Dental Implant Solutions
All-On-4 Dental Procedure
Implant Surgery Video
Dr Michael Sempf's QualificationsView Transcript Hide Transcript
The big difference, you know, in more so with All-on-4 is two things. You need appropriate infrastructure on site. So you need a cone beam CT scanner to do the appropriate planning. You must have your onsite lab, so that procedure entails surgery one day, and either teeth that afternoon, or most commonly the following day. So you need an onsite laboratory with someone who's got the appropriate experience and training to deliver that prosthesis, which not many places have, and our onsite technician/prosthetist is a very accomplished, experienced guy in that field.
And because personally, you need appropriate training and experience. I've done my normal degree that most guys have done. I've done a postgrad diploma in implants at Sydney, 2011. And since then, with emphasis on the All-on-4 training, I've been to Portugal to train with Professor Malo, who's the founder of the technique, and locally in Australia with the Malo Clinic in Melbourne. Dr. Larry Benge who's the Australian ambassador for the procedure.
Duncan Davidson is his name. A very skilled technician and different. So there's no one quite like Duncan I think in Queensland in terms of experience in that area. So he's involved in the planning and the workup for the patient. So for the patient who proceeds, we don't just book him into surgery. There's a bit of a process to plan, to design their teeth prior to surgery date. Duncan is involved with that.
Duncan has two hats. He does the technical work. He makes the teeth. So Duncan makes those. But he also is a prosthetist who if you've got, not having implants, he does the entire process. So if someone is getting dentures, Duncan is the man that makes them. Take the records. So he's very skillful and knowledgeable in designing teeth shapes and those sort of things. So Duncan is involved in the planning workup stage. Then I do the surgery. I do the following steps the following day, but Duncan makes the teeth for us as well. So he's got enormous experience in that area. And this is a real team process, and I can't do what he does. He can't do what I do, but together it's a sort of team environment.
Costs involved with All-on-4
What is All-On-Four?
What to expect from All-on-4
Are You a Candidate for All-on-4?View Transcript Hide Transcript
The All-on-4 technique is a graftless solution so that it's designed to avoid bone grafting.
So the big four on upper jaw, for example, there are cases where when we get a CT at the console, there's no bone, or there's very little bone volume or no thickness in the upper jaw.
There's a solution to solve that (also graftless) which is abutment implants, which is implants that go into the cheekbone.
Abutment implants are performed by an oral surgeon, not myself. This is a very good alternative for someone with no bone on the top jaw at all.
On the lower jaw, it's very rare that there's not enough bone for the All-on-4. I can't think of many, if any, we've not been able to do.
So on the top jaw, it shrinks more horizontally, whereas the lower jaw there's always some vertical bone for the procedure.
There's no plan B on the lower jaw - you can't just use abutments. Using abutments is a common, routine solution for patients with no bone on the top jaw.
What are the benefits of All-on-Four?View Transcript Hide Transcript
The big advantage, of course, is they're (the teeth) fixed in place, so they don't move anymore.
The other big one is that bone is like muscle in that it needs to be loaded and stimulated.
Denture wearers suffer from a problem, over time, where the pressure of the denture on the gum and the bone causes more vertical bone loss over time, which can make implant treatment much more complex in the future.
Whereas dental implant treatment loads the bone internally so it preserves bone density & bone volume. It's much like having a muscle that is being used regularly, it maintains that growth & volume. It's also good for facial contours as well, they get less collapsed over time.
Teeth that are broken down and decayed lead to long-term infection, which causes bone change and bone loss as well that can complicate future dental implant treatment in most cases.
Same with gum disease - Long-term untreated gum disease on terminal teeth can sacrifice more bone over time and that makes it very hard/challenging to do implants later on.
So, if your teeth are on the way out, it's nice to intervene reasonably early rather than wait until it's too late.
Your All-on-Four ConsultView Transcript Hide Transcript
The patient comes in and gives us an idea of what they're trying to achieve with the treatment, try and identify their primary problems, whether it's loose dentures or failing teeth. They are the two main categories. If they're keen to proceed, we get a cone-beam CT scan, which reveals the available bone they've got for the procedure. On rare occasions, there is no bone available, and we can't do it. So it's very convenient for patients to know they can come for their consult and know there and then if they're candidates.
Once that's been performed, they are given a treatment plan, which is generally the same as a template they have they can access online. The patients go home and think about it. I don't push them into making a decision. If they're keen to proceed then we start getting some records in the coming weeks thereafter.
Yeah, so All-On-4 [SP] people tend to know what they want. They have done some research and they come in to see if they're suitable candidates. For a general implant consult, there is other alternatives. So we cover those at that consult, whereas All-On-4, they typically want to know if they can get it done.
