All-On-4
Dental Implants
Spokane Valley, WA

The All-on-4 dental implant procedure was developed by Portuguese dentist Dr. Paulo Malo in the late 1990s. Dr. Malo developed this innovative treatment concept as a solution for patients with significant tooth loss or those who were facing the prospect of complete edentulism (no natural teeth remaining). The procedure aimed to provide a fixed and efficient solution for full-arch rehabilitation using dental implants.

The All-on-4 technique involves the strategic placement of four dental implants in the jawbone to support a full arch of prosthetic teeth. The implants are strategically positioned to maximize bone support and minimize the need for additional bone grafting procedures, making it a viable treatment option for patients with reduced jawbone density.

Since its introduction, the All-on-4 procedure has gained widespread recognition and acceptance in the field of implant dentistry. It has provided many patients with a reliable and efficient option for restoring their smile and improving their quality of life. Over time, variations and refinements of the technique have been developed, but the core principles of the All-on-4 concept remain the same.

Caring for your All-on-4 teeth is crucial to maintaining their longevity and keeping your oral health in excellent condition. Here are some tips for caring for your All-on-4 teeth:

1. Practice good oral hygiene | Brush your teeth at least twice a day using a soft-bristle toothbrush and a non-abrasive toothpaste. Be thorough in cleaning all surfaces of your teeth, including the gums and the areas around the implants. Additionally, use an antimicrobial mouthwash recommended by your dentist to reduce bacteria and plaque buildup.
2. Floss daily | Despite having full-arch prosthetic teeth, it’s still important to clean the spaces between the gums and the base of the prosthetic teeth. Use a floss threader or an interdental brush to clean these areas carefully. Your dentist can guide you on the best flossing technique for your All-on-4 teeth.
3. Attend regular dental check-ups | Visit your dentist for regular check-ups and professional cleanings. They will assess the health of your All-on-4 teeth, monitor the condition of the implants, and address any potential issues at an early stage.
4. Avoid hard or sticky foods | While All-on-4 teeth are designed to withstand normal chewing forces, it’s still advisable to avoid excessively hard or sticky foods that can put excessive stress on the prosthetic teeth or dislodge them. Opt for a balanced diet that includes a variety of nutritious foods to support your overall health.
5. Protect against teeth grinding (bruxism) | If you have a habit of grinding or clenching your teeth, inform your dentist. They may recommend wearing a night guard or suggest other measures to protect your All-on-4 teeth from excessive force and prevent damage.
6. Be mindful of lifestyle habits | Avoid tobacco use and excessive alcohol consumption, as these can have negative effects on your oral health and increase the risk of implant failure.
7. Maintain overall health | Take care of your general health, as it can influence the success of your All-on-4 teeth. Follow a healthy lifestyle, manage any chronic conditions, and inform your dentist of any changes in your medical history or medications.

New dental implant arches, including those used in All-on-4 procedures, may feel different from natural teeth initially. Here are some aspects of the experience that you may encounter:

1. Stability | Full-arch dental implants are designed to be stable and secure. Once the implants have fully integrated with the jawbone, the arch should feel firm and stable, similar to natural teeth. This stability allows you to bite and chew comfortably without worrying about the arch shifting or coming loose.
2. Sensation | While dental implants themselves do not have nerves, the surrounding gum tissue can still provide a sense of pressure and touch. You may experience a different sensation compared to natural teeth, but over time, you should adjust to the feeling of the implant bridge in your mouth.
3. Speech | It’s common to experience slight changes in speech initially after getting full-arch dental implants. This can be due to the presence of the prosthetic teeth and adjustments your tongue and oral muscles need to make. However, with practice and time, your speech should return to normal as you adapt to your new teeth.
4. Comfort | Full-arch dental implants are custom-made to fit your mouth and provide optimal comfort. The materials used, such as ceramic or zirconia, are designed to mimic the appearance and feel of natural teeth. Initially, there may be some mild discomfort or soreness as your mouth adjusts, but this should subside as the tissues heal.

