ALL-ON-4 – About the treatment

Immediate smile reconstruction!

Thanks to the All-on-4® method, we make dreams of a beautiful smile come true in literally one day, even if you were advised against using standard implants due to your bone condition.

What is the All-on-4®?

All-on-4® (i.e. “all teeth on 4 implants”) is an innovative technique for tooth reconstruction developed by Dr. Paulo Malo using Nobel Biocare® implants. The All-on-4® procedure allows patients to obtain new permanent teeth in one day and without bone grafting.

What is the All-on-4® treatment?

On the day of the procedure, the patient is implanted with 4 implants in appropriately selected places in the maxilla and/or mandible. A fixed bridge with full teeth in the smile line is mounted on the implants on the day of the procedure. After half a year, the first (“temporary”) bridge is replaced with a permanent bridge reinforced with a special titanium beam (obviously invisible and imperceptible).

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Photos courtesy of prof. Paulo Malo. Presentation at the corporate forum sponsored by Nobel Biocare at the annual congress of the European Association for Osseointegration, Lisbon, 27 September 2019.

Who is the All-on-4® method dedicated to?

  • patients with severe tooth loss or severe periodontal disease
  • patients who are tired of wearing removable dentures
  • patients whose bone deficiencies make it impossible to place implants in a conventional way
  • patients who want to improve their appearance, quality of life and regain the joy of smiling

Bridges mounted on 4 implants look and function like natural teeth, and the rehabilitation period is reduced to a minimum.

Read an interview with Doctor Wiesław Frankowski about the All-on-4 procedure here.

Why is it worth investing in the original
All-on-4® procedure?

The original All-on-4® procedure is detailed and highly predictable. It is backed by nearly 30 years of research. Therefore, the success rate in the course of treatment with this method reaches 98%.

What are the benefits of the ALL-ON-4®?

LESS TREATMENTS

The All-on-4 treatment takes place in one day. Both the necessary extractions, tissue cleansing, implantation and tooth reconstruction take place in “one go”. This limits the number of your visits to the office to 3: consultation, preparatory pre-treatment appointment and the procedure. A new fixed bridge is made in the on-site laboratory and placed just a few hours after the implants are inserted. Importantly, the All-on-4 procedure does not require typical procedures for implant treatment, in particular bone reconstruction, which can extend the treatment process even up to 1 year.

Importantly, the All-on-4 procedure does not require typical implant treatments, in particular bone reconstruction, which can extend the treatment process by up to 1 year.

NO PAIN (AND FEAR)

It may surprise you, but the All-on-4® treatment does not hurt (!). This is because the patient receives very effective local anaesthesia and tranquilizers. However, if your fears do not allow us to calm you down, we also provide anaesthesia in the form of sedation or general anaesthesia under the care of an anaesthesiologist. Importantly, the recovery period after the procedure is also painless.

NO BONE GRAFT

With traditional implant placement, a bone graft is usually necessary, because after many years, the jawbone in place of missing teeth atrophies and is too weak to hold the implant. In the All-on-4 method, the implants are placed in 4 computer-defined locations, so they are not limited to a specific area. Therefore, we do not need to improve the condition of the bone for the implant to stay in it.

REDUCED COST

There is no denying that tooth replacement is always an expensive procedure. This applies to both implants and dental bridges. The All-on-4 procedure may seem very expensive at first. However, when comparing the cost of conventional implant treatment, i.e. the cost of individual implants and their reconstruction, as well as the cost of the entire care for almost a year, the All-on-4 price turns out to be definitely competitive. The costs of the aforementioned bone graft, possible lateralization of the nerve, cleaning of the sinuses, etc. are also gone.

FULL SET IN ONE DAY

The main advantage of the All-on-4 compared to other methods of tooth reconstruction is time. The second is quality and convenience. Not only does the metamorphosis of the smile take place almost immediately, but the effect of natural beautiful teeth and the comfort of wearing them cannot be overestimated.

THE ALL-ON-4® METHOD STEP-BY-STEP

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What is All-on 4® Permanent Bridge?

A bridge is a prosthetic work made of the highest quality materials, i.e. titanium, porcelain or high-quality acrylic. The bridge is deceptively similar to natural teeth, significantly improves speaking and chewing functions and, of course, facial aesthetics.

