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.
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 severe fracture of acrylic may require the whole thing be sent to the lab. This is an inconvenience for a patient and dentist. We should check for wear on the back teeth with this occurs because the real solution to fixing the problem may be to replace the back teeth to regain the proper vertical. In heavy grinders we may consider using gold as seen below in the worn teeth section.
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.
Dentists – The best method of getting a tooth back on in your office is to sandblast both surfaces. Then add an acrylic primer to both surfaces and cure it. Then add some sort of flowable composite material. What you use is not as critical but Gradia Gum or Gradia Plus are great examples of what to use. Finally place a liquid lightcure varnish over the top. DT thread on topic.
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. One problem with wear is that it can cause the anterior teeth to break off. So one must check wear of posterior teeth when replacing anterior teeth that broke.
Solution – Replace the teeth at a cost of perhaps a thousand or two. Can be several thousand if want to switch to more durable material like gold as seen in al-Qarni JPD 2022 article.
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, another case for F-Tx rescue implant in JPD Yilmaz 2020. 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.
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.