Who Is the Right Candidate for All-on-4 Dental Implants and How Is That Determined

*Collaborative Post

One of the greatest developments in implant dentistry in the last few decades is All-on-4. It provides a fixed full-arch restoration for a patient with failing or missing teeth using only four implants, sometimes without bone grafting. Before offering All-on-4 to a patient, experienced dentists like Erskine Dental Care go through a comprehensive evaluation process to ensure that a patient is suitable for the treatment and that it will yield optimal results. All-on-4 is not appropriate for every patient and requires a different approach depending on the patient. 

What the Assessment Process Involves

A thorough clinical evaluation is the first step in deciding if a patient is an appropriate candidate. This includes high-resolution imaging, usually a cone beam CT scan, which gives a three-dimensional view of the jawbone. A CT scan enables the clinical team to evaluate bone volume, bone density, and anatomical structures that affect implant placement. The clinical team also assesses general health, medical history, current medications, and any medical conditions that may influence healing or implant integration.

Bone Volume and Why It Matters

All-on-4 is designed specifically to work in patients with reduced bone volume. With these implants, the back two implants are sloped to fit into the remaining bone under missing teeth, particularly if the teeth have been missing for a while and have resulted in bone volume loss. This is the main benefit of the technique over traditional full-arch implant procedures, which often involve bone grafting in cases of inadequate bone quantity. There is, however, a minimum bone volume threshold where even angled implants cannot achieve reliable stability. If a patient’s bone volume is less than this threshold, another treatment method may be needed. 

Bone Density as a Separate Consideration

Bone volume and bone density are not the same thing. However, both are essential for All-on-4 implants. If the bone volume is sufficient, it implies that there is enough bone available to hold an implant. Adequate bone density is defined as the bone being dense enough to provide the stability needed for the implant. The upper jaw is also less dense than the lower jaw, which is why the success of All-on-4 in the upper jaw should be carefully assessed and requires experienced clinical judgment. A CT scan provides the information needed to assess density alongside volume.

General Health and Systemic Factors

Some medical conditions and medicines make implant treatment unsuitable. Diabetes can make healing more difficult, as well as increase the risk of infections occurring around the implant. Certain drugs, such as those that are prescribed for osteoporosis, can interfere with bone metabolism and raise the risk of complications with the implant. Active smokers are at greater risk of implant failure than non-smokers. None of these factors means that a patient should not be considered for treatment. Each factor is evaluated on a case-by-case basis and does not automatically disqualify patients from treatment. 

Patients Who Fall Outside the Ideal Profile

All-on-4 may not be suitable for everyone who has failing teeth or extensive tooth loss. Some people may need preparatory treatment before the implant can be placed. Others benefit from a different implant protocol. If the bone volume is not adequate even for angled implants, bone augmentation can be used as a preparatory procedure, but this increases the time and complexity of the treatment. If systemic health concerns are causing unacceptable risk, other restorative treatment options may be considered that do not require implants.

What Patients Can Expect From a Thorough Assessment

If the All-on-4 evaluation is carried out properly, a patient can get a clear picture of treatment and the outcomes before committing to treatment. A thorough evaluation determines if the technique is suitable for their situation, what preparations might be required, the realistic time frame, and what other options are available if All-on-4 is not the best choice. This information can help patients make an informed decision, instead of agreeing to a treatment without knowing if it is the right one for them.

*This is a collaborative post. For further information please refer to my disclosure page.