This article describes the revolutionary technique making it possible for patients of all ages and presenting with all stages of periodontal disease to receive new and beautiful teeth in a single dental appointment.

All on Four Dental Implants: Introduction

All on Four dental implants offer the comprehensive oral rehabilitation solution to patients suffering from tooth loss and who are looking at a future of edentulism (not having any teeth). This ingenious tooth replacement technique was designed by European Implantologist Dr. Paulo Malo and essentially enables dental implantologist to replace a patient’s entire mouth of missing or failing teeth using only four dental implants (hence the name of the technique) and a fixed (non-removable) and fully customized prosthetic dental bridge. While the All on Four dental implants procedure may sound incredibly simplistic, the advantages it has over traditional tooth replacement and implant techniques has awarded it with ‘breakthrough’ status in the medical fields of dental implantology and oral rehabilitation!

All on Four Dental Implants: Battling Periodontal Disease

In spite of our incredibly advanced technology, medical treatments and the widespread availability and variety of oral hygiene products, more than 26% of Americans will enter into their late adulthood without any of their original adult teeth. This is according to statistics released by the Center for Disease Control, who also claims that approximately 100 million people in the United States are missing between 11 and 15 of their permanent teeth and will eventually require complete oral rehabilitation by the age of 65! So, what is the culprit behind this pervasive problem of tooth loss and the millions of candidates for All on Four dental implants?

Periodontal disease is characterized by a chronic and acute bacterial infection of the soft tissues surrounding and supporting the teeth, in other words, your gums. Poor lifelong oral hygiene, smoking, excessive drinking, drug abuse, serious illness (cancer, HIV/AIDS, diabetes) and even genetics can cause you to become especially vulnerable to periodontal disease. So pervasive is this oral affliction that an estimated 80% of Americans suffer from some form and stage of it! The problem with periodontal disease is that its symptoms can be as innocuous as mild inflammation of the gums with no pain or discomfort. It is for this reason that patients seldom seek treatment from an oral surgeon; however, if left alone, periodontal disease can become acute and result in bone loss in the jaw, tooth decay, gum deterioration and tooth loss!

The Great Paradox Entirely Avoided by All on Four Dental Implants

It is here that a great paradox emerges: The people who suffer from advanced periodontal disease and tooth loss are the ones who most need to receive dental implants! However, the loss of bone tissue due to bacterial infection means that their jaws just won’t be able to support dental implants using traditional techniques. This is where the incredible advantages of the All on Four dental implants step in. Patients who have previously been told that they are not dental implant candidates are often able to receive a complete set of beautiful new teeth in as little as a single dental appointment! The All on Four dental implant technique has revolutionized the field of implantology and it is making complete oral rehabilitation possible to people of all ages and stages of periodontal disease and tooth loss!

Dental implants are offering a more effective and durable alternative to dental bridges and dentures and enabling people to successfully restore their missing or decaying teeth. People lose single or multiple teeth in the upper and/or lower jaw due to gum disease or a traumatic experience. Instead of choosing traditional dentures, they look for a more durable and natural looking replacement alternative. Treatment options like single dental implants and multiple dental implant methods are bringing a lasting solution to teeth loss conditions and helping people to smile again. 

Dental implants have now become a standard of treatment for all those who are losing single or multiple teeth in the upper and/or lower arches. However, not all oral surgeons specialize in dental implant methods. So they propose removable dentures or fixed bridges with wire wrapped around the adjacent teeth to keep them in place. This does not prove to be the most comfortable solution.

People with missing teeth can now seek replacement in dental implants. Dental implants are artificial tooth roots that your oral surgeon or dental implant expert uses to replace your original roots using a surgery technique. Instead of relying on the gum line like traditional dentures or using healthy teeth in the adjacent areas as anchors like dental bridges, dental implants provide a lasting support to the replacement tooth or bridge. Made of titanium metal that easily integrates within the mouth and replaces the natural roots, dental implants never make uncomfortable noises or slip during speaking or eating. Moreover, they prevent bone loss and cause no harm to the adjacent teeth. The dental implants look and function just like natural teeth. Under proper care and regular maintenance, the implants can last for a life time.

What dental implants offer?

1. The implants help to restore single or multiple missing teeth without damaging adjacent teeth.
2. Eliminate the requirement for a partial or full denture.
3. Provide stable support for replacement teeth, making it more secure and comfortable.

