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Cost of ALL ON 4 Dental Implants

Smile Makeover with ALL ON 4 Dental Implants 

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What is All On 4?


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TALENT : Dental Implants have been around for some time now, but the costly and lengthy treatment process sometimes put off people from getting implants.

But new techniques such as ‘All On 4’ may offer an attractive immediate solution for those who wear a denture, or have deteriorated teeth, and wish to avoid wearing a plate.

I’m here with Dr Alex Fibishenko from the Centre for Aesthetic & Implant Dentistry where the All On 4 technique has been Implemented since 2005.

Dr Fibishenko, what is all on 4?

ALEX : Quite Simply All On 4 refers to the replacement of “All” teeth supported “On 4” Implants.

This technique involves placing 2 implants in the front and two at the back.

The back implants are placed at an angle which overcomes the bad quality bone that is often associated with the back of the jaw, and most often avoids the need for bone grafting.

By placing the front implants straight and tilting the back ones, we also create a strong base, almost like a tripod, to support the teeth, which also allows us to fit the final teeth immediately or within days of the surgery.

This procedure is the most common treatment in our clinic today for full arch rehabilitation and is suitable for almost all lower cases and most upper cases.

TALENT : Is 4 Implants enough to replace a full set of teeth?

ALEX : As with any surgical procedure, each case needs to be assessed on its individual merits, but in the vast majority of cases 4 implants in not only enough, but advantageous.

In the past, when replacing a full set we’d place more implants in to cover for any single ones that don’t work.
But today we know that implants work by bonding to the jaw bone, which also makes them so permanent that they cannot be easily undone.

So not only do we have to place them in a way that is conducive to high aesthetics and function, but we also have to make sure that they are easily cleanable. All this is made possible with the All On 4 technique.

Because implants are under the gums and not visible, having fewer implants makes cleaning simpler and more effective.

TALENT : So I can see that by using fewer implants it makes it easier to clean and probably more comfortable over time. But what about the aesthetics?

ALEX : Over years of clinical follow up we developed a number of techniques that can be used in combination with the All On 4 method to improve the outcome, efficiency and contingency of total rehabilitation on Implants. I called this concept All On 4 Plus to differentiate it from the traditional All On 4 method.

All On 4 ‘Plus’ recognizes that every patient is different. Each treatment is planned on an individual basis and whilst certain patients may need additional implants or procedures for appropriate long term support, we aim to avoid prolonged treatment duration with advanced techniques that afford minimal disruption to our patient’s day-to-day life and function.

Whether its with four or more implants, with or without grafting, the All On 4 Plus is our outcome based treatment planning philosophy where we focus on achieving predictable results with optimal function and aesthetics.

Today all procedures at the clinic follow the All On 4 Plus philosophy.

What is All On 4 Plus?


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TALENT : All On 4 Plus has gained tremendous popularity in recent times. The Centre for Aesthetic & Implant Dentistry owns trademark.

Dr Fibishenko, what is the All On 4 Plus concept, and how is it different from the standard “All On 4” method.

ALEX : Over years of clinical follow up we developed a number of techniques that can be used in combination with the All On 4 method to improve the outcome, efficiency and contingency of total rehabilitation on Implants. I called this concept All On 4 Plus to differentiate it from the traditional All On 4 method.

All On 4 ‘Plus’ recognizes that every patient is different. Each treatment is planned on an individual basis and whilst certain patients may need additional implants or procedures for appropriate long term support, we aim to avoid prolonged treatment duration with advanced techniques that afford minimal disruption to our patient’s day-to-day life and function.

Whether its with four or more implants, with or without grafting, the All On 4 Plus is our outcome based treatment planning philosophy where we focus on achieving predictable results with optimal function and aesthetics.

Today all procedures at the clinic follow the All On 4 Plus philosophy.

 

Why All On 4?


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TALENT : I’m with Dr Alex Fibishenko from Centre for Aesthetic & Implant Dentistry in Melbourne.

Dr Fibishenko, we’ve been talking about Immediate full set replacement with the All On 4 method, can you tell me why a patient may opt for this treatment?

ALEX : The All On 4 treatment is for patients who have lost or are about to loose all or most of their teeth.

