All on 4 broke

Is your All on 4 broke?

All on 4 broke and you need a repair or replacement? If so check out some of the issues and options to fix the problem. You may also find out find out why your all on 4 broke and what if anything you can do to prevent it from occurring again. The term all on 4, hybrid denture, AO4 are interchangeable. The issues on this page occur with many implant supported dentures.

Well what specifically about the all on 4 broke?

There are many things that can break or fail on an all on 4. Starting at the very base a dental implant can fail and need removal. Implants or the abutments attaching the implant to the all on 4 denture part can break. Screws of the all on 4 can break or come loose. The metal support can break. Finally the teeth or acrylic can break of fall off. Each problem has a specific solution to fix and also should possibly change how your dentist and you maintain your all on 4 going forward. I will discuss each type of breakage individually with tips on how to fix and how to avoid in the future.

Teeth and acrylic of the all on 4 can break

This is by far the most common issue we see. Studies show that half of acrylic all on 4 prosthesis will have a tooth or acrylic fracture @ the 10 year mark. One study also shows that nearly half will have porcelain chip or break in the first 5 years as well, but I feel strongly that the type of crown they tested was the primary cause for the high failure rate. In my personal experience porcelain does MUCH better than that. Also in my experience, acrylic patients that have teeth break continue to do so no matter what we do to “fix” it. Our industry knows this and labs market the fix as changing materials.

Broken hybird dentures causing headaches.

The simplest fracture is when an individual tooth comes out. This is fairly easy to fix and we often just fix it in the office. A more sever fracture of acrylic may require the whole thing be sent to the lab. This is a pretty big inconvenience for a patient.

Image all on 4 broken tooth

Example of a single tooth broken out of an all on 4 that we can repair in the office, however, this does become a recurring issue.

Image of an all on 4 broken back tooth.

A broken back tooth with acrylic also missing requires we send in the entire prosthesis to the lab for a week or two.

Solution – The dentist or the dental lab can replace the tooth, teeth, or acrylic at a cost of several hundred to maybe a thousand or so depending on severity.

Prevention – Wear a night-guard to protect your investment and be careful what you are eating.

The teeth on an all on 4 can wear down.

It is my belief that the percentages we see of wear correlate directly with the percentage of patients that suffer from sleep bruxism. The exact percentage of the population that suffer from sleep bruxism is not well known.  A questionnaire study from 1981 shows the number of sleep bruxers to be 13% but I personally don’t trust a questionnaire study on bruxism at all. About 1/3 of prosthesis will show signs of wear at the 10 year mark.

Solution – Replace the teeth at a cost of perhaps a thousand or two.

Prevention – Wear a night-guard to protect your investment.

Failure of a dental implant on the all on 4.

This is pretty rare but it does happen. Typically if the dental implant survives the first year it’s chances of long term survival are very high. When a dental implant fails, it needs removal. However, if we catch a dental implant that is just failing, there are things we can do to help ensure that you keep the implant. There are procedures such as LANIP that can sometimes save a failing dental implant but that is the exception not the rule.

If the dental implant fails and needs removal this can be a major issue. However, if your mouth was over-engineered and you have extra implant then we can remove the implant and it will not impact the prosthesis on top. If you have only 4 implants and one fails your prosthesis can be in serious trouble of complete failure.

Below is this case about 1 year after delivery. The area had an infection that would not go away and we could place the probe into the infection site. After awhile the infection ate up enough bone to cause the loss of a dental implant. Fortunately we we over-engineered the aces and had 6 total implants so the loss of one middle one didn’t impact the case at all.

A couple of methods do exist to replace a lost implant from an all on 4 or more.

If there is a metal framweork one can take off the prosthesis, place a new dental implant, and laser weld to the existing prosthesis to save the day. That is a fantastic save and is something that some labs can accomplish days.

I have also seen where the site is over-drilled and a new implant placed into the same socket, also saving the day. The case study in JPD shows this novel idea to replace a missing dental implant.

Finally I have also seen dentists restore a lost implant with the new locator system F-Tx.  They were even able to retrofit a zirconia frame by drilling the hole larger without fracturing the prosthesis, even though there was no follow up to see if it lasted, I still found it impressive.

Image of lost dental implant all on 4

Solution – If have enough implants do nothing. If not add an implant at a cost of around 2k plus costs to attach to prosthesis, which can be hefty. Or possibly can add the implant into the failed location via the Villa method.

