Guidelines - All On 4 Clinic



Guidelines for choosing a Dental Implants Specialist

Be ware of clinicians calling themselves “specialists”. A dental ‘specialist’ qualification is a higher degree and often indicates a restricted area of practice such as orthodontics (braces), endodontics (root canal treatments), prosthodontics (crown and bridgework), oral-surgery (wisdom teeth and mouth surgery), Maxillofacial (orthognathic and reconstructive surgery), periodontics (gum treatment), paedodontics (kids), oral medicine (TMJ and mouth pathology), among other areas of practice, but sadly there is no registrable specialty dedicated to Dental Implants.

The type of training that a dentist, or any kind of dental specialist, should undertake before offering dental implant treatment includes not only post graduate courses, but more importantly private residency and mentor programs in order to attain the necessary knowledge and skill-set. 

A focus on other areas of dentistry could, in fact, preclude adequate exposure and repetition with implant procedures, thus preventing a clinician from gaining the experience required to develop and maintain the necessary skills for undertaking more complex treatments, such as All-On-4.

As there is no way for consumers to otherwise determine who has the appropriate qualifications to undertake implant work, and especially treatments like All-On-4, and especially since such treatments are difficult to undo, do not be afraid to ask about your surgeon’s training and experience.

Assessing the Type and Level of Experience of your surgeon with All-On-4 Dental Implants:

Like in other areas of medicine and surgery, there will be those who are talented or exceptionally skilful, and will attain the required skills quicker than their peers, but there are also those who would never achieve the required level of skill no matter how many implants they place.

Below are some questions you should ask to help you derive relevant information about your surgeon. You may click here to download the questions in a format that you can send to your surgeon.

What kind of implant-surgery training have you had outside of university?

Training courses are typically listed on the clinicians profile or may be available online. These should include numerous surgical and restorative implant courses over time as All-On-4 requires cross-disciplinary skills in both aspects of the treatment.

Have you completed a residency specific to All-On-4 procedures?

It is important to know that the doctor, whether dentist or specialist, has completed one or more residencies in All-On-4 procedures and was personally mentored by more experienced clinicians.

How many implants have you placed in total?

From my personal observations of many of the dentists and specialists who have attended my own residency programs, or who I have personally seen operate, anything less than 1,000 implants would be considered inadequate to do even the simpler All-On-4 cases autonomously.

How many implants do you do per month?

This is an indication of repetition and reinforcement in this area, which is a known and critical factor in any kind of surgery. It is important that the surgeon is regularly exposed to various kinds of implant cases with various degrees of complexities. Anything less than 50 implants per month in my opinion would be inadequate for undertaking All-On-4 work.

How many implants have you done before doing your first All-On-4?

Based on my personal observations, if a clinician gets into All-On-4 earlier than after having placed at least 1,000 implants, they may be doing so too early in their career.

This question is explored in detail under Old habits die hard: the perils of All-On-4 surgical experience without appropriate training and insight.

How many All-On-4 procedures do you do per month?

Provided that the clinician had adequate training and progressively built up their implant experience as indicated in the above section Old Habits Die Hard, it is important that there is also adequate repetition of these procedures in order to continue doing them well and progressively improve. To that effect, anything less than six All-On-4 procedures per month may not be enough for most to upkeep and improve their own skills.

Do you perform bone grafting, gum grafting and sinus grafting (lateral approach)?

Bone grafting is a critical skill that any clinician doing All-On-4 should have.

Be ware of clinics that market themselves as offering completely “graft-less” procedures. They may be doing so because their clinicians do not have those skills, or purely as a marketing strategy where grafting is intended to be taken as being complex, or requiring numerous stages. What lay people don’t quite know is that in most cases bone grafting can be done at the same time as the implant surgery and has no effect on the stages or timing of the treatment. On the contrary, where the bone is poor, as is often the case in the upper jaw and sinus areas, procedures like Sinus Grafting may help improve the outcome with All-On-4, and offers contingency in the long term by rebuilding lost bone.

If the clinician is not undertaking bone grafting procedures on a regular basis, they may also not have adequate knowledge or skills at their disposal to adequately deal with any unexpected complexities during surgery.

It is important to know that the clinician:

  • Undertakes multiple grafting procedures every month, including sinus grafting; and,
  • Can offer you sinus grafting as an option with your All-On-4 surgery

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