Where are dental implants applicable?

An experienced dental implant expert will inspect the condition of your existing teeth and decide how and where to place your dental implants. Based on your current condition the dentist will create a treatment plan perfect for your needs. Commonly, dental implants are recommended for the following conditions:

Dental implants for replacing a single tooth: A single dental implant can help you to replace a single missing tooth. Here, the dental implant replaces the missing tooth and its root.

Dental implants for replacing multiple teeth: Dental implants can be integrated to replace multiple missing teeth. Missing teeth and roots are being replaced with the help of dental implants.

Dental implants for replacing a full arch of teeth: A full set of implants can replace your entire set of teeth, both bottom and top arches.

Nowadays, dental implants are emerging as a practical treatment option for people who have already lost single or multiple teeth in the upper and/or lower arch due to periodontal diseases, tooth decay, accident or some other traumatic condition. They are helping people to fill in the gap created in place of missing teeth and get back the confident smile they once had. Teeth gaps tend to discourage people from smiling as they are worried about the image the gap portrays. However, dental implants are helping to make people feel comfortable smiling again. 
There are alternative treatment options available for replacing the missing teeth like traditional dentures and bridges but they don’t prove to be as effective and as durable as dental implants. Partial and full dentures have been catering to the teeth replacement requirements of people for more than thirty years. However, dental implants have exceeded dentures in providing a more permanent solution. Similarly, single dental implants have started to replace the removable and fixed bridges which were once a popular option. Multiple dental implants are helping people to restore several missing teeth without needing support from the adjacent teeth. They also ensure the least damage to the remaining teeth and reduce the discomfort often associated with other alternative solutions.
People are relying on the dental implants method to enhance or restore their smile. These natural looking implants are helping them to overcome the restrictions of full or partial dentures and obtain a beautiful smile.
People with traditional dentures often face problems with eating and talking. However, permanently fixed dental implants are helping them to speak fluently without any fear of implants slipping. Implants also provide people the ability to have a stronger biting force again. In this way, implants are enabling people to restore their facial structure which means they look and feel more healthy and youthful.
Dental implants are not all the same. Normally any dental implant less than 2.5mm in diameter is referred to as a mini dental implant. But just because they are diminutive in size doesn’t mean the results cannot be spectacular for certain categories of patients.
Dr. Brueggen has placed hundreds of mini dental implants. When used to help keep a lower denture in place they have proven themselves to be dependable and durable. This is not the case with uppers and their use should be avoided in the upper arch.

When asked; what is the preferred solution. Regular dental implants or mini dental implants Dr. Brueggen responds: “Usually regular dental implants. Their size provides more strength and greater anchoring to the jaw and much more sophisticated attachments to secure the denture to the dental implant.””Additionally a mini dental implant should rarely in ever be used for any purpose other than to help hold a lower denture in place.” “Traditional dental implants offer many more restorative choices than mini dental implants”.
However, Dr. Brueggen says that every case must be evaluated on its’ own merits and mini dental implants are sometimes the treatment of choice.
Two examples would be:
1.    Cost – some patients, especially elderly folks already wearing a lower denture, cannot afford the cost of traditional implants.
2.    Health – some patients have health issues that make implant surgery too risky. Mini dental implants can be placed with only light local anesthesia and no incisions or stitches.
Mini dental implants can be placed quickly and since they require no incision or stitches they are ideal for certain cases. Additionally an existing denture can frequently be used further reducing time and cost and an equally exciting feature is that the denture can be secured by the mini dental implants the same day they are placed. A denture cannot usually be secured by regular dental implants for 4 to 6 months after they are placed.
Since no incision or surgery is required for mini dental implants, they offer an ideal dental treatment option to high risk groups, including:

1. Heart patients with a recent surgery
2. People with severe diabetes
3. Those who want their lower denture to be more firm
4. Those with a limited budget for other options
5. Those who are regular smokers
6. People with blood clot problems
7. Those getting bisphosphonate treatments or medicines for osteoporosis
Benefits of Mini Dental Implants
The benefits of mini dental implants can be stated as follows:
1.    Easy Procedure
2.    Reliability
3.    Great Functional Value
4.    Affordable Price
Every patient wearing a lower denture owes it to themselves to at least have it secured by mini dental implants