So for example, a single tooth consult, it might be a failing single tooth. There could be alternative choices for that patient. We'll cover those in detail. For the person seeking All-On-4 they're coming for [inaudible 00:01:05] so it's a more simple consultation.
So if they proceed, we get records of their current teeth shape, or if they've got dentures we take records of their denture shape. We get patients' feedback on if they like where their teeth are currently, in terms of shape, color, and those sort of things.
Often their teeth are looking a bit sad, so there is some pretty major changes to come. CT scan as we said. But really we're trying to get the teeth shape and vision [SP] pretty close to perfect before the surgery day. So when we come to surgery we transfer the pre-surgery mock-up to the records we have at surgery. So when it comes to the following day we transfer the planning onto that record and the patient can see it in their mouth the following day. So they see a prototype [inaudible 00:01:48] the following day to verify the color's right, the shape's right. Once they're happy and I'm happy, then we can process during the day. So we're trying to streamline things so the day after surgery isn't quite as laborious.
All-on-4 dental implant case studyView Transcript Hide Transcript
So typical case that we completed recently, and this patient came looking for an All-on-4 solution X-ray - obviously he had terminal teeth with no chance of repair.
He had All-on-4 for both the top and bottom jaws. Now, these big black circles here where the sinuses are on the upper jaw. A sinus is a big airspace in the jaw where there's no bone, so we can't use that for dental implants.
In the past, that case would have had sinus grafting, which means packing bone into those spaces. And then waiting six months for the bone to consolidate and then implants can be placed in that region vertically after six months. More time for healing and people come back four months later, so it'd be a 10-month process.
With All-on-4, we angle the implants into the high-quality bone that runs along the front of the sinus and then two at the front. On the lower jaw, there's nerves that interfere with implant placement, these black circles, where the nerves exit on the lower jaw, as we go backwards, there's limited bone height and thickness above the nerve for safe implant placement.
So again, we tilt the implants like this to miss the nerve and then two at the front. This is him (the patient) the following day. So again, this is the sinus wall here, sinus wall here, implants are angled to miss the sinus, two straight at the front, lower jaw, there's a nerve here in here. So we tilt the implants to traverse where the nerve exits, and we then get a full arch of teeth.
This was a 2-day process as opposed to 9 - 10 months for a grafting case.
This is the dental bridge that patient received the day following surgery. It has internal reinforcement, which you can see here on the X-ray. This bridge must finish flush at the back implant, here and here, we can't go beyond these implants on the first set of teeth.
It's part of my lab protocol, is too much stress on the bone and the teeth if we extend backwards initially. Once we have the bone integrating and these implants fuse to the jaw, we can then extend further with cantilever.
So the first bridge has reinforcement which is moderately strong, the ideal second set of teeth come at 4 months and it looks like that. That's a one-piece titanium milled frame, very very strong. It's not segments like you see here how they're prefabricated parts.
What we've done here for out patient is milled from one piece of titanium, very strong and the cantilevers are going backwards.
A lot of people in the market who are advertising all-on-4 present this as their final product (segmented). It's very important for patients to be aware that this is the ideal final product (showing GC Dental Solutions All-on-4).
These ones (showing segmented) wear over time and things start breaking, this one (showing GC Dental Solutions All-on-4) you cannot break the frame.
The cost for the second set of teeth at4 months is $8,000, that includes the frame and the other teeth.
How much do All-on-4 dental implants cost?View Transcript Hide Transcript
So, All-in-Four is a technique that was developed by Professor Malo from the Malo Clinic in Portugal. All-on-4 simply entails four strategic dental implants supporting an entire arch of teeth. In the past where grafting was required, there'd be a lengthy process which was both more costly and more time-consuming for patients.
With All-on-Four, with the use of four strategic implants, we can progress from either a denture or file-in teeth to a fixed-bridge in two days with less implants, that also lowers costs compared to in the past doing more implants, which are more difficult to clean and maintain as well. So the big benefit, only four implants required, lower cost, and immediate function.
So the cost of All-on-Four dental implants, it varies from case to case. But for most people, for the surgery, teeth out, if required, and implants and the teeth is $17,000.
For some people that can be their final solution.
For a lot of people, they do need a second set of teeth once implants have integrated and connected to the bone. The big reason is, for the first set of teeth, they must finish at the location of the last implant. There's a sinus on the top jaw, which limits where the implant can be placed. On the lower jaw, there's a nerve that limits how far that back implant can be. Once the implants have connected to the bone and integrated, the second set of teeth extend further backward with cantilevers.
So it's useful to get that second set of teeth to get more teeth. People have a fuller smile with back teeth and there's more teeth in for chewing purposes. Some people, their anatomy is such that they need the second set of teeth. But for most people, we encourage the second one. It's stronger and more durable over time as well.
The second set of teeth is an additonal $8,000.