When is All on 4 the Best Option? 5 Factors to Consider When Creating Your Dental Treatment Plan

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Dental implant treatment is versatile, and procedures like All-on-Four are increasingly popular. However, every person is unique, and we must create a custom treatment plan to meet your needs.

Certain factors must be considered when creating this plan, including:

  1. Speech.
  2. Adapting to the thickness of the bridge.
  3. Proprioception (your body’s perception of the restoration).
  4. Parafunction (oral habits).
  5. Risk of cavities.


Speaking with a new prosthesis can be tricky, especially with full arch restorations like All-on-Four. An implant bridge can require significant horizontal and vertical bulk to ensure it is strong enough, and replacing more than just teeth is often necessary. Usually, bone and soft tissue, like gum and jawbone, need to be restored, resulting in a restoration that feels bulkier than you may expect.

Consequently, it can sound different when someone first tries to talk with their new teeth. This is because their tongue is hitting a hard surface rather than soft tissues, so certain aspects of speech may appear slurred.

It is important to be aware of this factor; with time, it’s usually possible to retrain your tongue so you can speak naturally. However, if you are concerned about your speech, we can discuss other options. This may include saving existing natural teeth and replacing those missing with individual implants or a dental bridge that restores fewer teeth.

The potential problem with this option is that more implants and additional procedures like bone grafting may be needed. It may take longer to complete treatment, and the additional procedures can increase the cost.

Related Articles: Eligibility Criteria for All-on-4 Dental Implants

5 Factors to Consider When Creating Your Dental Treatment Plan

Adapting to the Thickness of the Bridge

Although All-on-4 teeth look good, they feel very different from natural teeth. Some people find it difficult to adapt psychologically to the thickness of the restoration because it feels so different from natural teeth and tissues.

To ensure you understand treatment better, ask to see a model of an All-on-Four bridge so you can touch it and get a good idea of its potential bulk. If, after seeing the restoration, you feel the bulk will be a problem, then we can discuss other options that only replace missing teeth. These alternative solutions may involve a greater number of dental implants and an increased need for bone grafting, so ultimately, treatment could cost more and take longer to complete.

Once they understand the potential compromise required with an All-on-Four restoration, many people are happy to proceed after all available solutions are considered.

Related Articles: What to Eat After Placement of All-on-4 Dental Implants


When you have natural teeth, they are attached to your jawbone by periodontal ligaments, stretchy pieces of tissue that register when you bite or chew food. A dental implant isn’t held in place with a periodontal ligament but fused in your jawbone. Registering the same sensations (proprioception) as a natural tooth takes considerably more force. Proprioception with a dental implant is similar to a tooth numbed with a local anesthetic.

Because of this different feedback, people with full arch restorations like All-on-Four are more likely to use excessive force when biting down than people with some natural teeth remaining. The excess force can fracture the restoration or cause bone loss. Chewing food also feels different, so it’s harder to chew food properly initially, and this sensation can be worsened if you need both arches replaced with All-on-Four restorations.

One solution to this problem is to treat each arch separately, staging treatment so one arch is restored initially and you can learn to become accustomed to eating with the new bridge before restoring the opposing arch. Staging treatment gives you time to become accustomed to eating with the bridge. During this time, your facial muscles and jaw joints will get accustomed to providing additional feedback. Another advantage of separately treating each arch is that your jawbone would benefit from increased healing time, allowing greater osseointegration to occur before both arches are restored.

Related Articles: Long-Term Maintenance of All-on-4 Dental Implants


Oral habits (parafunctional habits) like clenching and grinding or bruxism can impact treatment. This is because your natural teeth can detect changes in forces more easily than implant teeth. Often, bruxism is a nocturnal habit. If it is not treated before an All-on-4 procedure, then an overdenture could be a better option than a fixed arch of teeth.

The overdenture clips onto the implants but can be removed at night. The implants can then be protected with a night guard made to fit over them. This treatment protects the dental implants and the prosthesis, decreasing the risk of damage.

Related Articles: Post-Operative Care for All-on-4 Dental Implants

Risk of Cavities

Some people have a higher risk of tooth decay than others, and this can be due to lax oral hygiene or dietary habits. When someone has significant signs of tooth decay, it is often possible to remedy this problem and save the teeth by restoring them with dental fillings. However, it may indicate that the patient could have problems looking after dental implants.

People can change their oral habits, follow a good oral care routine daily, and see a dentist regularly for checkups and cleanings, but not everyone will make or is prepared to make these improvements. Others may lack the dexterity needed to clean around implants easily. Dietary habits can be another sticking point, and it might be better to have implant treatment requiring a more simplified oral care routine.

One option is an overdenture, where a denture will clip onto the four dental implants but is easy to remove for cleaning. Removing the denture makes it much easier to clean around the implants thoroughly.

Related Articles: Comparison of All-on-4 Dental Implants

Dental implants can be a lifesaver for anyone missing teeth, restoring the ability to eat and self-confidence in your appearance. All-on-4 is a versatile implant treatment that can be extremely successful with the right aftercare. However, it’s vital to be aware of the factors that can affect success and know about all other treatment options. The better you understand the treatment and all possible limitations, the more likely you will be highly satisfied with the outcome.

Page Updated on May 13, 2024 by
Dr. Rahmani
Implant Dentist
) of
NYC Dental Implants Center
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