Prevention – Not much one can do other than maintain excellent hygiene, however many failures happen for unknown reasons.

Implant or the abutments attaching the implant to the all on 4 breaking is pretty rare.

I am sure this can occur but I have not ever seen it personally or heard about it happening. However, I have seen individual implants break and we must remove them. This seems less likely when we attach 4 or more dental implants together because we can distribute the forces out more.  I have never seen a metal abutment break, but the zirconia ones are notorious for this. I do not think anyone uses zirconia for their all on 4 dentures and I have never seen or heard of an all on 4 abutment breaking ever. Depending on how many implants you have this type of breakage could be irrelevant or very damaging.

Since I have not seen this type of breakage I will include a photo of what a single abutment breakage looks like.

Solution – Dentist replaces the screw which should cost hundreds to maybe a thousand or so.

Prevention – Nothing you can do to prevent.

All on 4 screws can break or come loose.

This is also rare. Typically if this happens it is not that difficult to remove them and replace. Around 10% of prosthesis have a screw come loose by the 10 year mark and about half that number have a screw break.

Pushing the limits on what is possible is a sure way to increase the chances of this happening. We have one patient with an all on 2 and both screws have broken.

Solution – Replace the screws at a cost of a few hundred dollars.

Prevention – Not much. Have dentist check design of the bite, in other words how the teeth come together.

 

The all on 4 framework can break

If this happens you can really say the all on 4 broke. This is also rare but if it happens it can be a major issue, perhaps even ruining the entire prosthesis. A fracture of a zirconia framework requires a remake, but quality zirconia have a 99% 5 year survival rate. A fracture of a metal framework can have a laser weld to repair it. Under 10% of metal frames will fracture by the 15 year mark.

Solution – Big issue if breaks somewhere that you need a repair, so if the all on 4 broke in the very back and you can go without then no biggie. If you have a metal framework we can laser weld it back together. This is not cheap or easy and cost is a couple thousand at least. If zirconia you are out of luck and are going to have to get a new one.

Prevention – Not much you can do. Dentist can limit cantilevers or in layman’s terms not add so many teeth to the the back.

 

All on 4 broke and you need help?

If your all on 4 broke, we can help you with any issue dealing with your dental implant prosthesis. Whether it is a surgical dental implant issue or a prosthesis complication, just give us a call and we can try to find a solution for you.

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22 Responses to “All on 4 broke”

  1. Rita RomeroAugust 16, 2018 at 12:10 am #

    This is a very informative web page. Thank you. I had an All on 6 procedure done 5 years ago. I have had nothing but problems. The teeth on the bottom arch have not broken, but is very ill fitting. The top arch is another story. One tooth broke and was replaced. Another tooth has broken 3 times! Today an entire piece peeled off! A front tooth and the 2 next to it, including the pink plastic. All I see is metal. What are my options? I totally DO NOT trust the lab that originally made these and have done the repairs.
    Do you have any idea what a replacement arch would cost? Are there better options for me? I baby these teeth, I am still on a soft diet! Very boring! Any info would be helpful. Thank you.

    • Bauer BryanAugust 16, 2018 at 1:44 pm #

      A not uncommon issue from the original prosthesis design. The most cost effective thing is to switch to a milled monolithic denture set up. Companies like Avadent that I talk about in digital denture blog will mill one piece to go onto the frame. The advantages are the entire acrylic portion is one unit and it is stronger since it comes from a block of pre-cured acrylic. Cost of new one depends on what all on 4 tooth material you want to use and how fixable you want it to be in future. A new prosthesis by itself made of high end individual teeth will run around $20,000. I love the idea of individual teeth because any dentist anywhere no matter how little they know about an all on 6 can figure out how to make you a new tooth easily. It is just like preparing a normal tooth for a crown, which all dentists can do. You can probably find something similar to what you have for around $10,000, maybe less. However, you will likely run into same issues. I have a lot more info on the all on 6 cost here.

