All-on-4 implant procedure, performed at Tribeca Advanced Dentistry, is the result of significant advancements in dental technology and technique. It allows us to restore an entire arch of missing or damaged teeth in a single appointment. Dr. Malkin has performed all on 4 procedure for NYC and LA patients since 2007.
This technique was developed by Dr. Malo and Nobel Biocare to immediately replace a full arch of teeth without needing bone grafting. It is an alternative to removable dentures. As the name suggests, only four implant posts are needed to support the entire set of fixed teeth. For the sake of comparison, other more conventional methods typically take six to ten implants for fixed implant bridges. Not only is placing fewer implants more cost effective, it also doesn’t require bone grafting.
This procedure uses what is called “tilted implants.” Four posts are placed strategically at a 45-degree angle. There are two reasons for this. First, it increases strength and stability. Secondly, it avoids damaging the sinus cavity around the upper jaw as well as the nerve canal in the lower jaw. Because the implants are tilted, they are able to anchor better into the jawbone, improving support. We also use longer dental implants so that the need for bone grafting is reduced. For the sake of clarification, bone grafting is when the jawbone is supplemented to provide a better base for implants.
Tribeca Advanced Dentistry uses NobelGuide software to plan post placement. Once those posts have been placed, we create a custom fixed bridge to support prosthetic teeth.
You can read Dr. Malkin’s all-on-4 article in a prestigious peer-reviewed “Inside Dentistry” magazine.
All-on-4 has been clinically proven to have a very high success rate when using NobelBiocare implants. Clinical studies published by National Institute of Health have shown 98% percent overall implant success after 3 years for all-on-4 procedure. None of the 36 patients wearing 44 arch prosthesis had a prosthesis failure after 3 years. Journal of Oral Implantology reported even better results with 99.6% implant success rates when using NobelActive implants made by Nobel Biocare (our practice uses exclusively Nobel Biocare implants). Keep in mind that this often quoted research was done utilizing Nobel Biocare implants. The efficacy and success rate of other implant brands is unknown for this procedure.
All-on-4 procedures are one of the several options of “immediate load” (“teeth in a day”) procedure when 4 implants are placed per arch. Depending on your dental needs, we may place more than 4 implants per arch but you will still walk out with new functioning teeth right after your procedure.
Our team of prosthodontist Dr. Malkin and periodontist Dr. Moldovan have specialized in all-on-4 procedure for years. Our philosophy may be different from many other offices: we simply never cut corners, even if it means more time and more work. We don’t do any dental lab work on premises, apart from minor adjustments, and send our dental lab work to Beverly Hills Dental Lab with who we’ve had a multi-year partnership. We’re using only NobelBiocare implants, co-inventors of all-on-4 procedure. Finally, we absolutely stand by the results of our work – we will work tirelessly until you’re satisfied with the results.
You can read further about “Teeth-in-A-Day” which may answer additional questions about how you can get new fully functioning teeth in a single day.
In general, its is difficult to determine the exact price without seeing the patient and taking 3D CT scan. There are some parameters which apply to any case. All-on-4 is more cost effective than a more “old school” procedure of placing a larger number of implants and having a patient wear a denture until the implants heal. If you do both upper and lower arches (the full mouth) at the same time, the cost may be lower per arch because you only need to pay anesthesiologist once. This price includes surgery, anesthesiologist fees, implants, dental lab work.
The procedure consists of two phases.
The first phase is the surgery of removing teeth, placing implants, and installing an acrylic implant bridge. It constitutes about 2/3 of the cost. The second phase is 4-6 months later, once implant and gums are fully healed. In the second phase, a permanent implant bridge is fabricated to reflect changes in bone and gums. It can also incorporate desired changes in the appearance of the bridge done at surgery. This final bridge is made from zirconia frame with porcelain over it.
To give you an estimate, I recommend patients come to our Tribeca office for a consultation where I can provide with a detailed treatment plan spelling out all costs and steps. We very rarely deviate from the treatment plan costs so I can assure that we will not ask you to pay more mid-treatment.
Please keep in mind that a lot of places just quote you a fee for the first part (tooth removal, implant placement, and the temporary bridge placed at surgery) and leave out the need for the permanent bridge once bone and gums heal. That is why their price might look different in the beginning – always insist on a full treatment plan for the full course of the treatment. I believe our prices to be very competitive not just for New York city but nation-wide, especially considering the quality of our implants, materials, and top-notch dental lab.
Dr. Malkin and Dr. Moldovan have explained their dental treatment approach and philosophy in a lecture given to NYU post graduate dentists:
For a more in-depth technical discussion of All-on-4 and other types of full arch dental rehabilitation, you can look at the lecture slides Dr. Malkin presented at Union County Dental Society.
You can also look at Nobel Biocare Web site, our trusted partner, who, with Dr. Malo, pioneered All-on-4 treatment concept.