Teeth are lost because of trauma or disease. Trauma may come in the form of an accident or excessive biting forces. Disease is generally tooth decay or periodontal disease [gum disease] but there are other categories such as cancer and various neoplasm’s of the jaw that may result in tooth loss. Studies show that more than 50% of the population have one or more missing teeth. Trauma commonly causes the loss of a single front tooth. The effect this has on a persons’ well being is obvious. Fortunately an experience dental implantologist can usually remove the remaining root, place a dental implant, and secure a new tooth to that implant in one visit of an hour or two. The loss of a single tooth in the back is usually caused by tooth decay or periodontal disease. Sometimes this can be treated just like front teeth but for various reasons it is often more time consuming.

 More often than not the treatment for a single missing back tooth is as follows:
1.    Extraction of the damaged tooth and grafting of the root sockets. Wait 4 months then
2.    Placement of a dental implant to replace the root of the single missing tooth. Wait 4 to 6 months then
3.    Placement of an abutment on the dental implant and record taking for the fabrication of a crown to replace the single missing tooth. Wait 3 weeks then
4.    Permanent attachment of the abutment to the implant and cementation of the crown to the abutment.  TREATMENT COMPLETE

The need for replacing a single missing tooth in the back is often times not as intuitively obvious as the need for replacing a single missing tooth in the front; but it is important. Teeth are very movable. We’ve all witnessed an Orthodontist putting tension on a tooth with a small rubber band and moving it where ever he wants. Each tooth in the mouth has a position and a purpose. When there is a single missing tooth the body’s natural reaction is to drift adjacent teeth into the void that is created. Over time a single missing tooth may actually cause a change in the position of every other tooth in the mouth. Malocclusion may then develop contributing to TMJ [tempromandibular  joint] dysfunction, headaches, muscle spasms in the neck and shoulders, food impaction between teeth, tooth decay, periodontal disease, and other problems. Because these problems don’t always develop and because they may occur years after the single tooth is lost, people often times don’t associate the loss of their tooth to the problems it caused. It is a shame that a single missing tooth is frequently ignored in light of the possible consequences but the development of dental implants for the replacement of a single missing tooth is encouraging many more people to seek early treatment.

Multiple missing teeth usually follows a single missing tooth. Each time a tooth is lost and not replaced it accelerates the process of losing more teeth. As multiple teeth are lost all of the problems associated with a single missing tooth are exaggerated. But there are additional concerns as well. Those would include but not be limited to:

1.    Collapse of vertical dimension- As multiple back teeth are lost the mouth loses their support when we close causing the chin to get closer to the nose. This has the effect of deep folds at the corner of the mouth and thinning of the lips. It can easily age a persons’ appearance by 10 to 20 years.
2.    Collapse of facial structure-As multiple back teeth are lost facial support of the cheeks is lost causing a sunken in look. Once again the result is premature aging.
3.    Bone loss- The bones of our upper and lower jaws have only one natural purpose; the support of our tooth roots. When the roots are lost the bone begins to melt away much as a muscle does that is not used. This results in further lose of facial support and can make the wearing of artificial prosthetics such as dentures impossible. It can also make the placement of dental implants more challenging.
4.    Inability to chew foods properly-The mouth is the first in a series of organs designed to assimilate and digest foods. The more thoroughly we can chew the food the better the whole system works. Mom wasn’t wrong when she admonished all of us to chew our food more slowly and thoroughly.
5.    Inability to eat a healthy diet-As more and more teeth are lost it becomes increasingly difficult to eat a balanced diet. Important staples such as raw vegetables and nuts become impossible to eat and we lose out on the many vitamins and minerals they provide.
6.    Inability to eat the foods we enjoy-Corn on the cob, ribs, steaks, fajitas, etc. become impossible to eat. Many people don’t know how much being able to eat what they want means to them until it’s too late.
7.    Embarrassment-There is a social stigma associated with missing teeth. Many people simply quit smiling or hide their smiles with their hands. That is unfortunate because we know of very few people who lost their teeth because they wanted to. Each person has their own story and all of them or sad.