  2. Patient xJanuary 13, 2019 at 5:00 am #

    I’m very disgusted with dentists not telling the truth about the all on four. I even asked the questions about how long I could expect my new and very expensive teeth would last. My front top teeth have now broken 6 times in three years. Sometimes the repair will last a week and other times I’m lucky I get four months. I even told my dentist that the lab rep said none of my questions mattered because they wouldn’t fit after 2 and 1/2 years. She said that wasn’t true. This is after I have the all on four in my mouth. I was told that the all on four that was considered temporary would be used in case I had to have repairs. No, that’s not true either. My dentist is a prosodontist and can make teeth. I think my teeth break because the material is poor and when she repairs one break, she places pressure on the teeth next to it. I paid $34,000 for my all on four. Now I find I may have to pay more than that just for repair or that’s what I gleaned from your article. My dentist moved one hour away and she’s very good about getting to me quickly, but I’d rather have teeth that don’t break and that I swallowed a few times before I knew they were broken. How can dentists get away with such fraud? My teeth are all one piece of plastic. Is it possible that I got a bad dentist? It seems to me she’s very good, but having so many breakages is causing me to wonder much less the cuts that I suffer when I’m out of town and can’t get to her. She had me sign a paper saying that her warranty is now finished. She always says my gums and implants are in very good shape. I’m very happy about that, but I can’t understand why new plastic would cost so much. At least the implant specialist did a great job.

    • Bauer BryanJanuary 15, 2019 at 4:49 am #

      Materials that one can use vary. Grinders and clenchers break things much easier. It would be costly for you to switch but there are other choices for what the all on 4 can be made from both teeth and substructure. Short of that consider a essix style retainer. It will protect the teeth. If you grind or clench at night that can help protect them. Everything that any dentist makes you can and will break eventually, finding something that works well for some people is just more challenging.

    • Patient yJanuary 24, 2019 at 4:11 pm #

      I could have written this comment . This is exactly what has happened to me. I am so angry at this point. I just had one of the teeth in my lower arch break off. I feel the same way you do about it being the teeth not the implants. I feel like I have wasted $35,000.00 and I do not have $35,000.00 to waste. My husband is totally livid. I have never liked dentists and I like them even less now. I feel they have found a product that they are able to charge you a fortune for and so they sell it with nothing but propaganda. All the reviews I read on the internet before I had this done, I now know that they were paid to say what they tell you about how wonderful these false teeth are.

      • Bauer BryanJanuary 24, 2019 at 9:43 pm #

        You had one tooth break off? Is this the first time? If this is the first time this has happened take a deep breath and relax. Natural teeth break, denture teeth break, all on 4 teeth break, even the porcelain teeth we can put on the all on 4 break. 50% of the people will have a tooth break out of the plastic ones in the first 10 years. There is no material that never breaks, but the porcelain teeth are much stronger. They cost a lot more though too so most patients choose the acrylic ones. Remember most people that get an all on 4 were either getting that or a denture. The majority of dentures are hated so much that the owner never even wears it. If the all on 4 is less than 5 years most labs and dentists fix for free too.

  3. Patient xFebruary 19, 2019 at 6:11 pm #

    Dr. Bauer. I feel I have left a bad impression of my dentist. In truth I continue to see her because of her commitment to excellency. I should’ve said that I think many dentists are sold a bill of goods. She is a prosodontist and creates beautiful work. However, I do think dental professionals should be willing to explain that the All on Four will continue to drain the pocketbook. I noticed that you include zirconium in the lists of materials that break down at relatively the same amount of time as acrylic.. Does this mean that zirconium is being pushed as a more lasting and stronger material for the All on Four? Sorry for my rant. I’ve been upset about the quality of the acrylic and the monetary output. Am I correct that you would recommend acrylic over zirconium? I do not have bruxism but I am a clencher. Recently I bought an Oral B mouthpiece and I’m diligent in wearing it. I’m glad that you have created this blog because it has given good information. Thank you. Is there a way to delete my first post ?

    • Bauer BryanFebruary 26, 2019 at 3:16 am #

      Zirconia was pushed as better and stronger material, until dentists started seeing those break too. And when they break the whole thing is ruined. At least we can repair acrylic. And it’s relatively cheap to repair. I can delete the comment but I think it’s good for others to see that they are not alone in their feelings. I wrote this blog so people know others have the same issues and you are not alone. I think the majority of dentists do their best to let patients know this is not the end of the rode for them and they will have maintenance issues. I think the vast majority have fewer and less frequent issues with their all on 4 then they ever did with their teeth. I like to say that if you are capable of destroying what God gave you, it’s only a matter of time until you destroy anything I give you too. I like this method of all on x the best but there are downfalls to it as well.

