Our innovative techniques with All On 4 Plus allow us to take impressions and records to start the fabrication process of the final prosthesis immediately after your surgery. We fit customised stents to the implants and these provide the necessary reference points and serve as a first try-in of the teeth in your mouth. From this immediate post-operative try-in, our technicians, using our special methods, are able to ascertain the required changes in terms of aesthetics, function and speech, and go on to then implement these changes into a brand new set up of teeth in wax, which we try in your mouth within 2 hours of your surgery for further fine-tuning.

As the teeth are set up in wax to your individual requirements and specifications, our clinicians are then able to make any further adjustments to attain the final aesthetic and functional result.

We use a High Impact Acrylic material, which is processed and fabricated after the aesthetics are finalised at the try-in stage, which often takes place on the very same day. Within the processed acrylic there is a stiffening bar to give the prosthesis additional support and rigidity. The connecting cylinders that are used to attach the prosthesis to the fixtures are processed within the prosthesis, which ensures a reliable connection and ultimate fit. Processing and finishing of high impact acrylic takes approximately 12 hours, so it would typically be inserted the very next day.

In a bid to save costs and make the process even quicker, an alternative method that we have seen involves the retrofitting of a pre-made denture onto the fixtures. The dentist would make a standard denture before the surgery, and would then fit metallic cylindrical collars to the fixtures and make holes in the denture where the cylinders emerge. The cylinders are then attached to the pre-fabricated denture through the openings with plastic material. This makes the prosthesis rigidly attached to the implants, and albeit less than ideal, one other possible interpretation of an immediate fixed bridge. But there are numerous issues with this method, most concerning of which are the following:

• cleaning is extremely difficult because the denture cannot be adjusted to ideal contours as that would cause loosening and detachment from the metallic cylinders, which attach it to the implants. It often results in bad odors and taste in your mouth, which leads to inflammation and potential bone loss around the supporting fixtures
• The method of attaching the metallic cylinders to the denture is not reliable, and the bond is susceptible to break down around one or more of the connections, resulting in the elimination of the advantageous cross-arch stabilization when all the fixtures are reliably attached to the prosthesis. This may result in overloading and failure of the implants.

Those who adopt this method agree with the above, but often argue that the prosthesis which they fit immediately after surgery it is only for a temporary period of 3-4 months while the implants are healing, after which time they would convert it to something that is more reliable. At the All On 4 Clinic, our philosophy is that we do not want to place the implant ‘ecosystem’ under strain, and especially not during the most critical period of initial healing. The problems with the fixtures otherwise may not be evident immediately, but this alternative and cheaper method may cause longer-term issues with peri-implant health, which cannot be reversed.

In addition, we also do not believe that three to four months is an adequate period to allow us to diagnose the nature of the bite and the direction of the forces in your mouth. It then follows that when using alternative methods that force you to have another prosthesis after that time, apart from those additional hidden costs, it might not be the right type of restoration for the long term. At the All On 4 Clinic, we generally advocate wearing our final bridge solution for 3-5 years before deciding on whether to replace it for the same type or to upgrade to other options. During this time the prosthesis may start to show signs of stress in certain cases, such as hairline cracks, which would provide us with key information about the magnitude and direction of forces in your mouth. When the forces are beyond the tolerance of the acrylic material a breakage may occur. When breakage is a result of vertical forces, then upgrading the base material would be the treatment of choice, whereas if a tooth shears off due to excessive horizontal forces, then the only way to reliably fix the problem is upgrading the material of the teeth themselves.