All on 4 Treatment process

Complementary Consultation:

  • Digital and surgical planning
  •  Cone beam 3D scan taken
  •  Take impressions of your teeth
  •  medical history checks
  • Evaluate your teeth for implant placement

Second consultation:

  •  Discuss your questions about the procedure with our team
  • Review of digital smile design and picture of final outcome
  • Full discussion surrounding treatment options and costing
  • Presentation of similar cases and patient journeys
  • Tooth colour and shape selection
  • Any additional radiography, photography or measurements

All on 4 dental Procedure:

  • Review and discussion with the medical doctor performing your sedation
  • Checking into the recovery suite where you will be based after surgery and where you will be able to secure your belongings
  • Final review of the procedure and the day ahead with your surgical team. Pre-op medications will be given.

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  • You will be given the anaesthetic which will mean you will not remember anything and it will make the surgery seem as though it has taken 5 minutes.
  • After you are sedated you will be made numb and any remaining teeth and infection will be removed before commencing the AO4 procedure.
  • During the procedure the jaw bone will then be flattened to enable the fitting surface of the bridge to be smooth. This also ensures that when you smile the junction between the All-On-4 bridge and your gums cannot be seen. It also removes the dirty and infected bone that often surrounds the necks of the teeth. This process is called an alveolectomy.
  • Four dental implants are then placed on the upper or lower arch (or both) according to the pre-designed surgical guide. Abutments (connectors) are then fitted to the implants before the gums are sutured back over. These abutments go through the gums and connect the implants to the bridge.
  • Once you have woken up, the surgical guide is then attached to the abutments by titanium cylinders. This allows our team to assess the look and position of the teeth before the bridge is made.
  • Copings are then placed onto the abutments in order to take impressions of the implants and surrounding tissues. This is then picked up by our master technicians who spend the rest of the day, or overnight (if upper and lower), creating your custom fitting bridge.
  • That evening (4-6pm) the bridge is then screwed into the abutments and the bite is evaluated and adjusted. We are now working on the implants so there is no need for anaesthetic and the procedure is painless.
  • Post operative instructions are then explained to your carer and you and printed for later revision. Prescriptions, ice packs and a mouthwash are included in your take home pack.
  • Our team will contact you in the next two days to see how you are doing.


Post Operative Review:

  • At the 2 week mark we take the bridge off, remove the sutures and evaluate the healing process. The bridge is replaced and the bite and aesthetics are again checked. The access holes for the screws are then sealed with a resin material.
  • Your dedicated oral health therapist then goes through the cleaning process at length with you. You will be shown how to best maintain your AO4 and look after your bridges.

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  • Finally at a 6 month review we evaluate your All-On-4, the way it is wearing and how it is being cleaned. A final healing check is done and a review of maintenance and a clean is done with your oral health therapist. You can also discuss upgrading your bridge and the alternatives at this appointment.


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Pre & Post-operative care

Pre Operative Care

  • You must fast (no food or drink except a few sips of water) from midnight the night before surgery •
  • Do not drive yourself to or from the surgery and please be accompanied by someone. They will likely want to go for a walk or leave the surgery while you are in surgery and recovering. They can go home and come back before the bridge is issued if that is more convenient.

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  • If you have any questions, write them down so you can ask the team before surgery.
  • Discuss your medications with your dentist, GP or sedationist prior to taking them before the procedure .
  • Wear comfortable, loose fitting and warm clothing.
  • Bring an Ipad or something to read if you’d like and a secure bag for your belongings


Post Operative Care

  • Take prescribed antibiotics until they are finished
  • Take pain relief tablets as prescribed, alternating nurofen and panadol/panadiene forte every 2 hours is usually very effective
  • Take anti-swelling medication if prescribed (Dexamethasone)

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  • Use the anti bacterial mouth rinse (Curasept)  given to you. Rinse 3 times a day for two weeks ONLY.
  • Eat soft foods for one month. Avoid crusty breads, raw fruit and nuts or over-cooked chewy meats in this time. Soft pasta, rice or tender meats are ok.
  • Use ice packs as much as you can for 2 days to reduce swelling and bruising
  •  No strenuous exercise or alcohol for 48 hours and NO smoking for one week
  • If issued, wear your splint/night guard every night. It should be cleaned in running water only
  • Do not try to clean under the bridge until the stitches are removed, brush any remaining teeth as you normally would
  • We will contact you within 48hours to see how you are doing
  • You must attend the review appointment after 2 weeks.


Caring for All on 4

Caring for your AO4

  • Using a waterpik and X-floss, preferably both, at least twice a day to clean under the bridge
  • Do not use highly abrasive toothpastes when cleaning/brushing your bridge
  • Look after your remaining teeth in the opposite arch if they are there

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  • Wear your splint religiously, unlike natural teeth, implants have no give and the force during night time clenching can cause breakages. Your splint is the best protection
  • Do not chew pens, fingernails or bite chop bones. Be sensible with what you chew and eat.
  • Return to the Sydney Implant Institute 6 monthly examinations and routine cleans


Post-Operative Care –
How to clean All on 4 dental implants

So here we have a water flosser which pretty much is a high-pressure water hose which will be used to clean under the bridge. Each model of water flossers are different however some will have a dial whilst others will have a control button in which you can modify the pressure of the spout. Ideally we’d like to be using a medium setting however when first starting off it is recommended that we use a low setting in order to disturb buildup underneath the bridge.