  4. ChristineMarch 7, 2019 at 12:13 am #

    I had extractions on upper arch with an immediate acrylic temporary bridge placed 4 weeks ago today. After 1 week one of the acrylic teeth broke. The dentist I used called in the dental technician where by they cemented it back (on think), however, a few days later the very same thing happened. Not eaten in four weeks now but am very anxious. After the tooth broke the first time, the dentist said I have bruxism, which I have never suffered with before so he said I needed to have botox which would stop it – it didn’t instead I am having constant muscle spasms in my jaw both when I am asleep and when I am awake, not sure if this is due to the botox or not. Having had this surgery abroad it is not like popping down the road…. have to take an expensive flight now tomorrow 🙁 Terrified atm as to what the dentist will want to do. Not a good experience t in the first place. Not sure I could go through it for a second time Eeeek

    • Bauer BryanMarch 17, 2019 at 5:45 pm #

      This is a known complication that occurs. Known complications is a great reason not to do something like this overseas. There is a good chance this is not going to go well for you. Often when the temp breaks it takes implants with it. It’s hard to manage when the patient can not be seen right away. These things happen no matter where you have it done but if you are far away it’s a real problem. I wish you luck but there is little that can be done for you. Stick to the soft diet is all you can do.

  5. Lana M HammondMay 3, 2019 at 6:27 pm #

    Hello,
    When you suggest that zirconia should not have so many teeth in the back ( I believe you called them cantilevers), what is the recommended number for a top and a bottom arch to decrease chances of fracture to a zirconia framework? Thank you for your response.

    • Bauer BryanMay 6, 2019 at 10:01 pm #

      It’s not about number of teeth but how far past the last implant the teeth go. We call it an AP spread and 1.5x is considered ok. However, that is a very rough guideline and it comes from metal not zirconia. How far can you go with zirconia is not really known but the less you can do the better. Certainly not more than 1.5x

  6. TonyJune 30, 2019 at 10:51 pm #

    Hi, I have a cemented all on 6 that I have had for 2 years and have always hated the looks of them. They barely show when I smile. What would be the cost to replace them?

    • Bauer BryanJuly 1, 2019 at 5:10 pm #

      To replace both with plastic would cost you around $25,000. Higher end teeth and or materials would cost more. Depending on critical you are going to be about esthetics of the materials you may not notice the difference between porcelain and plastic. The good thing is that usually not showing teeth is a fixable problem that does not require implant removal or more implant placements.

    • Bauer BryanJuly 1, 2019 at 5:18 pm #

      I’m sorry I just noticed it’s cemented on so I am thinking it is metal and porcelain. Those are just a few thousand higher. About $30,000 for both together. Just one is $18,000.

  7. ChristineJuly 9, 2019 at 6:11 pm #

    6 months to the day and I swear if There is an after life I would go down a different route. My tongue is red raw as I am constantly sucking my top arch, plus the numbness hasn’t gone away as yet, plus pretty sure the dentist was using me as a guinea pig, plus instead of 6 he implanted only 4 and yet added 16 acrylic teeth which I fear was probably too many 🥴🥴 atm I would be happy to have them removed which terrifies me even more.

  8. Robert SaucedaAugust 20, 2019 at 8:30 pm #

    Hello Dr.

    In contrast to the comments here about having nothing but problems, how many of your cases have ended in failures?

    Is it true that the implant will last forever (IF no complications arise) or will they need replacement after 20 years?

    I have had the all on 4 done on 08/16/2019 by Dr. Monarress in San Antonio, by all accounts an expert in this procedure. Only the lower was done at this time for financial reasons and I wanted to get the maxillary done when finances permit (currently have all natural teeth on top minus one wisdom tooth. ) no issues, no pain and yes I’m still very new into this but alot for all the “94-99 success” rates I see comments like those above and its a real bummer, I dont want to be known as a dental cripple.

