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All the below content has been written by Dr. Sandip Sachar.

All-on-4

For many people, biting into an apple, chewing a steak or eating corn on the cobb, is virtually impossible after the loss of teeth.  A solution to this lies in recent advancements in implant dentistry.  At Sachar Dental NYC, we offer the all-on-4.  The all-on-4 is a combination of a denture and dental implants.  For most people all it takes is four dental implants to support the entire arch of teeth. (Arch of teeth refers to all of the top teeth, or all of the bottom teeth.)  The all-on-4 is a permanent solution to replace missing teeth for aesthetics and function.  Up to 95% of your ability to chew can be restored which exceeds that of a traditional denture.

What is an all-on-4? 

Losing one’s teeth is unfortunate but can happen from long-standing periodontal disease or other reasons.  Previously, the only option to replace all the teeth was a removable denture.  The denture is an oral appliance that covers the entire palate and is held in place with denture adhesive. New advances in implant dentistry have allowed us to replace all of the teeth with a permanent denture that looks and functions better than a traditional removable denture.  We are able to anchor the denture to the jaw bone using 4 (or more) dental implants.

There are many names that are used to describe the all-on-4.  These include: Implant denture, snap in denture, permanent dentures, all-on-4 dentures, and denture implants.  Generally, all of these terms described a denture that is mounted to dental implants.

All-on-4s start with dental implants that are secured into the jaw bone.  The dental implant is usually made of titanium, and is screwed into the jaw bone.  Once the bone has healed around the implant, we are able to replace the teeth with the all-on-4 denture.  The all-on-4 denture mounts to the dental implants in one of two ways.  There are bar retained all-on-4s, and ball retained all-on-4s. These are very similar but differ slightly on how the denture is attached to the implants.  Our implant specialist will discuss with you which option is best for you.

Why would I need an all-on-4?

An all-on-4 is an option for anyone that has lost all the top teeth, all of the bottom teeth, or both.  Traditionally, we would use a removable denture to replace all of the teeth.  A removable denture covers the entire palate and is adhered to the gums using a denture adhesive when needed. All-on-4 provides a more convenient alternative to dentures.  They are also superior in aesthetics and function.

Features of an all-on-4

An all-on-4 allows us to replace all of the teeth without the necessity of surgery to perform dental implants for all of the teeth.  We are able to use only four, or sometimes more, dental implants to mount the denture to the jaw bone.  This allows us to replace all the teeth with an excellent looking smile.  The all-on-4 denture also restores a more youthful appearance of the facial structures that is lost with loss of the teeth. This also allows one to be able to eat many foods that are unable to be eaten with missing teeth or even traditional dentures.

What are alternatives to an all-on-4?

The all-on-4 has a few alternatives to restore all of the teeth.  Traditional dentures are the most obvious alternative.  A traditional denture is less convenient and often requires denture adhesive to keep it in place.  The all-on-4 is permanently mounted to the dental implants and does not require continued use of dental adhesives.

Another alternative to an all-on-4 to replace all the teeth with the use of a dental implant supported bridge.  The all-on-4 has the advantage of being less costly and also can replace the appearance of the gums.  A bridge does not include the pink appearance of the gums.

Another alternative to the all-on-4 is an implant supported removable denture.  The advantage of the all-on-4 is that it does not require removal of the denture.

All-on-4 Vs. removable dentures

Many patients that come in for an all-on-4s are patients that currently already have removable dentures.  All-on-4 is a much more convenient option to traditional dentures.

The all-on-4 denture cannot move around and slip around like a traditional denture.  The all-on-4 feels more like natural teeth and are less bulky in appearance than a removable denture.  The use of the all-on-4 can help preserve the jaw bone that may be lost over time with a traditional denture. The all-on-4 can last a lifetime whereas removable dentures often need to be continually refitted and replaced.  The all-on-4 does not require continued use a denture adhesive.  Some denture adhesives can even be detrimental when consumed.  The all-on-4 denture allows one to eat many more foods that a traditional denture does.  The all-on-4 does not cover the palate which can be an annoyance to patients.  Covering the palate can also interfere with your ability to speak, ability to taste and to sense temperatures. 

And finally, with a permanently adhered all-on-4 denture, there are no more embarrassing situations where your denture can become loose in public.

How is an all-on-4 inserted into my mouth?

The first step to inserting an all-on-4 into the mouth is to extract any remaining teeth that need to be removed.  We will also perform a clinical examination and x-rays to assess the bone structure.  The bone needs to be strong enough to support the dental implants and the all-on-4 going forward.  If we determine that the bone is not strong enough to support the implants, we will perform a procedure such as a sinus lift or bone graft first.

