How does your dentist plan for your All on Four Implants to minimize problems? Third in a series of blogs relating to the All on Four Implants topic.

In this third article of our series on All on Four implants, we will discuss what happens after you decide to go ahead and get an all on four implants, but before it happens. As a matter of fact, your dentist will work several hours before even thinking about starting to work on your mouth. Given that this dental implant technology does not come cheap, it is best to plan the procedure and all the required steps well beforehand, to minimize problems. So, your dentist will have to work on a preliminary (or definitive) surgical plan tailor-made to you and your mouth’s structure.

The five basic steps

Recall that in a previous blog How do you know if All on Four Implants are Right for You?, we wrote that before knowing for sure whether you are a candidate for All on Four implants and deciding that this surgical technique is right for you, it is standard procedure for your dental surgeon to perform the following:

1. A visual inspection of your dental set.
2. A suitability questionnaire to inquire about your overall health.
3. Some noninvasive tests and measurements.
4. A preliminary surgical plan.
5. A preliminary budget.

Once the dental surgeon has told you it is OK for you to have an All on Four implant, and you have decided it is the way to go, your dentist will prepare a surgical plan and budget to review with you. We will discuss the surgical plan in this article.

A preliminary surgical plan

There is a fundamental reason why a surgical plan is in order. If a dental implant placement is performed poorly, the final implant can have detrimental effects on the long-term success of a prosthesis. For example, Cooper reported^[1] That dental implant malposition is the primary cause of delayed implant failure and implant- and implant prosthesis-related complications. To further enhance dental implant planning and surgery success, some dentists have proposed^[2] an eight-step digital protocol. Now, we will not subject you to telling you in detail about the proposed eight steps; instead, we have summarized them in non-technical terms.

The essential eight steps are listed as:

1. Restorative Classification. Depending on each case, the surgery can range from “basic” (that is, just implant with no changes to the bone structure) all the way to “restorative” (when changes to your bones or other oral structures are required). The dentist in charge must ascertain the level of complexity right from the start.
   
   
2. FSCP, VDO and Occlusal Plane. With all in four implants, the way you smile might change. So, a digital smile design should be performed to evaluate the positional requirements of single and multiple implants. And for you to know ahead of time what your smile will look like.
   
   
3. Restorative Design. In this step, the dental team carries out a long list of technical evaluations.
   
   
4. Implant/Abutment Design. The available bone height and width are important factors in the final prosthesis design, so your dentist will take special care to evaluate more technical aspects regarding bone and soft tissues in your mouth.
   
   
5. Depth, Angle, and Position. Using 3D implant planning, the implant platform can be positioned ideally in your mouth.
   
   
6. Confirmation of 360 Mucosal Seal. The dentist must study in detail how the soft tissue surrounding bones and implants will most likely seal around these. It is vital that the seal is good to prevent problems such as infections or unseemly gaps.
   
   
7. Anatomical – Bone, Nerve, and Sinus. After the implant platform position has been established, other anatomical structures may need to be evaluated: nerves, sinuses, teeth in the other jaw, or other implants which you might already have.
   
   
8. Implant Width and Length. Finally, the last step in the surgical plan is to decide on the final implant width and length. 3D planning applications facilitate the virtual positioning of the implant into an ideal position, with consideration given to all of the prosthodontic steps and the patient's anatomy.

Dr. MacLean's eight-step protocol is beneficial for a dental team as it allows them to run through a checklist to help them detect problems prior to surgery.

A well carried out surgical plan can allow clinicians to inform patients about any limitations involved in their specific case, and it can ensure that the implant platform depth is positioned ideally for esthetics, function, occlusion, and longevity.

Our Specialists will be interested in studying your surgical case.

If you have experienced severe teeth loss and are looking to solve this issue, the All on Four dental implant is an excellent option for you. How to know if they are right for you? After doing your research, visit a dental surgeon to let them guide you in deciding whether to proceed with this treatment. Once you have decided to go ahead, our specialists will discuss the surgical plan with you to ensure your treatment will be successful.

At Woodshore Family Dentistry, we believe in staying current with technical changes. Woodshore Family Dentistry has experienced dentists that can help you solve your missing teeth-related issues. Do you have any questions about All on Four Implants? Call Woodshore Family Dentistry to schedule an appointment with a dentist.

 Your blog post "Woodshore Family Dentistry is privately owned by Dr. Vishal Pattni and Dr. Saumeen Desai. Both doctors have extensive experience in improving and customizing smiles. Please call the office at 979-341-9890 for a free consultation and smile evaluation." 

^[1] Cooper LF. Prosthodontic complications related to non-optimal dental implant placement. In: Forum SJ, ed. Dental Implant Complications: Etiology, Prevention, and Treatment. Hoboken, NJ: Wiley; 2015:539-557.

^[2] https://www.aegisdentalnetwork.com/cced/2020/07/successful-implant-planning-and-surgery-an-eight-step-digital-protocol