 These are but a few of the problems that people face because of single and multiple missing teeth. Now, dental implants offer amazingly simple and dependable solutions. Dental implants for single missing teeth or multiple missing teeth are artificial roots made of titanium that replace the roots of natural teeth. For a single missing tooth one implant is placed and a crown is attached to it. The result is a natural looking tooth that functions and works just like the natural tooth that was replaced. Many people think that with multiple missing teeth that one dental implant is required to replace each tooth; that is not usually the case. For example if three teeth in a row are missing it is often possible to replace them with only two dental implants and a fixed bridge between them. With the amazing All on 4 protocol and entire arch [16 teeth] can be replaced with only four implants and a fixed bridge.

 The placement of a dental implant is usually quick and almost painless for those who are candidates. One requirement is an adequate quantity and quality of bone. As mentioned previously when a tooth is extracted the bone that once secured its’ root begins to melt away. Some studies indicate that up to 40% of the bone volume in that area may be lost in the first twelve months. Modern dentist with an understanding of oral surgery and implants place materials in the sockets where the tooth roots were to prevent this from happening. The result is a healthy site for the future placement of a dental implant. Dentist with a more advanced understanding of dental implants may actually place an implant into the socket when the tooth is extracted. When this can be achieved it is the best and simplest solution for preventing bone loss. But because many dentist do not understand dental implants and the protocols necessary for preserving bone, and because many patients take a cavalier approach to the loss of a tooth, sometimes there is a need for an implant but not adequate bone to support it. Modern implant designs minimize this as do implant placement protocols such as those of the All on 4 technique but they cannot eliminate the occasional need for more bone.

When there simply must be more bone, bone regeneration procedures are required. This normally incorporates one of many different types of materials that replace the lost bone volume and encourage the formation of new bone. With the advent of stem cell and bone morphogenic enhanced materials this has become far simpler and more predictable. What once required a maxillofacial and an orthopedic surgeon in a hospital setting can now be predictably performed by a well trained dental surgeon in his office. Once this new bone has matured, usually 4 to 6 months, a single or multiple tooth replacement dental implant can be placed just as predictably as if the graft had not been required.

Single Dental Implant Procedure:-

Steps for placement of a single dental implant in the site of a single missing tooth
•    After conscious sedation is administered the placement site of the single missing tooth  is infiltrated with local anesthesia. 
•    A small incision is made in the soft tissue covering the bone in the single missing tooth site and an osteotomy is prepared. An osteotomy is the same thing as a pilot hole made prior to the placement of a screw in wood. Once the osteotomy is completed a single dental implant is threaded into it. Now we have a man made root where the natural root was. Just like a natural root this dental implant is beneath the gums and in the bone and cannot be seen in the mouth. A piece called an abutment is screwed into the single dental implant. The abutment provides the transition from the dental implant beneath the gums to a tooth above the gums. Impressions are taken of the abutment and they are sent to a dental laboratory  
•    In about three weeks a crown is returned from the laboratory and it is secured to the abutment with glue [cement]. You now have a new tooth that looks, functions, and feels just like a natural tooth.

Dental implants for the replacement of single missing teeth and multiple missing teeth have become as routine for dental implantologist as fillings are at your family dentist. For those with single missing teeth they offer an exceptional replacement solution that can help prevent future problems. For those who have lost multiple teeth or all of their teeth dental implants can give them back their smile, confidence, and self esteem. It can truly give them a second chance.

Dental implants are providing a more reliable and effective alternative to traditional dentures and helping people to successfully replace their decaying or lost single or multiple teeth. When we start to lose multiple teeth, in the upper row or lower row or both, it becomes necessary for us to replace those missing teeth with stable and natural looking teeth. Otherwise, we may have to suffer from the discomfort and embarrassment associated with dentures and bone loss and a disfigured facial structure. The multiple dental implant method is bringing a permanent solution to multiple tooth loss conditions and creating smiles again!

Dental implants are now providing basic treatment to all those who are missing one or more of their teeth in the upper and \ or lower jaw. However, not all dentists are professionally trained in dental implant procedures. So they recommend fixed bridges or removable partial dentures with wire clasps that wrap around your remaining teeth to keep them in.