In other words, if you wear a loose denture, or have deteriorated teeth from advanced gum disease or tooth decay, you may benefit from the cost-effective immediate aesthetic and functional improvement that All On 4 offers.

Those who wear dentures understand the problems with dentures and need little convincing to look alternatives.

Dentures can be bulky, uncomfortable, loose, and because they are loose, the anticipation of them falling out at any time often leads to reduced confidence or self esteem.

Dentures also have what we call flanges. These are plastic extentions that fit under the lips to help improve denture retention, but this also leads to flattening of the lips or unnatural aesthetics.

So dentures may impact on your life by affecting speech, comfort, the ability to chew food, the ability to taste food and wine, and aesthetics.

So making a decision to explore alternatives to dentures with fixed dental implants is really about improving your quality of life, …and doing so with the “All On 4” and “All On 4 Plus” techniques at our clinic is all about doing it in the most effective, safe and streamlined process possible.

 

All On 4 Cost?


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TALENT : All On 4 is the total replacement of all teeth supported by 4 titanium implants. Sounds Expensive.

ALEX : Implant treatment is not cheap, and not everyone can afford this.

For suitable patients, a standard all-on-4 treatment at our Melbourne Implant clinic is in the vicinity of $24,000.

Whereas cost is always a factor, for the many patients that we have treated with All On 4, I guess it’s more about the value through the potential improvements to their quality of life that is also almost instant.

TALENT : Can patients claim any rebate for the All On 4 treatment?

ALEX : Health fund rebates vary. To get an idea the likely rebate, patients can call their health fund and ask for their limit on ‘Major Dental’ for the year, and for an All On 4 treatment that would amount to the approximate rebate. It can vary from $800 to $2,500 depending on the fund and the patients rate plan.

Australian taxpayers may also qualify for a tax offset of 20%. This amounts to around $4,000 and is possibly the most significant amount that eligible patients could entitled to in tax time.

Certain patients who are referred under a specific Medicare scheme may also be entitled to a Medicare rebate for All On 4.

However, Dental treatment is not generally rebated through Medicare, except where treatment is done under General Anaesthetic, a medicare rebate can be claimed for the anaesthetist.

 

What are Dental Implants?


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TALENT : In 1965 the first patient received dental implants. Since that time literally millions of people have been treated with dental implants worldwide.

Dr Fibishenko, what are dental implants?

ALEX : Dental implants are titanium fixtures that are inserted in the jawbone to serve as anchors for the replacement of missing or deteriorated teeth.

When a single tooth needs replacing, whether its because of trauma, failed root canal treatment, decay or gum disease, a dental implant can be placed at the same time as the tooth extraction, where possible. This is called “Immediate Placement”.

When conditions allow, it is often possible to also fit the tooth to the implant at the same time as the implant surgery. This is called “immediate loading”, – that is, the loading of the implant with a tooth.

TALENT : What if there are a few teeth missing, do you need a separate implant for every tooth?

ALEX : Not really. When a segment of teeth needs replacing, it is often preferred to do an implant bridge. That is, 2 implants, for example, can be used to support a segment of 3 or 4 teeth, – and when an entire arch needs replacing, a full set of teeth can often be fitted to as little as 4 implants.

 

Why Dental Implants?


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TALENT : Dental implants are used as permanent anchors to replace missing or deteriorated teeth.

Why would someone go for dental implants as opposed to other menthods of teeth replacement.

ALEX : Dental implants are resilient and strong and create a reliable foundation in our jaw to attach a tooth or a segment of teeth too.

Other methods include a denture or a bridgework.

Those who wear dentures often complain of looseness, discomfort, inability to bite or chew properly, reduced ability to taste wine, soreness, and so on and so forth.

In fact, one of the most common reasons that people seek dental implants is so that to get rid of their dentures.

With a tooth bridge, the dentist has to file down the teeth on either side of the space to receive crowns that can then be used to support the missing tooth. Filing down teeth can lead to nerve damage and the possible need for future root canal treatment.

Whereas with Dental implants, the adjacent teeth remain untouched.

Also with a bridge, a long span to replace say 3 or 4 teeth can often compromise the prognosis of the supporting teeth. Having implants instead, can avoid this and can help retain your own healthy teeth for longer.

The other thing about dental implants is that they have been very well research and have a very high success rate.