It’s important to note that everyone’s experience may vary, and it may take a short period of adjustment to fully adapt to the feel of your new dental implants. If you have any concerns or persistent discomfort, it’s recommended to consult with your dentist. They can assess the fit and make any necessary adjustments to ensure your comfort and satisfaction.

During the All-on-4 dental implant procedure, you will be under anesthesia, which helps ensure that you don’t experience pain or discomfort during the surgery itself. The use of local anesthesia and/or sedation will depend on your specific needs and the recommendation of our dentist.

After the surgery, it’s common to experience some level of discomfort, swelling, and soreness in the treated area. However, the degree of pain can vary from person to person. Some individuals may experience minimal discomfort, while others may have more significant soreness or sensitivity.

We will provide you with instructions on how to manage pain and discomfort after your All-on-4 surgery. This may include prescribing pain medication or recommending over-the-counter pain relievers, such as ibuprofen. Applying ice packs to the outside of your face can also help reduce swelling and alleviate any discomfort.

It’s important to follow your post-operative care instructions carefully, including any dietary restrictions, oral hygiene practices, and taking prescribed medications as directed. These measures will aid in minimizing pain, promoting healing, and reducing the risk of complications.

If you have concerns about pain management or if you experience severe or prolonged pain after your All-on-4 procedure, it’s crucial to contact our office promptly. Our dentist can evaluate your condition and make any necessary adjustments or provide additional guidance to ensure your comfort and well-being throughout the healing process.

After an All-on-4 procedure, it is common to experience some degree of discomfort or pain. The level of pain can vary depending on individual factors such as pain tolerance, the complexity of the procedure, and the body’s healing response. Typically, the first 48 hours after the procedure is when you will experience the most discomfort. However, the pain is typically manageable and should subside over time as the healing progresses.

The recovery time for an All-on-4 procedure can vary from person to person, and it depends on several factors such as your overall health, the complexity of your case, and how well you follow post-operative care instructions.

Typically, the initial healing takes a few weeks. Complete recovery and adjustment to the new teeth can extend over several months. Each person’s recovery time can vary, so it’s best to consult with our dentist, who can provide more specific information based on your individual case and guide you through the recovery process.

There are many things that we do at Nightingale Family Dental that set us apart. From our delicate and personalized care, to our ability to reduce cost through the use of cutting-edge technology, we strive to go above and beyond to deliver the highest level of care at the best price in the area.

Many dental implant practices will advertise a low price as “bait”, and add additional costs for their premium options. Not us – all of our prices include top-of-the-line final zirconia bridges and there are no hidden costs or fees.

While this may be a good option for some patients, in the rare case of complications, it may be difficult to continue working with the same doctor who placed your dental implants if you traveled thousands of miles or out of the country. Most local offices will not be willing to fix these “out of town” cases. One advantage of having a temporary set of fixed teeth on the day of your surgery is that you get to test them out and see what you like and don’t like. For your final zirconia bridges, we can do try-ins to ensure that your teeth look exactly how you want them to look. While it’s great to get your final teeth immediately, it does come with some serious downsides that should not be overlooked.

Mini implants have a time and a place for certain individuals who have extremely low bone volume. Most of the time these patients are not candidates for a traditional All-On-4 implant procedure and would need advanced implants that only a skilled surgeon should take on. If you are offered mini implants as an option I would recommend getting a 2nd or 3rd opinion to educate yourself on the best treatment route for your needs.

Snap-in dentures are a good alternative to the All-On-4 if you are willing to compromise the quality and function of the denture for the price.

We recommend having them cleaned at least once a year.

Yes, implants can fail and there are many factors that influence a failure. Infection, hygiene, medical conditions, smoking, diabetes, and neighboring tooth infection can all be major risk factors that contribute to an implant failing. It is recommended that you follow our post operative instructions to ensure that you do everything in your power to have a successful implant therapy.

