Who is an Ideal Candidate for All-on-4?

All-on-4® is four to six implants secured in the jawbone that support an entire arch of natural-appearing false teeth. While this permanent restoration is a great choice for many who have lost all or most of their teeth, the periodontist must ensure each individual is an ideal candidate for success. Due to its complex nature, patients must meet the standards below.

Understanding the candidacy process

All-on-4's candidacy process may be more intricate due to patients being able to reverse the final decision at a later date. However, during the initial consultation, the periodontist will review the following:

Bone density

Considering the periodontist will need to surgically insert the dental implants into the alveolar bone (the bone under the gums), there needs to be a sufficient and healthy amount. Some patients may not meet this standard during the consultation. Fortunately, there is another option. The periodontist can recommend a bone graft for those whose bone density is not too far gone or are free from diseased bone. This procedure uses an artificial material that simulates bone and stops recession, making All-on-4 more likely.

Overall oral health

The periodontist will check for signs of abnormalities that may indicate disease, infection, or inflammation. If found, the periodontist must treat these signs before moving forward in the All-on-4 process. Furthermore, the periodontist may require the patient to be clear of the disease, infection, or inflammation for a certain amount of time to ensure it does not try to make a return and compromise the implants.

Moreover, the same cannot be said for those who consistently maintain poor oral hygiene. This often indicates that the patient will not properly care for their mouth or follow instructions during the All-on-4 process, which can take up to nine months. Considering multiple surgical procedures are involved, the periodontist must ensure the patient will follow all instructions perfectly to reduce complications or implant failure risks.

Tobacco consumption

Equally as important as the above two factors is whether or not the patient consumes tobacco in any form. The World Health Organization, WHO, reports that tobacco, smoking in particular, greatly distorts a patient's immune system. In turn, this negatively impacts the body's ability to heal properly, increases the risk of infection, and increases the risk of uncontrollable bleeding during surgery. More so, after installing the implants and the body has time to heal, smoking can cause implant failure or implant rejection (when the body rejects the implants).

Therefore, the periodontist will likely run tests to check for alarming signs in the bones using X-rays as well as performing a physical examination. If the patient shows no alarming signs, the periodontist may have the patient stop consuming tobacco for a certain period of time to see if they will be able to do so for the entire nine-month process and afterward.

Underling medical conditions

Lastly, the periodontist will review the patient's medical history, checking for underlying medical conditions that may inhibit the body's healing abilities, such as diabetes or human immunodeficiency virus (HIV). Again, the patient will undergo multiple surgical procedures. Therefore, multiple healing procedures will follow suit. Considering safety is the periodontist's number one priority, they will find another smile restoration solution if necessary.