When is ALL on 4 the Right Treatment Plan?
Posted on 7/3/2023 by Greg Kammeyer
|Given we now have clinical research covering over 20+ years, using a minimum number of implants for full arch (Jaw) immediate teeth, a key question is “how many implants should we use for All on X ?”
In the lower jaw, very often 4 implants is enough. The bone is very dense (oak to pine wood), and few of these lower jaw implants fail using the All on 4 approach.
In the Upper jaw, it’s a whole different story: The bone is much softer (balsa wood to Styrofoam), the forces are much more off axis so parafunction (grinding and clenching) wreaks havoc with the posterior most implant. Most often, the patient’s teeth being removed or denture will tell the story on how much force they put on their teeth. Also I routinely palpate the masseter muscles, as they hypertrophy and get more firm with over use. So in the upper jaw I will most often use 5 or 6 implants. Rarely in the extreme cases I will use 8 upper and 6 lower implants.
Dr Carl Misch noted: “over build the case”. The emotional, time, financial etc costs for the patient and the dental team are much higher than in routine restorative dentistry.