The bridge is easy to clean, so you will not have problems with maintaining proper hygiene.

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THE INSERTION OF IMPLANTS

The surgeon places 4 titanium implants in the jawbone and/or mandible at points previously planned based on the patient’s tomography.

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The Multi-unit connector

Special connectors are attached to the implants, on which a permanent bridge is then mounted.

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THE TEMPORARY BRIDGE

The temporary bridge is permanently screwed on the day of surgery. The bridge is fully functional and very aesthetic.

We have 4 versions of All-on-4®

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STANDARD

4 implants embedded without additional procedures within the maxilla/mandibular area
** Subject to sufficient bone quantity and quality in the patient

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HIGH SKILL

4 standard implants with additional bone/tissue preparation
** Subject to sufficient bone quantity and quality in the patient

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HYBRID

2 standard implants and 2 zygomatic implants or 3 standard implants and one zygomatic implant
** In the case of insufficient bone quantity in the jaw

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EXTRA MAXILLA

4 zygomatic implants
** In the case of severe bone loss in the jaw

What to expect during the consultation?

I

During your first visit to FRANKOWSKI DENTAL the specialist will check the condition of your teeth and gums. Then we will take a panoramic photo and computed tomography. Based on imaging using a special computer program, Dr. Frankowski will assess the condition of your bones within the jaw and/or mandible and offer you treatment options.

II

If the recommendation is the All-on-4® treatment, the Doctor will recommend the appropriate version of this treatment for your conditions. He will explain to you how he plans to perform the procedure and justify the choice of a specific option: standard, high skill, hybrid or extra maxilla.

III

Then, the Patient’s Assistant will tell you about the entire treatment process. You will be able to ask any questions that bother you. We choose the form of anaesthesia, the date of the preparatory appointment and the date of the procedure. We are now past the preliminary stage.

THE DAY OF THE PROCEDURE

I

The day of the procedure will be divided into two parts: surgical and prosthetic. In the surgical part, implants will be embedded and all necessary treatment activities will be performed. Then you will rest for a few hours in a special room, where we will cool the places affected by the surgery and take care of you. During this time, our technician will create a bridge for you, which we will then attach to the embedded implants. END of the first treatment phase.

II

After 10-14 days, you will return to us for the removal of stitches and the first control. Then we’ll see each other every two months. On the third visit (after about 6-8 months) we’ll start the second stage of treatment, i.e. impressions and fittings for the final bridge. This usually takes several weeks. Finally, we replace the temporary bridge with the final one and… DONE! You can enjoy your new smile forever.

ALL-ON-4® TREATMENT SCHEDULE

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ZYGOMATIC IMPLANTS

In the case of patients with severe bone loss, zygomatic (yoke) implants are the optimal solution. Zygomatic implants differ from traditional dental implants in that they are attached to the zygomatic bone (cheekbone) rather than the jawbone. They have a different, elongated shape and require a more complex procedure. It is a great alternative for patients that dramatically shortens the time of dental reconstruction and allows patients suffering from severe jawbone loss to return to a normal quality of life. In a great number of cases, the teeth are fixed on the day of the procedure. In this way, the patient avoids the multi-month cycle of invasive bone graft procedures in order to create the basis for conventional implants.

Who are zygomatic implants for?

It is worth considering the All-on-4® treatment with the use of zygomatic implants if:

you have been told that you have insufficient bone in your jaw and are not eligible for implants

you smoke cigarettes habitually and treatment with conventional implants is not recommended (due to the high risk of complications).

you want a durable alternative to loose dentures

Preparation for the treatment

I

Before placing zygomatic implants, we will perform a CT scan, thanks to which a specialist implantologist will precisely plan the placement of implants. The next step is to create a structural model of the jaw (the “template”), which will allow us to assess the shape of your cheekbone and jaw and perform the operation accurately.

II

The zygomatic implant procedure is usually done under deep anaesthesia, so you won’t feel any pain or discomfort. The operation will be supervised by a team of specialized medics headed by an implant surgeon and an anaesthesiologist.

