All on 4 (full mouth) Dental Implants near Windsor, Berkshire

Dr Sehmi has been carrying out full mouth dental implant treatment for many years, and people travel internationally to see him, however, this week we carried out the first all on 4 dental implant treatment at the brand new Dental practice in Wraysbury.

All on 4 is one solution to replace a full set of teeth with dental implants, and is considered to be one of the more complex dental implant treatments there are.

The way in which we do this treatment is actually very different to the way that most dental practices will do it.

There are many new technologies that can make this treatment quicker and safer for our patients.

These photos were taken before and after this treatment, the patient had loose dentures to begin with, and left the surgery with fixed teeth on dental implants.

Let me explain how we do this treatment, to do this I need to take you behind the scenes.

Planning

Planning, this is the most important part of the treatment. We always need to design the smile, using photos.

Often the teeth are not in a good position, the colours are often different, and its difficult for our patients to visualise a great smile. So we help them by showing them what a smile can look like.

There are a lot of variables, for example, when we position the teeth backwards a little, the lip will drop, meaning less of the teeth will be on show. This is difficult to show, but its something we take into account.

Once we are happy with the plan, we will digitally plan everything, using the patients CBCT scan. This is a 3D scan of the bone, and it will help up to understand where we can place the dental implants, and how many teeth we can support on these dental implants.

Guide Manufacture

Dental implants can be placed in two different ways, we can place them "freehand", and we have placed thousands like this. The other method is to place them fully guided.

In 2020, I made a video about guided surgery, its a little old, but it will help explain what this is. You can see the video here.

Guided dental implant placement is more precise, and making guides for an all on 4 case is far more complex than making a single dental implant guide.

As there are several stages in the treatment, so we need to make several different guides, and it typically takes 3 hours to design the guides for an all on 4 treatment.

To design these guides, we need to use a very specialist computer software. We can combine the patients individual CBCT scan (the x ray) and a digital model of their teeth. Once we have these records, we can manipulate them in the software, and make all the guides that allow for a more precise treatment.

We will do this for almost every case these days, as we can make the treatment simpler on the day, and slightly quicker.

Not only are the guides premade, but also the temporary teeth that were designed using the software are also printed in the specified colour that we agreed on in the consultation appointments.

The Day of Treatment

As we have done so much planning for each case, normally the treatment is carried out quickly and efficiently.

Typically, we will start the treatment at 0900, and the surgical part of the treatment is finished by 11am, and then the teeth are adjusted, polished and fitted to the dental implants, and this is finished by about 1300.

For any treatment, it is possible that things don't go perfectly to plan. So it is important that we are prepared for this.

Once, we had a case where the guides did not fit. In this instance, we needed to revert to doing the whole treatment freehand (luckily we are experienced in doing this).

After Care

Immediately after the treatment, the mouth will be sore, but this normally subsides after about 1-2 days.

There is surprisingly little pain and discomfort after a treatment like all on 4. Bruising and swelling is very common, but this looks worse that it feels.

After 2 weeks, we like to see our more local patients for a review and to remove any stitches.

At this appointment, we will remove the teeth, and review the dental implants, remove the stitches and replace the teeth.

After this, we normally leave the implants to fully heal, and this can be 4-6 months.

Making the final All on 4 teeth

After the dental implants are fully healed, we then arrange a few appointments to make the final teeth. This is where we can look at the details.

Normally the temporary teeth are very good, and we only need slight changes, however if more significant changes are needed, we will redesign the smile, so that it looks perfect in the temporary materials.

We look to make sure that the fit on the implants is perfect, then look of the teeth, smile and gums are all perfect.

There are a lot for changes that we make, moving from the temporaries to the final teeth.

The materials for the final teeth are much stronger, and there is much more choice in the look of the gums, the colours in the teeth, and the details, like the curvature of the teeth corners.

These little details contribute to creating a fantastic looking end result, that our patients are completely happy with, and it gives back the confidence to smile effortlessly.