All on 4 maintenance

All on 4 maintenance or All on 4 cleaning

This information applies to acrylic or porcelain prosthesis and to all on 4 or implant supported denture or implant supported full arch bridge (or any other name).

Patient take home sheets are found on this implant supported denture link.  Very similar to this information.

How do we clean under and maintain an all on 4 prosthesis?

There are two different questions here.  One is how does your dentist care for your all on 4?  The second is what maintenance costs and issues are there?  I cover the second issue of all on 4 maintenance here.  On this page I will just say two things about maintenance.  When it comes to all on 4 maintenance, if you have an acrylic all on 4, expect some problems.  Primarily, as this all on 4 maintenance study shows, you will need to replace the plastic teeth as they wear down and break.  One other all on 4 maintenance issue that I will touch on is that of protection.  Get a night-guard made.  Whether you have acrylic or porcelain all on 4 teeth, a night-guard will protect your investment and is well worth the up front cost.

What I will discuss here is the all on 4 cleaning protocol and costs of the procedures.

The main question we have to deal with when discussing all on 4 cleaning is whether it should be removed or not to clean.  This answer will depend on how well the prosthesis was made, how well you are taking care of it, and how fast you build up tartar.  If all the tartar can be cleaned off and the implants look like they are in good shape, I recommend leaving the all on 4 prosthesis on and cleaning around it.  The reason for this is two fold.  If there is no problem, why take it off?  If you do take it off, you may need to change out the screws that cost the dentist between $25-100 a piece.  Think about a paperclip as you bend it back and forth.  The metal screw is undergoing similar forces and if taken on and off enough will break inside the dental implant, which is a major problem.

If no problems, we do a yearly x-ray and cleaning on all on 4 and/or implant supported dentures.  If you have some natural teeth left then it is cleaned whenever the teeth are cleaned, so 1-4x year based on your needs.

People often want to know how often we should remove the implant supported prosthesis to clean under it.

Below is the quote from the American College of Prosthodontists. Their position paper on this topic is the standard which we should all follow. I also happen to strongly agree with it and have had the same opinion since long before they came out with the paper.

“Removal of a fixed, screw-retained implant prosthesis for evaluation is not needed unless there are signs of peri-implantitis, a demonstrated inability to maintain adequate oral hygiene, or there are mechanical complications that require removal.” Exert from the 2016 ACP position paper.

All on 4 cleaning cost

If we can leave the all on 4 on and clean it, then the fee is our regular cleaning fee, which in 2015 is $98.  There also is the regular exam fee which is $96 for first time patients and $51 for patients after that.  The yearly x-ray is $142.  If you have dental insurance, most of this is covered.  If all of your natural teeth are missing, then a once a year visit may work fine for you.  If you build up a lot of tartar, we’ll see you more often.

all on 4 maintenance

Zirconia framework porcelain implant supported bridge

All on 4 have to come off to clean and examine the dental implants?

There are several reasons why the all on 4 must come off.  You may have too much tartar to clean the prosthesis without taking it off.  It may be poorly designed so that the underside can not be cleaned by you or us.  This design problem is common and sometimes unavoidable.  We strive to make the underside convex, but on occasion it must be concave due to anatomical factors.  The third reason to take the all on 4 off, is that we suspect a problem or need to do some all on 4 maintenance.

If you need all on 4 maintenance, or we have to take it off for another reason, the fee is $600 for either just upper or lower or both (that fee covers the removal and replacement of the prostheses and cleaning of it and the implants – it does NOT cover the exam or x-ray).  The dental code for this procedure is D6080. We will replace the screws every other time we take it off.  We charge $45 per screw.  That means your number of dental implants x $45.

Factoring all this in, your all on 4 maintenance fee can run from $291 (1 exam, 1 cleaning, 1 x-ray) up to something fairly high.  Most people are in the $300-800 yearly range.  These are pre-insurance fees.  If you have any questions on what your fee will be, we offer complimentary consultations to determine what your specific situation is.

All on 4 have to come off to repair?

The most common time this occurs is when a tooth or section of acrylic break off of an all on 4.  The dental code for this is D6090 and I typically charge my removal fee of $400 for one or $650 for two and anything the lab charges.  This does not cover any other fees that might come along with this procedure.  It also does not cover the cost of replacing screws if this is required.


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18 Responses to “All on 4 maintenance”

  1. February 15, 2018 at 12:00 am #

    Why does my bottom denture not stay put with two implants in front and unable to bite foods or unable to chew meats.