 

Benefits of Dental Implants?


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TALENT : Dental Implants have become a popular means of teeth replacement.

What are some of the benefits of Dental Implants?

ALEX : If done correctly, successfully integrated implants are permanent and reliable.

They improve the function and appearance and can make a big difference to patient’s quality of life.

Patients can smile with confidence without the fear of their denture falling out. They can bite and chew everything like with natural teeth, and they can also taste their food and wine, something that is often a problem with dentures.

Because the implants are independent, the adjacent teeth are preserved and this helps improve their longevity as well.

TALENT : Dental implants are permanent and reliable, but how do they work?

ALEX : Dental Implants are biocompatible, which means our body likes them. The bone bonds to the titanium through a process called osseo-integration. It a biological bond, so it’s reliable.

A Dental Implant is the actual fixture in the jaw bone. We then fit an abutment to the implant that serves as a connecting screw, and to which we can then fit a crown or prosthesis.

All these are the implant components.

Patients don’t come to us for implants; – patients want teeth they can function with and great smiles.

So because implants are so permanent and cannot be easily undone, it’s important that they are placed in such a way so as to make them look real. In some cases this may involve additional procedures that can often be done at the same time as the implant placement.

 

How Dental Implants Work?


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TALENT : Dental implants are permanent and reliable, but how do they work?

ALEX : Dental Implants are biocompatible, which means our body likes them. The bone bonds to the titanium through a process called osseo-integration. It a biological bond, so it’s reliable.

A Dental Implant is the actual fixture in the jaw bone. We then fit an abutment to the implant that serves as a connecting screw, and to which we can then fit a crown or prosthesis.

All these are the implant components.

Patients don’t come to us for implants; – patients want teeth they can function with and great smiles.

So because implants are so permanent and cannot be easily undone, it’s important that they are placed in such a way so as to make them look real. In some cases this may involve additional procedures that can often be done at the same time as the implant placement.

 

Dental Implant Cost?


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TALENT : Dental implants are today’s best alternative to dentures or failing natural teeth.

Sounds expensive. What do implants really cost?

ALEX : A single dental implant at our clinic costs approximately $2,500. Then there is also the cost of fitting the abutment and the final tooth that costs about $3,000. So in total, for a single implant you are looking at an overall cost of $5,500. There may be other costs, such as if a patient needs additional concurrent procedures that may sometimes be required to enhance the aesthetic result.

A 4-unit Implant bridge, that is 2 implants supporting a segment of 4 teeth, costs in the vicinity of $14,000 overall.

But when an entire arch needs replacing, because its not necessary to place an implant under every tooth, full set replacement can be, in most cases, supported by 4 implants and cost in the vicinity of $24,000.

Dental implants are expensive and not everyone can afford them. But for many the value of dental implant treatment is far more significant than the actual cost because of the potential improvement to a patients self esteem and quality of life.

 

How Long Dental Implants Last?


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TALENT : Dental implants offer permanent replacement of missing or deteriorated teeth.

But how long do they really last?

ALEX : There are two main components to implant treatment, the implants themselves and then the replacement teeth that are fitted to the implants.

The implants themselves are permanent. But every person is different in the way that they bite, the types of food they consume and habits that they have, and all that can affect the longevity of implants.

As to the teeth that are fitted on the implants:

Typically, single teeth replacement, or replacement of a segment of teeth, is done with implant supported porcelain crowns or bridges. Like with crowns or bridges on natural teeth, these may need replacing every 10-15 years. In most cases the implants themselves don’t need replacing provided they are kept healthy.

Full set replacement on dental implants is most commonly constructed from a high impact acrylic material. These teeth need replacing approximately every 5-8 years, again depending on patients bite, diet, and so on. The replacement of acrylic teeth is a fraction of the cost of the initial implant treatment and probably a similar amount that patients would have spent over that time for alternative treatments.

In some cases we fit porcelain teeth for full set replacement, and these can last, again, 10-15 years, but they are also more expensive to replace than acrylic teeth.

To get the best life out of your implant-supported teeth, its very important to keep them clean, avoid smoking, keep a healthy lifestyle and have regular check-ups and cleans at the dentist.

 

What Are the Risks of Dental implants?


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TALENT : Dental implants are so common that almost every person you meet will have had this treatment, or at least know of someone who has.

