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 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.