III

Most likely, we will fix the bridge on implants on the same day. The recovery period lasts only a few weeks and is not associated with pain or the need to withdraw from life. Very quickly you start to function as if you had your own natural teeth.

Remember!

Having a bridge mounted on implants requires daily oral hygiene. In addition to the appropriate toothbrush, toothpaste and mouthwash, we recommend using a water irrigator (e.g. Water Pik), which will thoroughly clean the spaces between the gum and the bridge. You can optionally use Superfloss dental floss. You will also need visits to the hygienist every 6 months, during which we will professionally clean your bridges so that they will serve you for many years.

Frequently asked questions

Yes, the patient really gets new teeth in one day. It seems amazing, but it’s possible thanks to three of our strengths:

First of all, Frankowski Dental uses the original All-on-4® procedure, which is implemented step by step with the use of compatible high-quality components. This allows the procedure to be carried out efficiently and provides full medical safety.

Secondly, Dr. Frankowski, who performs the procedure, is a specialist with over 30 years of experience and above-average knowledge in the field of implantology gained from the greatest celebrities of dental surgery, including the creator of the All-on-4® method, Dr. Paulo Malo.

Lastly, Frankowski Dental has its own, well-equipped laboratory, thanks to which the bridge mounted on implants is made on-site right after the implantation procedure. The technician works closely with the doctor and the patient, so there is no need to send the work to an external prosthetic laboratory, which significantly shortens the time of its completion.

Usually there is no such need. The procedure does not require deep sleep, local anaesthesia is enough. To reduce the level of stress (which is natural in such situations), the patient is given special tranquilizers. In difficult cases, the procedure can be performed under general anaesthesia or sedation.

Most patients who have dental implants experience mild discomfort after the procedure. The anaesthesia usually lasts a little longer than the procedure itself, so most patients won’t feel anything until the next day. Some may experience slight swelling and bleeding, but this is part of the healing process and is completely normal. If the patient experiences pain, it can be easily relieved with ordinary painkillers, or those obtained at the clinic.

However, aspirin derivatives should not be taken until the tissue has healed, as acetylsalicylic acid may cause bleeding complications. Patients receive additional recommendations before and after the procedure along with the documentation. Each patient also has time to discuss their questions and concerns with the surgeon.

It all depends on the complexity of the procedure and its scope. The implantation procedure usually starts at 9.00 a.m. and lasts several hours. Then the patient rests in a special room, on a comfortable sofa under a blanket. They can watch TV or sleep and relax, cool the operated area with special equipment and receive light liquid meals and drinks.

During this time, the technicians prepare the bridge, which will be attached to the implants after previous fittings. When the bridge is ready, usually in the late afternoon, the doctor installs it on the patient, we refine the details and it’s ready! You can go home with a new smile on your face.

Swelling or slight bruising may occur a few days after the procedure. Patients usually do not feel pain, but sometimes experience slight discomfort in the mouth. However, the body adapts to the new conditions quite quickly. Within a few days, patients get used to the new quality, although sometimes it takes a little longer. However, everything depends on the individual predisposition of the patient. No one recovers the same way. It is important to strictly follow the doctor’s instructions and take all prescribed medications.

Of course. We encourage someone close to the patient to make the waiting time more pleasant while we prepare the prosthetic work. Nevertheless, the whole team tries hard to make every patient feel comfortable and safe. We offer not only medicines, but also a smile and a kind word.

It all depends on the individual characteristics of the patient, but usually within a few days patients start to function normally, and after a few weeks they do not feel any symptoms.

We care for the bridge on implants just as we care for our own teeth. However, there are special brushes and tools that can make it easier for you. Initially, patients should use a toothbrush with an angled neck, which will make it easier to reach places that are difficult to reach with a regular toothbrush. After that, a simple soft brush is enough. We also recommend using dental floss and interdental brushes to clean the space between the bridge and the gum. You should clean your teeth and spaces at least twice a day.

In addition to daily care of the teeth, regular visits to the hygienist are necessary, who will remove the structure and thoroughly clean it as well as the patient’s own tissues. Such professional implant hygienization should take place every 6 months. Thanks to this, your new teeth will serve for many years and we will prevent infections around the implants. Importantly, only then is the work guarantee valid.