    • February 15, 2018 at 3:39 am #

      For some people two is not enough on the bottom. Lower dentures suck, sometimes even with 2 implants helping out. 2 more implants will help but you will never eat the same with dentures. Our take home paper work says “Remember dentures are not a replacement for teeth, they are a replacement for no teeth”. In other words they are better than no teeth but they are NOT as good as teeth.

  2. March 5, 2019 at 4:07 pm #

    What a RIP off you are!
    It takes 5 mins to remove both upper and lower jaws so your charging wat too much. Once off cleaning is a lot more simpler than cleaning them in place!!!
    You are scandalous sir!!!!

    • March 6, 2019 at 4:43 am #

      If you are a doctor or work in the field and are used to taking them off, I would recommend learning to make them so that you no longer need to take them off to clean them or learn how to adjust them so the patient can clean them. This has been the ACP position for awhile, for Australians that would be similar to your APS I believe. The position paper on the topic can be found online. If you are a patient I’m sorry to say yours likely wasn’t planned ideally if it needs removal to clean. You are in the luck though because the majority of these can be made non-removable and cleansable while in place with the right doctor! The steps for making your prosthesis cleansable by your doctor can be found on our site!

  3. April 30, 2019 at 7:16 pm #

    This is the most comprehensive site (info AND images) I’ve reviewed (and I’ve reviewed ALOT of sites over the past year or so). Were I in Illinois, you would my first and ONLY choice for 4-on-1 –but I’m not. I don’t suppose you have any colleagues in the Atlanta, GA area who maintain your high professional and ethical standards?

    • April 30, 2019 at 10:17 pm #

      Sorry Kathleen I do not. I have found the dentists with the MAGD and FAGD after their names are very well trained. Perhaps you can use this website to find those and then cross reference a list of those offering the service. Click on the button that says AGD Fellow and Masters. Good luck!

  4. May 14, 2019 at 5:04 pm #

    You are comprehensive when discussing your fees and issues that may occur because of cleaning. I’ve had my all on four acrylic for five years. I clean it myself because when I went to the hygienist, she didn’t know what to do so she started scraping on the area of the pseudo separation of the teeth. All she was doing was damaging the acrylic. My dentist has told me that my mouth is exceptionally clean. I use a waterpik, toothbrush, thick denture floss and a type of pick if needed. My teeth keep shearing off in the front of my mouth, but the prosthesis itself is still intact. I would love to understand what just my top front teeth keep breaking.

    • May 14, 2019 at 6:06 pm #

      Because it’s acrylic and acrylic breaks. Very common with acrylic. 50% will experience teeth breaking in first five years. If you wear and essix over it at night this will happen less.

  5. November 19, 2019 at 1:23 am #

    what is the normal cost of replacing the o-ring on the implants? And can you buy them and do it yourself?

    • November 19, 2019 at 4:39 am #

      If you are going to the original doc then cheap (dental cheap anyway). Maybe $1-400. New dentist will cost more and some won’t do it cause not worth getting involved. I seriously doubt many could do it themselves. I don’t even think you could find out the parts you need and even if you could I’m not sure you could ever find a company to sell them to you.

  6. December 30, 2019 at 11:15 pm #

    Don’t bother with this procedure it’s too time consuming and look at the prices they charge for problems, get the G4 procedure, it’s a 2 day procedure and I’m going on my 4th year with no problems and great looking teeth (better than anyone else around me, that’s for sure.

    • January 5, 2020 at 12:10 am #

      It’s the exact same thing just that a doc put his name on the process. It’s what almost everyone does for their temporary now but G4 just adds metal to the temporary instead. It makes sense, especially for lower surgical risk patients.

  7. March 29, 2021 at 11:24 pm #

    My husband got all-on-5 & all-on-6 fixed hybrid dentures in Mexico 3 years ago, and went back for cleaning 2 times. Does your clinic do the maintenance cleaning on these? Then we don’t have to keep going back to Mexico every year.
    Thank you.

    • April 12, 2021 at 4:53 am #


  8. September 23, 2021 at 9:58 pm #

    How often do you recommend cleaning my all on 4 upper and lowers if you have to remove them and or if you clean them in place? What determines if they have to be removed or not?
    Thank you,


    • October 4, 2021 at 6:16 pm #

      Most we never remove some we remove once a year. Typically if they need removal we adjust them to make them more patient cleansable so that we do not need to remove them as often. Like this If you are someone that builds up tartar quickly we need to remove more often.

  9. June 8, 2022 at 2:06 pm #

    Great website for info. Nice work and nice citations. You’re doing a nice service for the public.

    Jeremy Lansford DMD, MAGD

    • June 11, 2022 at 1:56 am #

      Thank you. Appreciate the kind words.

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