All on 4 or none on 3?

All on 4 or none on 3?

Last Sunday I lectured at the level 2 accreditation course for ASID to the dentists who wanted to learn more about implants. Four hours on implant prosthodontics. One of the key topics we discussed was the all on 4 concept. For those of you who are wondering all on 4 is a technique for constructing an Implant supported bridge with 12 teeth on only four implants.

As the title of this blog suggests if one implant fails the entire bridge fails, often this means the remaining implants can also fail from overloading if the bridge is not removed as soon as possible. But the problem is worse than that as the bone supporting those implants is lost as well so retreatment can mean a long period of grafting, followed by new implants then the new bridge.

There is an old saying l learnt years ago, “don’t look for bargains in healthcare or parachutes”. It is a bit tongue in cheek but means you wouldn’t buy a second hand parachute on eBay (well I hope you wouldn’t!) and don’t cut corners with your health. Implant bridges should be over engineered to allow for misadventure in the future. In the top jaw in particular six or more implants should be placed where ever possible. There are many variables for your dentist to consider including gender (guys often have higher bite forces), history of clenching or grinding, what is in the opposite jaw and and bone density to name just a few.

Would you gamble with your mouth or have something that is over engineered to cope will most contingencies? I know what I would do.