Full arch prosthesis maintenance or all on 4 maintenance
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
Waterpick or airflosser and/or superfloss twice a day. 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 it should be removed or not to clean. This answer will depend 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 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 the cleaning protocol will be based on the remaining teeth.
If no problems, we do a yearly x-rays on all on 4 and/or implant supported dentures. If you have some natural teeth left then they are x-rayed 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. A small fracture can just be smoothed off. 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 be poorly designed so that the underside cannot 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 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.