The next step to insert an all-on-4 is to place four or more dental implants into the jaw bone.  Our dental implant specialist will decide how many dental implants are necessary to anchor the denture to your jaw bone.  The process of getting an all-on-4 requires multiple visits.  After the implants are inserted into the bone, we will allow time for them to heal and the bone to harden.  Once we determine that the bone strong enough to receive the all-on-4, we will take a mold of your mouth to ensure proper fit of the denture and placement of where to mount it onto the dental implants.  At Sachar Dental NYC, our dental implant specialist is also a prosthodontist specialist.  In this case, the same person will place your dental implants as well as design and fabricate your denture.  This unique circumstance allows our specialist the ability to best perform the all-on-4. While your permanent denture is being fabricated by our dental laboratory, we may give you a transitional denture for aesthetic reasons.

Once we receive your permanent denture, you will come back for an appointment to permanently attach it to your dental implants.  We will then give you detailed instructions on how to care for your new teeth.

What should I expect after an all-on-4?

After your first visit, when we insert your dental implants, you may experience discomfort after the anesthesia wears off.  There may be mild swelling and bruising of the area.  We will instruct you to not eat until the anesthesia wears off.  You will be given other specific instructions at the time your visit that are case dependent.

At your next visit you will receive your permanent denture.   At the completion of your visit, we will give you detailed instructions on how to care for your new denture at home.  Your next follow-up visit will be at your normal six-month visit for checkup and cleaning.

How long should my all-on-4 last?

Dental implants are considered a permanent solution for missing teeth.  Your all-on-4 is expected to last many years.  At Sachar Dental NYC, our dental implant specialist has over 25 years of experience of placing dental implants for patients in New York City.  We have many patients that remain satisfied with their dental implants for over two decades.

How do I care for my all-on-4?

In order to prevent problems with your dental implant, we recommend that patients continue to perform good oral hygiene at home with brushing as well as coming in twice per year for your regular dental checkups and professional dental cleanings.

What is the cost of an all-on-4 in Midtown Manhattan, NYC?

At Sachar Dental NYC, our charges for all-on-4 denture ranges from $15,000-$25,000.  These charges can be broken down into separate procedures and billed in intervals.

The actual cost depends on how many implants are required and that will be determine by our implant specialist during your consultation.

We are able to bill patients and their insurances on separate visits.  We will discuss billing in more detail at your consultation.  The cost for dental implants is a covered service for most dental insurances, and we always offer payment plan options.

Does my dental insurance cover the cost of an all-on-4?

Most PPO dental insurance plans usually cover the costs of each stage of your dental implant and all-on-4 treatment. The dental implant is usually covered at 50% up to the annual maximum. The denture may be covered at 50-60%.  Additionally, tooth extraction and bone graft, when necessary, are often covered up to 80%.  Prior to coming into Sachar Dental NYC, we always check on your dental insurance benefits and inform you as to what your total out-of-pocket costs will be before performing this procedure, or any procedure.  You will only be responsible for your percentage of the costs at the time of your visit.  We will then submit an insurance claim to your insurance company, and collect payment from them directly.

Can I use flexible spending dollars or a medical savings account for these charges?

Yes, you may be able to use your medical savings accounts or flexible spending dollars to cover charges related to your treatment.  At the time of your service, we will provide you with all the necessary documentation and receipts.

Do you offer payment plans for all-on-4?

At Sachar Dental NYC, we offer interest free financing through Lending Club and Care Credit.  In 15 minutes, we will let you know if you are approved for interest-free financing.  These options will enable you to make payments over the next 12-18 months without any interest charged.

Why are we the best dentists in NYC for an all-on-4?

At Sachar Dental NYC, we take great pride in our all-on-4s.  Our dental implant specialist is uniquely dual specialized in both prosthodontics and implantology.  Unlike most practices, in our practice, the same person places the implant and fabricates the all-on-4 denture.  Under these circumstances, the specialist is able to visualize the entire procedure from start to finish.  When he places the implants, he is already visualizing the aesthetics of what it will look like when final denture is placed.  This removes one variable of an implant specialist having to work with a prosthodontist, restorative dentist to make the denture.

As a prosthodontist, our specialist is able to ensure that your denture has equal biting pressure on all areas versus increased load in one spot.  This will ensure that the denture functions properly for decades and lessens the possibility of failure of any of the implants.  This is another reason why we are so successful with our all-on-4s, having the same person that is a dental specialist in implants and prosthodontics.

At Sachar Dental NYC, we utilize the best dental laboratory in New York City.  Our lab technician is truly an artist when it comes to producing the denture.  He is also an expert when it comes to making adjustments to ensure that your denture fits on to the dental implants properly.

We take great pride in our very high success rate, and our very high patient’s satisfaction with their all-on-4s.  Experience matters, and we have been placing dental implants for over 20 years at Sachar Dental NYC.  As always, at Sachar Dental NYC, we use the least toxic and the highest quality materials.  We always use the best dental laboratory in New York City, which contributes to our high success and satisfaction rate.

Also, at Sachar Dental NYC, we always opt to perform the least invasive procedures possible.  We do not rush into extractions that result in all-on-4s.  On many occasions, patients have come in expecting to have a tooth extracted, and we were able to save the tooth.

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