What are the Risks with “All-on-4” Dental Implants?

“All-of-4” is a dental implant procedure that is becoming more and more popular. And for good reason.

But first, let’s answer the question: “What is “All-on-4?” For the uninitiated, “All-on-4” refers to replacing a full arch of teeth in one day. It is a one-time, complete restoration of all of your teeth. In one day, all your teeth are removed, and a full mouth bridge is applied. That can mean replacing the top teeth or the bottom set of teeth in one sitting. Some patients will do both, top and bottom – again, accomplished all in one day.

Sounds intimidating? Not really. More conventional methods require six to ten implants to secure fixed bridges. As the name implies, “All-on-4” requires only four implants. As a result, it takes less time and generally does not require bone grafting.

Expensive? As a one-time payment, it might seem expensive. But over a lifetime, “All-on-4” procedures are remarkably cost effective. Especially so, if you have problematic teeth that may require a series of implants and surgical remedies.

And the most important upside, patients typically walk away with a full-mouth of new dental work that is fully functional – which in turn can have an important impact on your overall health.

So to summarize the benefits of “All-on-4”:

  • More cost-effective than full-set implants: fewer implants and only a single procedure
  • More comfortable and convenient than dentures
  • Minimally invasive
  • Fast – the procedure of extracting teeth, placing implants, and placing crowns done in a single visit
  • Greatly reduces the need for bone grafting
  • Natural looking
  • Long lasting (if cared for properly)

So let’s say, you are ready and willing to do something so revolutionary and dramatic. And let’s say you are ready to invest the money into what for most of us is an expensive dental procedure.

But there is one more question everyone should ask: What are the risks and potential side-effects – both short and long-term?

To explore, the possible problems with “All-on-4”, we went to Dr. Rich Nejat from Advanced Periodontics and Implant Dentistry. Dr. Nejat was one of the early adopters of the “All-on-4” procedure. He developed several patent-pending methodologies used in the implementation of “All-on-4”, which have been subsequently adopted by many other dentists. As a result, he is one of the most experienced practitioners in the field.

“It is an important question, and one many dentists don’t like to dwell on. After all, “All-on-4” is a money maker. That is not to say it is not worth it. It is, especially so, if the dentist who performs the procedure is experienced and provides excellent aftercare. Overall, patients report high rates of satisfaction – both aesthetically and functionally.

“However, as with any surgical procedure, there are possibilities of complications. First, there is the anesthesia. We use different types of anesthesia. Some patients want mild anesthesia, where they stay awake through the procedure. Others want to be asleep the whole time and require a professional anesthesiologist to be on hand. There is a third state which is conscious sedation, where the patient remains in a twilight state. There are benefits and risks associated with each type of sedation and pain management. For most people, the anesthesia wears off quickly. But you should make sure that you give the providers an accurate and up-to-date medical history. Problems are unlikely. But, don’t be shy about asking about medical preparedness, especially in the case of an elderly patient.”

Dr. Nejat then picked up a consent form and began to read: “Now onto the procedure itself. Look at the consent form. It usually covers areas like pain, swelling, infection, and discoloration. It also usually mentions numbness of the lip, tongue, chin, cheek, or teeth may occur.”

Then he read the fine print: “The exact duration may not be determinable and may be irreversible. Also possible are inflammation of a vein, bone fractures, delayed healing, allergic reactions to drugs or medications used, etc.”

He continued reading: “I understand that if nothing is done, any of the following could occur: loss of bone, gum tissue inflammation, infection, and nerve sensitivity. Also possible are temporomandibular joint (jaw) problems, headaches, referred pains to the back of the neck and facial muscles, and tired muscles when chewing.”

“Yes, these are all rare phenomenon, but if they are in the consent form they probably have been reported. And there are other factors to consider, the implant may or may not take. Or it may not be comfortable. It may need further adjustments.

“I am not trying to scare people away. In general, “All-on-4” is safe and effective. However, it all comes down to skill and experience of the dentist.  First and foremost, when considering “All-on-4”, check out their history of the individual dentist. Do not buy the brand.

“What do I mean by that? The procedure is becoming so popular that there are now franchisers marketing “All-on-4”. Remember, a name-brand franchise is a marketing platform, not a dental practice. Now that doesn’t mean that a dentist who works under a brand name franchise isn’t good. I know several fine dentists who practice under these franchise names. But there are also newbies, who are less experienced. They are using the franchise to attract business. So do your homework. Check out the dentist who will do the work. Check out their credentials and make sure they have the experience.  After all, it is your teeth.

“And then make sure you ask about the backend or aftercare plan. And what will be the costs? That’s important. No dental or medical procedure can come with a guarantee. It’s human biology – just too many variables. We provide a generous follow-up plan and are very transparent about the cost of maintenance. Yes, “All-on-4” requires maintenance.  You need to return to the dentist three or four times a year for cleaning and adjustments. If well, maintained the bridge work can last a lifetime. And should be worth the investment, especially if you choose the right professional.”

For more information, contact Dr. Richard Nejat at
Advanced Periodontics and Implant Dentistry
Address: 110 E 40th St #500, New York, NY 10016
Phone: (212) 581-1090