement without many of the problems of the All-on-4. Many patients have taken advantage of this option and are thrilled with the results.
The 3 on 6 procedure was specifically developed to address the concerns with bone removal, artificial gums, and ongoing bone loss that come with All-on-4. It consists of three bridges that are permanently secured to six implants. The bridges only have teeth, no artificial pink gums, so it looks natural when the lips are pulled back. In addition, the segmented bridges allow for increased implant and bone stimulation unlike the All-on-4. 5-year studies have shown that many 3 on 6 patients maintain their bone levels and some have even increased their bone levels after 3 on 6 treatment. All of this equates to a smile that patients can hope to keep for the rest of their lives.
Patients should take the time to educate themselves on the pros and cons of the available options before making a decision on which treatment option they prefer. Smile Clinic offers both All-on-4 and 3 on 6 treatment and can let a patient know if they qualify for the 3 on 6, or if another option would be more appropriate. Patients can schedule a free consultation by contacting a Smile Clinic office.
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