Full Arch Bridge is Failing: Is All on 4 For Me?

Question:

Judith asks:

I am interested in the All on 4 Procedure (upper) because my full arch bridge is failing (lost teeth in car accident 40 years ago). Anyway, I have come across information saying that without implants where the molars are, the patient will suffer facial collapse. I certainly don't want that to happen! Also, for the permanent all in 4 teeth, should the be made out of acrylic instead of ceramic?

Answer:
Answered by: Dr. Steven M. Moss

Rutherford, NJ

Hi Judith,

It sounds as if the "All-on-4" procedure may be for you...and you are not alone!

It's very common for longstanding full-arch bridgework to fail after years and years of service. With the All-on-4 procedure, you can have the extractions, the implants and the fixed bridge all in the same day, and never wear a denture!

It's the prosthesis (bridge) that supports the soft tissues that are not overlying bone (lips and cheeks), not the implants. So as long as your bridge replaces some back teeth, the lost bone and gum tissue, you shouldn't notice any significant changes to your face.

There are pros and cons of both acrylic and ceramic teeth. Acrylic teeth are cheaper and easier to repair, but they wear out faster and can change color over time. Ceramic teeth look more natural, are color stable over time, and will not wear as quickly so they will last longer. But they are more expensive.

You have to always consider what the replacement teeth will oppose as well (i.e. natural lower teeth? a lower fixed porcelain bridge? another all-on-4 bridge? or an acrylic lower removable denture?). The answer can vary for each.

I hope this helps!



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Expert Advice and Comments
mike, a dental assistant's picture

Collapse

We think of two types of "facial collapse," one horizontal and one vertical.

With horizontal collapse, the cheeks and lips are sucked inward to fill the space of missing teeth. With vertical collapse (also called a "collapsed bite"), loss of teeth and/or bone height allows the mouth to close further than normal. ie: The chin moves closer to the nose. Lips & cheeks sag & push out or just get squeezed.

Vertical collapse ages the face and increases likelihood of "TMJ" or Temporomandibular Joint Disorder (TMD) symptoms ranging from pops & clicks to debilitating pain. Fortunately, most people don't get the severe symptoms.


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