Fixed dental bridges require grinding down healthy adjacent teeth so they can be used as anchors to support the missing teeth. They are a dramatic improvement over removable partials with their wire clasps but in the long run more than 30% of the teeth used for attachments are lost to tooth decay or other problems. Now where one tooth was missing there are two, and then three and-----------and the process continues to repeat itself more and more rapidly until your smile is disfigured, you can no longer eat the foods you enjoy, and your facial structure is collapsing. Soon you are looking at the need to replace your teeth with full dentures or dental implants.

Why let this happen? If you are missing one or a few teeth have them replaced with dental implants immediately. Not only will they not harm your natural teeth they will help them by eliminating food impaction and distributing the work load of chewing more evenly. People often believe that you need a dental implant for every missing tooth. That isn’t necessarily true. Often three missing teeth can be replaced with only 2 implants by bridging between them. In the amazing All on 4 protocol a full arch of missing teeth can be replace with only 4 perfectly placed implants.

An ounce of prevention is worth a pound of cure!
1. What is a dental implant?

A dental implant is an independent artificial tooth root that is used to replace a natural tooth root that has been lost to accident or disease. Dental implants are typically placed to secure bridges, partials, dentures and crowns. Dental Implants don’t require support from adjacent teeth and thus cause them no harm. Better yet, teeth replaced with dental implants look, function, and feel just like natural teeth.

2. Will dental implants be suitable for me?

Advancements in dental implant design and placement protocols have made dental implants the gold standard for the replacement of missing teeth for almost everyone. Patients with specific health conditions including uncontrolled diabetes, osteoporosis, or irradiation of the mandible or maxilla for the treatment of cancer, may be at increased risk but they are still candidates and can usually be managed by a highly experienced practitioner. Certain cosmetic conditions can be a challenge as well but advancements in cosmetic dental implant procedures routinely produce beautiful, natural, esthetic results that patients often describe as far more beautiful than their natural teeth ever where. One of the most difficult conditions to overcome is actually a habit or an addiction rather than a condition; cigarette smoking. This is an annoyingly difficult addiction to overcome and many wonderful people who have extraordinary will power and a strong desire to quit simply can’t. That is unfortunate because as smoking is a strong contributing factor to tooth loss, smokers form a disproportionate number of those in need of dental implants. The majority of the patients I see for the All on 4 procedure are smokers. So though smoking is not a contraindication the patient and doctor must realize that they will be faced with a higher than normal number of complications. Fortunately if the doctor is highly experienced and the patient is persistent, cooperative, and determined a satisfactory outcome can almost always be achieved.

3. What are the benefits of implants over other dental procedures?
•    Dental implants are permanently fixed and thus the teeth attached to them will not slip or move insuring comfort and avoiding embarrassing moments.
•    Dental implants are easily maintained and are not susceptible to cavities.
•    Dental implants allow you to eat all of the foods you enjoyed with natural teeth.
•    Dental implants look like natural teeth providing a beautiful smile so you don’t have to live with the stigma and embarrassment associated with missing teeth or false teeth.
•    Dental implants promote bone growth and help maintain a youthful facial structure..

4. How comfortable are dental implants?

Dental implants are amazingly comfortable. Most patients are given nsaids such as Ibuprofen and methyl prednisone and report little or no discomfort. All on 4 patients can usually enjoy a light meal the evening after their surgery and most return to work in a day or two.

5. Who is authorized to perform dental implants?

Dental implants can be placed by any licensed dentist but very few offer this service. Significant additional training is required to place or restore dental implants. To provide both the surgical and prosthetic phases of dental implantology the demands for additional training is even greater but the benefits to the patient are substantial. Advanced dental implant procedures such as bone grafting and especially full mouth reconstruction with the All on 4 protocol or traditional protocol requires years of training and extensive experience. In choosing an implantologist you should look for a doctor who has additional post graduate training, has certification by the American Academy of Implantology or the International Congress of Oral Implantologist, has cat scan imaging technology , an in office dental laboratory, and extensive experience. Offices like this are very rare but it is worth your effort to find one.

6. Are dental implants easy to maintain?

You need to care for dental implants the same way you would your natural teeth. It is always recommended that patients meet with their dentist regularly and maintain proper dental hygiene to  insure long term satisfaction with dental implants.

Dental Implants - An Excellent Option for Tooth Replacement 

      Dental implants are simulated roots that are positioned properly in the jaw bone to grip the replacement tooth which offers a natural look and feel for the patient. They provide the patient the freedom to speak and eat with confidence. There is no need for the patient to fear slippage or dread the use of adhesives which are common with dentures.