Drooling occurs when a foreign body stimulates the saliva response. This is designed to aid in the breakdown of food when you are chewing. A new denture will mimic that response but don’t worry, your body will adapt and you will return to a normal saliva response in a few days.

Yes! We offer a couple options for sedation depending on what is the right fit for you:

Oral Conscious Sedation involves a prescription for sedative pills that are prescribed to you by our doctor. Sedative medication is typically given the night before to help you sleep, as well as the morning of your procedure to ensure your comfort throughout the procedure.

IV Sedation involves the intravenous administration of sedatives in order to put you in a diminished state of consciousness throughout the entire procedure. This also has other benefits for reducing post-operative swelling and pain.

No, All-on-4 bridges are not always attached to the implants on the same day as the procedure. The timing of attaching the bridge depends on the individual case and the recommendation of our dentist. Here are two common approaches:

1. Immediate loading | In some cases, immediate loading or immediate function may be possible. This means that the All-on-4 bridge is attached to the dental implants on the same day as the procedure. This approach requires careful assessment of factors such as implant stability, bone quality, and the patient’s overall health. Immediate loading can provide patients with immediate functional teeth, avoiding the need for a temporary denture or extended healing time without teeth. However, not all patients are suitable candidates for immediate loading, and it depends on individual circumstances.
2. Delayed loading | In other cases, a delayed loading approach may be recommended. This means that the dental implants are allowed to heal and integrate with the jawbone for a period of time before attaching the All-on-4 bridge. This healing period, known as the osseointegration phase, typically lasts several months. During this time, temporary dentures or provisional prosthetic teeth may be worn to maintain esthetics and function. Once osseointegration is achieved, the final bridge or prosthetic teeth are fabricated and attached to the implants.

The decision regarding immediate loading or delayed loading is made based on factors such as implant stability, bone quality, surgical complexity, and the patient’s specific needs. Our dentist will evaluate your case and recommend the most suitable approach for you.

Bleeding after an All-on-4 procedure is normal and expected during the immediate post-operative period. The duration and amount of bleeding can vary from person to person, but typically it should subside within the first 24 to 48 hours after the surgery.

If you notice that bleeding persists beyond the expected timeframe or if you experience severe or uncontrollable bleeding, it’s important to contact our office immediately. We can evaluate your situation and provide appropriate guidance or interventions to address the issue.

After an All-on-4 surgery, you may need some time to adjust to and learn how to use your new teeth properly. While the process of adapting to the new teeth varies from person to person, here are some general considerations:

1. Immediate adjustment | It’s common to feel a sense of novelty and difference when you first receive your new teeth. The size, shape, and position of the prosthetic teeth may feel different in your mouth compared to your natural teeth. Initially, you may need to consciously make adjustments to your bite and chewing patterns to accommodate the changes.
2. Speech adaptation | Your speech may be affected temporarily after the All-on-4 surgery and the placement of the prosthetic teeth. Certain sounds or pronunciations may require practice and adjustments as your tongue and oral muscles adapt to the new teeth. Regular speaking and practicing in different situations can help you regain clarity in your speech.
3. Eating and chewing | Eating with your new teeth may require some adjustments as well. In the beginning, it’s advisable to start with a soft diet and gradually introduce firmer foods as you gain confidence and comfort. Chewing patterns may need to be modified initially, and it can take some time to develop a natural and efficient way of chewing with the All-on-4 teeth.
4. Follow-up visits and guidance | Our dentist will provide you with specific instructions on how to care for and use your new teeth. We will guide you on proper oral hygiene practices, dietary restrictions, and any necessary adjustments to ensure optimal function and comfort. Regular follow-up visits will let us assess your progress and provide additional guidance as needed.

Remember that each person’s experience and adaptation process can vary. With time, practice, and patience, you should become increasingly comfortable and proficient with using your new teeth. If you have any concerns or difficulties, do not hesitate to reach out to our office.

