FAQ 1: How effective are All-On-Four Dental Implants compared to Traditional Implants?

All on 4 is a process or technique rather than a type of implant. This technique incorporates 4 dental implants in each arch to which a complete set of new teeth can be attached and it can happen in a single easy appointment, all in one day.

Traditional techniques using dental implants begin with the extraction of any remaining teeth and then a 4 month healing period. During that 4 months and until the case is finally completed at roughly a year and a half patients must wear full false teeth. After the extraction sites are healed the maxillary sinuses must be grafted. Sinus lift surgery is usually accomplished bilaterally. After is it completed 6 to 9 months are required before the dental implants are placed. Finally somewhere between 8 and 12 months after the initial extractions dental implants are placed. This usually requires 8 to 10 dental implants on the upper and 8 to 10 dental implants on the lower. Once the dental implants are placed another 6 months pass and they are uncovered and healing abutments are placed to develop the soft tissue around the dental implants. The dental implants that were until now completely beneath the gums now exit through the tissue much as a natural tooth does. Two more months are required and then impressions for the fixed bridges can be taken. After another 3 weeks the fixed bridges are ready for placement and if all has gone well the case is finished. All told cases treated in the traditional manner require roughly 18 months, 4 surgeries, and 16 to 20 dental implants. To make matters worse favorable results are not as predictable as they are with the All on 4 technique. Four of these dental implants will have been placed into grafted sinuses. The failure rate for implants placed into sinuses is approximately 12 % as compared to 2 % or less for those placed in the premaxilla which is the area used for the All on 4 technique. Thus one can easily see that complications occur at least 6 times more frequently with traditional techniques and that with the number of implants and surgeries the cost for the traditional approach is much higher. The only negative with the All on 4 technique is that it requires a master implantologist with  a large body of experience and a highly trained team including an in house laboratory dedicated to All on 4 cases. Thus there are very few offices capable of offering this service.

The All-On-Four dental implants don’t require additional surgeries or bone grafting, which has become a norm for traditional implants. It also proves to be more secure, comfortable & cost effective than traditional implants and is thus the treatment of choice for those who have already lost or are facing the loose of all of their teeth.

FAQ 2: What is so special about Dr. Brueggen’s All-On-Four Dental Methods?

Dr. Brueggen was professionally trained by Dr. Paulo Malo, the architect of the All-On-Four dental procedure. He has been performing dental implants for more than thirty years and specializes in providing successful implant solutions to patients with complex health problems and rare bone conditions.

Moreover, the Brueggen Dental Implant Center uses state-of-the art technology, including advanced imaging equipment and provides a lab facility, to provide patients outstanding and convenient dental solutions.But the greatest advantage to Dr. Brueggen’s All on 4 process is his team and their experience. Dr. Brueggen and his team have made the All on 4 dental implant reconstruction the focus of their practice. They do it every day and they’ve been doing it every day for many years. Equally important Dr. Brueggen has extensive training in general and cosmetic dentistry so he not only provides the surgery, he provides the new teeth as well. This makes the process seamless and is far superior to a surgeon and restorative dentist trying to work together on a case.

FAQ 4: How was Dr. Brueggen inspired to perform All-On-Four dental implants?

Dr. Brueggen has been handling dental implant cases since 1976 and is considered an expert in the field. He realized that the time and cost required to complete a full mouth reconstruction using  traditional dental implant procedures was far too great for it to be available to most of those who needed it. In 1994, he came to know about the unique All-On-Four dental implant procedure through papers published in dental journals. After reviewing the literature for over 10 years he was convinced that the results achieved with the All on 4 protocol were far superior to those achievable with traditional methods. Dr. Brueggen attended a lecture given by Dr. Malo and was further convinced. He asked Dr. Malo for his assistance in learning the technique. Dr. Malo agreed and arrangements were made for Dr. Brueggen to travel to Lisbon, Portugal to study with Dr. Malo.  His studies included both the prosthetic and surgical aspects of All-On-Four protocol. These days the All on 4 technique allows Dr. Brueggen to offer a lasting and predictable solution to people from all over the world.       

FAQ 4: What is the success rate with the All-On-Four Procedure?

Published data states that the success rate of All-On-Four dental implants in upper arches is approximately 97 to 98% and the success rate for lower arches is 98.2%. New data indicates perhaps even better numbers.    