      Usually, a patient becomes a candidate for dental implants for several reasons. The patient has either lost their teeth due to an accident or are about to lose one or more teeth due to decay. Dental implants offer a more permanent alternative to removable dentures or bridges. Both dentures and bridges neglect to stimulate bone growth which can cause some patients to experience excessive bone loss over the years resulting in a less than youthful feel and appearance.

      There are several varieties of dental implants but traditionally there are two basic categories. The first and most widely used is the Endosteal implant which is placed directly into the bone. This requires sufficient bone integrity to support the implant insertion. The second category is Subperiosteal implants which are used if the existing bone has already atrophied causing the jaw bone structure to become limited. The implant in this case is secured on top of the remaining jaw bone as opposed to being inserted into the bone. 

      The most recent and emerging type of endosseous or (root-form) dental implants are those known as, “All-on-Four dental implants.” The All-on-Four dental implants are made of titanium and the crown part resembles a significantly more natural looking tooth compared to traditional implants or dentures. These endosseous dental implants succeed because they are integrated within your existing jawbone and require a limited amount of overall implants. Where traditional implants often require an average of 8 to 10 implants all inserted into one arch, All-on-Four dental implants only require 4 implants each on the lower and upper arches providing a secure and long-term solution for tooth loss.  

All-on-Four dental implants are available at the Brueggen Dental Implant Center in Houston, Texas. Dr. Wayne Brueggen, Houston dentist, is the founder and sole owner of the Brueggen Dental Implant Center. Dr. Brueggen’s background includes expertise in both cosmetic dentistry and dental surgery. His over 30 years of experience in the dental industry and the treatment of over 20,000 patients has made him a highly respected expert in his field. Dr. Wayne Brueggen is the foremost leader in the All-on-Four dental implantprocedure. For more information or to schedule an appointment please visit 
This is a real experience at the Brueggen Dental Implant Center, commonly known as the “Houston Dental Implants” - we did a lower All-on-4 dental implants case for a 60 yr old gentleman from Colorado. 

A brief description of the condition of the patient provided by Houston Dental Implants:

He was in town on personal business and learned about Houston Dental Implants from a T.V. ad. His medical history was non-contributory. Dentally, he was wearing an upper and lower denture. There was a mobile and failing unilateral subperiosteal implant on the lower left, and one had previously been removed on the lower right. Subperiosteal implants are placed beneath the “gums” and rest on, but not in, the bone.

Subperiosteal implants are used when there is inadequate bone volume to place a dental implant into the bone, and the treating doctor is not aware or trained in other options. They experience a very high failure rate. I have removed a number of subperiosteal implants but have never placed one. 

These implants were placed in Colorado about 15 years ago when the upper and lower dentures were made. It was the doctor’s hope to attach the lower denture to the subperiosteal implants, but unfortunately, that was never possible. 

This patient was displeased with the fit of his false teeth. Even with thick denture adhesives, he was unable to eat, and the lower was unstable even in speech. He was a very active gentleman and very frustrated with his situation because his previous dentist had told him that he did not have enough bone for dental implants.

How did Houston Dental Implants made the life easier for the 60 year old, active gentleman?

Houston Dental Implants took a cat scan (a very sophisticated x-ray designed to allow precise measurements of bone in all dimensions) and determined that he did have enough bone for dental implants if the All-on-4 dental implants (a full set of upper or lower teeth fixed to 4 dental implants) technique was used.

Consultation revealed that financially doing this on the upper and lower was not feasible, so we elected to do a new denture on the upper and the All-on-4 dental implant procedure on the lower.  Our in-house lab pre-made the upper denture, so when he arrived at Houston Dental Implants in the morning; we were able to deliver that before I began the surgery.

Using conscious oral sedation, I began the surgery at 9:30 A.M. The failing subperiostel implant was removed, 4 endosseous dental implants were placed, and the surgery was completed at 10:55 A.M.

Impressions were taken for the lab and at 4:30 P.M., the patient was ready to leave with his new upper denture and new lower non-removable teeth attached to 4 implants.

His healing and recovery should be uneventful, and I anticipate making his final set of teeth in 6 months. Houston Dental Implants was hopefully able to minimize his dental troubles forever.