Full arch prosthesis home care and all on 4 home care
All on 4 home care is very important. There is no guarantee that an all on 4 will last your lifetime and if you do not take care of it at home it is unlikely to hold up well.
All on 4 home care for anyone with an implant supported denture.
This information applies to acrylic, composite, or porcelain prosthesis and to all on 4 or implant supported denture or implant supported full arch bridge (or any other name).
All on 4 home care and office care
Use a waterpik with the subgingival tip or Pik Pocket tip or an airflosser and some sort of floss twice a day. I like either superfloss or one of the idontix products that you can see below. You can use toothpaste to clean the prosthesis and mouthwash.
The main question we have to deal with when discussing all on 4 cleaning is whether we should remove it for a cleaning or not. This answer will depend how well you are taking care of it, and how fast you build up tartar.
If together we can clean off all the tartar 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 will need to change out the screws that cost $45 a piece. The reason is the screws start to breakdown. 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.
Annually or biannually cleaning visits will be required if there are no teeth left. If there are some teeth left then we base the cleaning protocol on the remaining teeth. If no problems, we do a yearly x-rays on all on 4 and/or implant supported dentures. Finally, if you have some natural teeth left then we x-ray them as needed.
All on 4 Maintenance
When it comes to all on 4 maintenance, if you have an acrylic all on 4, expect some problems. Primarily, 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. Wear your 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.
Ceramic versions will have something fracture given enough time. We can smooth off a small fracture. A larger fracture will be similar to a natural tooth breaking and require a new crown on it. If the fracture is really large, we will have to remove the prosthesis and send it to the lab to be repaired. Thus, you will need your temporary again, if this ever occurs.
If we need to remove
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 have a poor design so that you cannot clean the underside at all. 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 implant maintenance. Remember if we must take it off, I insist we change the screws every other time it is off.
Factoring all this in, your all on 4 maintenance fee can run from $291 (1 exam, 1 cleaning, 1 x-ray) up to about $800 a year for most people. These are pre-insurance fees.