After receiving new teeth through an All-on-4 procedure, it may take some time to adjust and become comfortable speaking with them. While each person’s experience may vary, here are some general considerations:

1. Initial adaptation | Initially, you may notice a difference in the way you speak with the new teeth. The shape, size, and position of the prosthetic teeth may feel different in your mouth compared to your natural teeth, which can temporarily affect your speech.
2. Tongue and muscle adjustment | Your tongue and oral muscles need to adapt to the presence of the new teeth. This can involve relearning the placement and movement of your tongue during speech to achieve clear pronunciation. It may take some practice and conscious effort to regain your normal speech patterns.
3. Articulation and clarity | Different sounds and phonetics may require adjustments as you become accustomed to the new teeth. You might find certain sounds more challenging initially, but with time and practice, you should be able to articulate and pronounce words clearly.
4. Professional guidance and practice | Our dentist can provide guidance and exercises to help you with speech adaptation. They can offer specific techniques to improve clarity and assist you in regaining your natural speaking abilities. Regular practice and patience are key to overcoming any initial speech challenges.

The adaptation period will vary from person to person. Some individuals may adjust relatively quickly, while others may require more time and effort. As you continue to use your new teeth for speaking and engage in normal conversations, you should gradually regain confidence and improve your speech.

After an All-on-4 procedure, it is important to follow our dentist’s specific instructions regarding oral hygiene practices, including the use of a water flosser or Waterpik. Generally, you should wait until the healing process is sufficiently advanced (typically 1-2 weeks) before incorporating a water flosser into your oral hygiene routine.

Deciding to undergo any dental procedure, including the All-on-4 procedure, is a personal choice that depends on various factors, including your oral health, specific dental needs, and your dentist’s recommendation. While age can be a consideration, it is not the sole determining factor for determining suitability for the procedure.

The All-on-4 procedure is typically recommended for individuals who have multiple missing teeth, severely damaged teeth, or significant tooth loss. It is designed to provide a fixed and functional set of teeth supported by dental implants. The decision to proceed with the All-on-4 procedure is usually based on factors such as overall oral health, bone density, and individual circumstances.

If you feel like you are too young for the procedure, it is important to discuss your concerns with your dentist. They will evaluate your specific situation, assess your oral health, and discuss the available treatment options with you. They can provide insights into the benefits, risks, and long-term considerations associated with the procedure, taking into account your age and individual circumstances.

Remember that age alone does not determine eligibility for the All-on-4 procedure. It is important to have a comprehensive evaluation and discussion with your dental professional to determine the most appropriate treatment plan for your specific needs and goals. They can address any concerns you may have and help you make an informed decision about your dental care.

Preparing for your recovery after an All-on-4 procedure can help ensure a smoother healing process. Here are some items you may want to have ready:

1. Prescription medications | If our dentist has prescribed any medications, such as antibiotics or anti-inflammatory drugs, be sure to have them filled and ready to use as instructed.
2. Ice packs | Cold packs or ice packs can help reduce swelling and alleviate discomfort in the immediate post-operative period. Have a few ice packs ready in your freezer to use as needed.
3. Soft and nutritious foods | Plan and stock up on soft, nutritious foods that are easy to eat during the initial healing period. Examples include soups, smoothies, mashed potatoes, yogurt, oatmeal, and soft fruits. Avoid hot or spicy foods that could irritate the surgical sites.
4. Oral hygiene supplies | Follow our dentist’s instructions on oral hygiene practices after your procedure. Make sure you have a soft-bristled toothbrush, gentle mouthwash (if recommended), and any prescribed oral rinses or gels. Our dentist may also advise on a specific technique or schedule for oral care.
5. Saltwater rinse ingredients | Prepare the ingredients for a saltwater rinse, which can aid in keeping the surgical sites clean and promote healing. Mix 1/2 teaspoon of salt with 8 ounces of warm water. Have a supply of this solution ready for use, as recommended by our dentist.
6. Gauze pads or sterile cotton balls | Our dentist will provide sterile gauze pads to control bleeding and protect the surgical sites. Ensure you have an adequate supply on hand.
7. Over-the-counter pain relievers | In consultation with our dentist, you may consider having over-the-counter pain relievers like ibuprofen or acetaminophen available to manage any discomfort during the healing process.
8. Entertainment and comfort items | During the initial recovery period, you may be resting at home. Have some books, magazines, movies, or other forms of entertainment available to keep you occupied. Comfort items like extra pillows and blankets can also help enhance your comfort.