    • Bauer BryanAugust 20, 2019 at 9:15 pm #

      Well you should realize no one will see this page unless they have problems so you are dealing with the 1-5% that have failures and there are at least 100k’s of all on 4 out there today. Maybe even in the millions, not sure anyone even would know exactly. I have not personally had a total “failure”, although every picture on here is mine except the picture showing a new implant being put in with the prosthesis. I have had implants fail, but have either been able to continue without or been able to replace them. So far, 100% of my implant failures came from issues with the temporary breaking. I have had teeth break on the final prosthesis of both acrylic teeth, full zirconia and individual crowns on metal (every framework and teeth option has issues IMHO). The popularity of the all on 4 and the sheer number being done ensures that we will be running into complications in the future. I have been practicing for 15 years and my oldest all on 4 is almost 8 years old. Over the next 20 years I am 100% I will see every issue on this page many times plus will eventually have some will have total failures. There are also offices that only do all on 4, they will see more complications because of the volume. Those high success rate of 95% plus means there are thousands of people with failures of some sort.

  9. Ben NgAugust 27, 2019 at 11:13 am #

    Hi Dr,
    Thank you for your article and blog replies. This is most useful.

    I’m in Australia and had both top and bottom AO4 fitted in May 2014. The teeth are acrylic.

    Since the start of this year the top left tooth/teeth have chipped 3 times. The first 2 times the lab repaired it free of charge, although alot of time required to visit the prosthdontist to undo the prosthesis and taking to the lab. Both times it took the whole morning.

    The last time it chipped I was on holidays and had to get it temporarily repaired. I don’t think it is very strong so am very cautious of when I’m eating.

    I rang the prosthodontist and they suggest that I “upgraded option consists of a cad-cam milled titanium sub-frame which is veneered with a zirconia super-structure.” which will cost me $24k AUD (upper only). This is a large amount considering i paid about$60k 5 years ago (including periodontist work).

    May I ask your opinion on the above recommendation? And also what are my other options this point in time (strange the prosthodontist have not given me any).?

    Thanks again in advance.

    • Bauer BryanAugust 27, 2019 at 1:33 pm #

      I think that is a good plan. At this point you have proven that you are one of the unlucky individuals that will continue to have this happen. What he/she is recommending now is my preferred plan. Depending what you have on the opposite jaw I would consider some nanohybrid teeth in the back. The reasoning for not making all the teeth zirconia is if both jaws are zirconia they are rather loud when people bite together and chew. Some people don’t notice but some really dislike it. Sounds like the upper will be zirconia and bottom stay acrylic so you don’t need to worry about that issue. Here is what I think is ideal. The costs you paid and are seeing are normal for this type of dentistry.

  10. Kevin BSeptember 2, 2019 at 5:05 pm #

    I’m about to go to a dentist who said he can do the ceramic dentures for $12,000 I already have the implants on the bottom I have four.I don’t know if I should just go with the regular dentures because I can get a much stronger bite at least I used to. My gums are a lot smaller now due to wearing regular dentures and keeping them in too long. I guess my question is should I go with the most skilled dentist who was a lab technician himself for 5 years before going to dental school or should I go with the non-American Not that that means anything that doesn’t quite explain everything but is doing a good deal for what I find around here in South shore Massachusetts.I have had a terrible three years at a dental facility that kept me there and kept doing the surgery is wrong I had to go through three surgeries just to get these four implants in place on the bottom. I’m worried no matter what I do the implants are going to fail.They aren’t Nobel biocare like most of the ones out there there is some random brand called prima connects. I don’t know much about the new ones that I might get but I just have a regular denture on the top should I even bother getting the permanent bridge on the bottom.

  11. NOREEN GEEHANNovember 16, 2019 at 2:21 pm #

    I had all on 4 done a year ago. I did not think I was candidate as i had significant gum disease and bone loss in right front. To my surprise the doctor said I was a candidate and he would do gum and bone repair.
    I prepared for surgery, particularly concerned about adjusting to temporary dentures, by watching videos and reading articles. On the day of surgery I was mildly medicated but asked the doctor about how to wear dentures and the maintenance. I was shocked when he told me I was getting all my new teeth today, no dentures. The surgery was completed and I had all new upper teeth in 3 hours. A week later the right front implant was infected. There was not enough bone or bone not strong enough and it splintered causing infection. The doctor cleaned the area and prescribed antibiotic. Months later the same implant failed again. Again, the doctor cleaned the area and prescribed antibiotic. Months later, again the same implant failed 3rd time! He removed the implant and scheduled to try again in couple months. Meanwhile I only have 3 implants for full upper. He attempted to replace the implant but was not able to remove bridge. So now I only have 3 implants for full upper which really concerns me!

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