But what are the risks of Dental Implants

ALEX : Like with any surgical procedure, there are certain risks patients must accept before receiving implants.

Like with any surgery, and depending on the type of implant treatment, there is the possibility or likelihood of swelling, bruising and pain. The pain aspect is very subjective and varies from patient to patient, but in our experience when we review patient and ask them about their pain experience, in the vast majority of cases the patients tell us that they did not feel the need to take the pain medication that we prescribed them, even those who had full immediate reconstruction with implants.

The other thing with surgery is that we often operate in the vicinity of blood vessels and nerves. There is always a risk of the surgery affecting these structures that may lead to numbness or altered sensation to a certain part of the lip or chin. But this is very uncommon in our practice.

Its also important to understand that the implants bond to the bone through a process called osseointegration. It’s a biological process. If this does not occur, or if that bond breaks down for whatever reason, then the implant is deemed to have failed and needs to be removed. Implant failure is also quite uncommon in our practice, but a risk nevertheless.

One of the more common things that can happen after implant placement is recession of the gum. This can make the tooth or teeth appear longer than the adjacent natural teeth. So we would often recommend some sort of tissue reconstructive procedures at the same time as the implant placement so that to lessen the chances of recession and the affect that it could have on the aesthetics.

Of course there are also the risk of infection, bleeding, and the unknown, …because every patient is different in every way.

But our practice is a dedicated facility and we treat hundreds of patients each year, -and the type and severity of complications with implants that we most often see are relatively benign.

 

Alternative Dental implants


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ALEX : Dental implants have gained unprecedented worldwide popularity in the last 10-15 years. There is a significant amount of research that goes into dental implants which makes them expensive.

Naturally when something becomes so popular and especially when its also expensive, alternatives are considered to make treatment cheaper.

The first alternative are the mini implants. These in general are used with clips to provide some retention for a denture. These implants are not regarded as a permanent solution as they have a relatively high rate of failure. These implants are a lot cheaper but are not recognized by most experienced professionals as sufficient for the retention of fixed crowns or bridges. The problem is, that if these implants fail, they often leave behind inadequate bone for retreatment with conventional implants.

When there is no sufficient bone left for conventional implants, bone grafting helps reconstruct the bone volume and helps achieve the most optimal implant placement once the grafts consolidate. But grafting can add a significant cost to the implant treatment. An alternative for highly resorbed upper jaws is what is know as Zygomaticus implants. But whilst they are cheaper, the do have certain potential problems that must be taken into account before embarking on this process that is complex to undo. The zygomaticus implants are covered in a separate section.

 

What is Bone Grafting?


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ALEX : When there is not sufficient jaw bone available for the placement of dental implants, bone grafting can be used to replace improve the volume of the quality of the bone.

Its is a surgical procedure that involves replacing missing bone with a material called a bone graft.

The graft materials most commonly used are synthetic or bovine bone substitutes, or the patient’s own bone if we can obtain this from within the oral cavity.

Grafting may sometimes be required in advance of dental implants. The grafts are then allowed to heal for a period of 6 to 12 months before the implants can be placed.

In most cases however, it is possible and often advantageous to perform bone grafting at the same time as implant placement, when we have access to the patient’s own bone during the surgery.

A graft is commonly used at the time of extraction of the teeth, when it is placed within the residual socket to preserve the shape of the jaw bone and minimise resorption. This is called socket grafting.

Another type of graft is when the graft material is layered on the outside surface of the jaw bone, to improve its width. This is known as an onlay graft.

Perhaps the most common type of grafting is the sinus graft. The sinus is a hollow cavity in the upper jaw. Being a protected space, a graft placed in the floor of the sinus is less susceptible to external influences, such as pressure from a denture, and is therefore quite predictable. It is today regarded a routine procedure to restore bone height in the back of the upper jaw for the simultaneous or subsequent placement of the implants.

The sinus is accessed from inside the mouth and the membrane that lines it is gently elevated. The bone graft material is placed beneath the membrane. The implants can be placed at the same time or after healing, depending on the condition of the bone at the time of surgery.

The grafted bone not only replaces the missing bone but also helps regenerate natural bone and improve the jaw bone volume for implants and long term support of the teeth.





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