17 Gerard St, Cremorne, NSW, 2090 | Mon to Fri: 8:30AM-6:00PM Sat: 9:00AM-12:00PM | Call (02) 9953-4189
patient after adult orthodontic treatment

With immediate implant teeth your new smile is just days away

Fast, fixed and cost-effective

If you've lost your teeth and wear conventional dentures, you're probably dealing with a range of distressing problems that are having a dramatic effect on your self esteem and quality of life.

Without teeth in place, bone density in your upper and lower jaw diminishes and your face can "sink", giving you a prematurely aged appearance. You may be having difficulty in chewing, which is limiting your choice and enjoyment of food, suffer jaw pain, discomfort and even bad breath if your dentures don’t fit properly.

You may feel self conscious about smiling. Your dentures might feel unstable, making you anxious that they will fall out when you least expect and embarrass you. Dentures can also look very obviously like… dentures.

Happy patient with immediate implant all on four

At Designer Smiles, in Cremorne on Sydney’s lower North Shore, you can have your smile not only restored but made beautiful and youthful with a full set of non-removable teeth in 1-3 days with the immediate implant teeth All-on-4 procedure.

Smile transformations are designed and performed by myself, Dr Sarkis Nalbandian, an aesthetic reconstructive dentist.

There's absolutely no age limit. One of our happiest All-on-4 patients was 85 when she had her treatment. Three months later she told us: "This is magic! I can now eat as if with my own teeth, bite an apple, taste the food, smile and talk without the denture falling out."

You will find there are many options available to suit your individual dental needs, as well as your financial and time constraints.

Attaching all-on-4 onto implants

What is All-on-4?

All-on-4 is a cost effective, advanced technique where a whole arch of teeth is supported by only four titanium rod dental implants strategically inserted in the upper and lower jawbone. These teeth look, feel and function like natural teeth.

patient with reduced facial height requiring all-on-4 procedure

Before All-on-4: Premature aging due to reduced facial height

All-on-4 only needs the kind of local anaesthetic similar to that you’d have for fillings or tooth extraction, but you can have sleep dentistry on request. I perform about 90% of all implant surgical placement procedures without the need for IV sedation.

You will never be left without teeth during the process. Once a correct diagnosis and treatment plan is worked out, the four implants and temporary teeth (bridgework) are placed so you can leave after one visit with functioning teeth and a beautiful smile. This takes approximately two hours.

You will be asked to follow a diet of soft foods for about six weeks while your jaw bone heals around the implants and your new All-on-4 permanent teeth are constructed and then fitted.

all-on-4 in place in mouth

All-on-4 final placement on lower jaw

Are you a candidate for All-on-4?

If you have been told you are not a candidate for traditional implants, All-on-4 may be for you because:

I was one of the first few clinicians in Australia to treat patients with all on 4 procedure. Experience and knowledge is everything. Patients who arrive in my surgery are sometimes in a terminal dentate state and are usually in a desperate situation looking for a solution. I find it extremely important to finding the best possible solution for each individual patient. I do not make the decision to remove teeth, which is irreversible, lightly.

Who can benefit from an All-On-4?

Remember Age is no barrier. If you have some, or all of the following:

Would my medical condition prevent me from having All-On-4?

Implant placement is similar to minor oral surgery. Medical conditions can affect the healing of soft tissues and implants with bone. Once I know your medical condition, the treatment will be modified accordingly to tailor specifically to your needs. It is extremely rare for me to refuse patients for implant placement.

Therefore, it is essential to tell me your full medical history. Some examples of these medical conditions include but are not confined to;

Please remember, our aim is to save teeth and no to remove teeth!

However, there are certain situations when few remaining teeth remaining are not conducive to comfort and function. Some patients are simply tired of having loose teeth and dentures. So careful examination and prognosis of remaining teeth are essential.

All-on-4 denture

I do not take this procedure lightly and will determine with you the best treatment plan and outcome. You need to realise that teeth are lost for a reason. Implants are not a panacea for fixed teeth.

You may have heard about the Paulo Malo technique as if he was the first person to carry out. The reality is that there were others before him. However, he improved on the technique and published useful data. Also, you should be weary of dentists advertising this procedure. The law does not prevent a dentist placing implants. Being a prosthodontist and implant surgeon, it takes 10 years of post-graduate training. You should check the dentist's training and post graduate qualification and make sure the training was not in a two day training course, that does not make anyone an expert.

It’s unfortunate to see patients making appointments with dentists and find out that 3 days following initial consultation they are booked for this all-on-4 procedure. A specialist would normally take few weeks to work out the best possible treatment plan and inform you in detail to help you through this complex treatment and adaptation period.

Maintenance protocol

Please remember that you're losing teeth for a reason. Data shows that loss is usually due to neglect. Implants are not teeth replacement, but replacement for missing teeth. Implant dentistry requires constant maintenance/recare visits to our centre that is individually tailored to you. You must commit to the maintenance/recare protocol specifically tailored for you, before we commit to treating you.

Procedure Steps to an All-On-4 Oral Rehabilitation

Appointment 1. Initial appointment. Oral examination, impressions, study models, radiographic records, clinical photography.

Appointment 2. Final consultation, discussion of treatment planning options and decision making All- On- 4 usually in the mandible (lower jaw) and all- on- 6 whenever possible in the maxilla (upper jaw).

Appointment 3. Not all teeth require removal. We like to keep teeth with good gum and bone support that are healthy. We proceed with removal of hopeless teeth and implant placement. We issue All-on-4 bridge same day.

Appointment 4. Review healing and make any alterations to the bridgework that may be required. Post op instructions: this will be individualised and tailored to your needs.

There are three different types of All-On-4

I do not just replace teeth using All-on-4 bridges, but I build faces! This means that besides replacing missing teeth, gum and bone, I can improve and provide support to the face. The implants supported bridgework provides the scaffolding to the facial soft tissues and this creates youthfulness and naturally: comfort, function and aesthetics.

In general, there are four options when it comes to All-On-4 bridges on the lower jaw. However, to simplify the treatment and costs we offer three types. Metal reinforced, Procera bar (titanium reinforced) and Zirconia based porcelain bridgework.

However, on the upper arch I prefer to place six implants whenever possible for better stability, since the bone on the upper arch is generally softer. This may incur additional fees to be discussed at a time of consultation.

Implant therapy requires long term maintenance and review. Your warrantee is to have a healthy life style and attend for regular reviews and hygiene therapy.

Your new smile starts now

Many of my patients, like yourself, contact us with a problem and are happy to find there are a number of cosmetic dentistry treatment options available. Call today or fill in the form to find out what we can do for you. Cosmetic dentistry is not just for Hollywood stars or supermodels – it's for you.

I work closely with you to create the most beautiful smile to suit your face. I offer a full range of dental services but never pressure you. Ultimately my job is to make sure you have all the information you need to make the right decision for you.

Thank you for taking the time to find out more about the All-on-4 procedure. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.

Dr. Sarkis Nalbandian
Registered Specialist
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)

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