High quality Zirconia. To learn more about Zirconia click here.

At Nightingale Family Dental, a single arch costs $#### and both arches (full mouth) are $####, but working through your insurance can lower this cost substantially.

We are completely transparent with our pricing with no hidden fees or add-ons. These prices include:

• Extractions
• Implants
• Bone grafting (except sinus lifts)
• Oral sedatives
• Fixed temporary teeth and fixed final zirconia teeth

If the quality of the bone can achieve enough primary stability to pass a specific threshold, then the implants can be connected to a denture during the healing phase. The denture splints the implants together, allowing it to not move, thus they will predictably integrate into the bone.

Don’t let one dentist’s opinion keep you from pursuing a life-changing solution with All-On-4 dental implants. There are several techniques in implant placement that can be used to have a successful outcome.

Yes! This is the ideal situation because you will have the most bone volume the day the teeth are removed.

No, Dr. Jimmy and Dr. Lisa are general dentist that has dedicated 100’s of hours of continuing education on implant dentistry. Our doctor continues to travel throughout the world to learn the latest techniques in this field of work.

Yes! We work with a number of financing companies. Patients who would like to break their treatment costs into affordable monthly payments can benefit from working with a financing company. It’s easy and quick to apply for, and you’ll receive a decision right away so you can proceed with your treatment promptly. Click here to view our financing options.

The procedure typically takes 3-4 hours per jaw.

Our digital approach using the latest technology allows us to adjust the design of your denture to create multiple prototypes. If you wish to make changes to the design we can easily accommodate your preferences until you are satisfied with both the shape and color. It is important to keep in mind that once you agree on a design and your final teeth are fabricated you will not be able to change the shape/color free of charge.

Most people try to save money by flying throughout the continental United States or even to international clinics. We would caution against this because if something were to go wrong, such as a denture breaking or an implant not integrating, you would want to have your surgeon on call and available to fix it as soon as possible. Traveling abroad can often be more expensive compared to coming to our office, especially since our pricing is already less than the competition.

No they do not. Your All-On-4 bridges are rigidly attached to your implants, which are firmly anchored in your jaw. If your All-On-4 teeth begin rocking for any reason, call us so we can bring you in for an evaluation.

It is referred to as “Teeth In a Day” because you are receiving a set of functional prosthetic temporary teeth in one day. Because there are often major changes in your mouth during the healing and implant integration phase, it is best to start with temporary teeth. This ensures the best long-term outcome with your permanent teeth.

Yes. Your temporary teeth are made of acrylic and can chip, crack, and occasionally break. A great benefit of acrylic temporary is that it can easily be repaired. If you have any issues with your temporaries, just give us a call and we’ll get you fixed up right away.

While it is possible for zirconia to be damaged, it is extremely uncommon. Zirconia is amongst the strongest and most durable materials available in the dental world.

Unfortunately, no. We cannot use your existing implants and they will most likely need to be removed. The reasoning is twofold:

1. Your existing implants will not be the correct position that the All-On-4 procedure requires
2. Bone grafting will likely need to be performed

No, you will not be able to remove your All-On-4 bridge(s) by yourself. Only a dentist can remove the bridge(s).

Yes, food can get stuck underneath the bridge(s). That is why we recommend daily use of a Waterpik and Proxabrushes for cleaning.

Generally, 4-7 days is sufficient. With that said, there is always the chance of bruising and swelling, and you’ll need to get used to eating and speaking with your new teeth. The longer you can take off the better.