Dr. Brueggen is firm in his conviction that the All on 4 process is the finest solution that dentistry has ever had and probably will have for the remainder of his career, for those who have lost all of their teeth or who are facing the loss of all of their teeth. There are three primary obstacles for people who need this procedure.
  1. Cost- A typical upper and lower case will cost around $50.000.00. About the cost of a high end new car. Not a daunting investment but certainly difficult for some. Our office has two treatment counselors available to assist patients in finding financing options. They can also help you explore other treatment options. For example, in some cases a lower denture can be secured with implants, also in just one day, for as little as $8,000.00. The treatment counselors responsibility is to treat you as an individual and make sure that a solution is found for you that makes you happy and provides you with the finest possible care.
  2. Fear-The second greatest obstacle for patients to overcome is fear. All most every patient who has lost all of their teeth or is in danger of doing so is a dental phobic. We solve that daily using safe oral conscious sedation.
  3. Inadequate Bone- The All on 4 procedure was specifically designed to allow a full arch of reconstruction without the need for sinus lifts or other forms of bone regeneration. That is possible on the lower virtually 100% of the time. The upper is not quite as predictable but it is still possible in over 70% of the cases presented to my office. When bone grafting is required we employee state of the art procedures  to cut down on time, discomfort and cost.   


Without a doubt the All on 4 method of dental implant placement and tooth replacement is the most remarkable dental advancement in the last 30 years. If you or anyone you know or love is suffering with false teeth or the prospect of having to wear false teeth there is no reason to put off help any longer.
 
I’ve been doing the All on 4 procedure for about 15 years.  Eventually it became a weekly procedure and now daily.  During this time there are very few mitigating factors or complications I have not seen or treated. The biggest challenge with the All on 4 procedure is and always has been upper cases. At least 30% of the patients who come to see me can’t have it done on the upper without preparatory bone grafting.

The focus of my current studies is finding ways to make this easier and more predictable. Currently when bone grafting is required to prepare a patient for dental implants the procedure is delayed by 4 to 6 months and over 40% of all grafted sites experience less than a perfect result often times requiring some type of revision surgery and occasionally needing to be completely redone.  Needless to say this adds time, expense, and inconvenience to everyone involved and better solutions are badly needed. The good news is that everyone realizes this. Regardless of what type of dental implants procedures are being done, single dental implants, full mouth individual dental implants, or the All on 4 procedure, adequate bone volume is always the limiting factor.

Tremendous resources are being dedicated to finding better solutions and indeed progress is being made. We can now synthesize proteins and stem cells in the lab that make bone substitutes almost as reliable as natural bone harvested from the patient. New and better techniques are being developed for the use of these materials almost daily. I attended a meeting in Hamburg, Germany recently and much was dedicated to this. I’m going to another one in October in Boston specifically to study new grafting techniques. All in all great progress is being made. But still, over 40% of all grafts have some level of complications. The problem with bone grafting for dental implants is not primarily with the graft materials. It is with the membrane, which looks like a sheet of paper, that the graft must be covered with prior to suturing the tissues over it. All grafts with the exception of autogenous block  grafts, those taken from the patient, require this covering. There are literally dozens of different membranes on the market, each with its’ advantages and disadvantages, but they all become exposed too often. Exposure occurs when the tissue over the membrane develops an ulcer that creates an opening that will allow saliva and bacteria to penetrate into the surgical site.  If this happens too early the graft is likely to fail and if it happens any time before 4 months, and it often does, the graft will be less substantial than initially desired.

The advantage of the new bone grafting materials is that they grow bone faster so the membranes don’t have to been maintained for such a long time. Though I haven’t experienced I have had colleagues tell me they have seen adequate results in some cases with only two weeks of membrane coverage. The advantage of the new bone grafting membranes is that when they do expose infection is less likely to occur and more easily controlled. I think however, that in the near term, the best solution is going to be the oldest solution simply done better; autogenous block grafts. In the past this has been a delicate procedure done by few and mastered by fewer. I did two of them today but only because I had to.  In severe cases it requires both an oral surgeon and an orthopedic surgeon working together in a hospital setting. Amazing new instrumentation which allows the cutting of bone without risk to nerves or blood vessels is going to make this a very safe procedure which can be predictably performed by even the less experienced dental implantologist. The use of autogenous bone in areas where the tissues are delicate and most susceptible to ulceration and bone substitutes in areas where membranes can be placed without a high risk of exposure will provide enough bone without resorting to a hospital operating theater. And minimizing the need for membranes should dramatically reduce complications.

All things considered I see the potential for many patients to be helped who previously could not because the risk – benefit ratio was too great. And on a daily basis more autogenous block grafts will be used because new procedures and instrumentation make them simpler. I am confident that this will open the door for many patients who were previously not good candidates for the upper All on 4 prodedure as well as more routine dental implant procedures.  It looks like another great year ahead with much to be learned and shared in the field of dental implantology.