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Designer Smiles
All On 4
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With All-on-4 Dental Implants 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 face difficulties in chewing food, suffer from jaw pain, have 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.

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-Four procedure.

Smile transformations at Designer Smiles, Sydney are designed and performed by Dr Sarkis Nalbandian, an aesthetic reconstructive dentist.

There’s absolutely no age limit. One of our happiest All-on-Four 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 needs and time constraints.

All-on-Four 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.

All-on-Four 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. We 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 jawbone heals around the implants and your new All-on-Four permanent teeth are constructed and then fitted.

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

  • It offers stability even in minimum bone volume
  • It provides good clinical results
  • It is significantly more cost-efficient than individual tooth implants

Designer Smiles was one of the first few clinics in Australia to treat patients with the all-on-4 procedure. Experience and knowledge is everything. Patients who come to us for surgery are sometimes in a terminal dentate state and are usually in a desperate situation looking for a solution. We consider it extremely important to find the best possible solution for each of our patients.

Age is no barrier for all-on-four dental implants. If you have some or all of the following, you are the perfect candidate for all-on-four:

  • Multiple Missing teeth
  • Terminal dentition: multiple loose and broken teeth
  • Teeth affected by Periodontal disease/gum infection
  • Loose dentures, unable to function: chew food comfortably

Implant placement is similar to minor oral surgery. Medical conditions can affect the healing of soft tissues and implants with bone. Once we know your medical condition, the treatment will be modified accordingly to meet your needs. It is extremely rare for us to refuse patients for implant placement. However, we require them to discuss their complete medical history with us, so we are in a better position to make a decision. Our patients must inform us if they have:

  • Uncontrolled high blood pressure
  • Uncontrolled diabetes
  • I.V bisphosphonates
  • Recent heart attack or cardiac surgery – usually 6 months, consultation with the cardiologist is required
  • Recent INR (clotting ratio) > 3.5
Please remember, our aim is to save your teeth and not to remove them! However, there are certain situations when the few remaining teeth 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. We 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 wary of dentists advertising this procedure. The law does not prevent a dentist from 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 a two-day training course that isn’t sufficient to 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-Four and Six procedure. A specialist would normally take a 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 a replacement for missing teeth. Implant dentistry requires constant maintenance visits to our centre. You must commit to the maintenance/care protocol specifically tailored for you, before we commit to treating you.

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Procedure Steps to an All-on-Four 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 on All- On- 4 usually in the mandible (lower 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 the removal of teeth and implant placement. We issue All-on-Four 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.

Types of All-on-Four

We don’t just replace teeth using All-on-Four bridges but build faces! This means that besides replacing missing teeth, gum and bone, we can improve and provide support to the face. The implants supported bridgework provides support to the facial soft tissues, ensuring youthfulness and natural comfort, function and aesthetics.

In general, there are four options when it comes to All-on-Four 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 we 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 the time of consultation.

  • Metal reinforced high impact acrylic - Most affordable All-on-Four. Constructed from high impact denture teeth and acrylic. Functional & aesthetics.
  • Titanium reinforced hybrid lower implant supported bridgework (Procera bridgework) - This bridge is reinforced with a (CAD CAM) computer designed & milled bar. This bridgework is very comfortable, durable and strong. Following three months of initial implant integration, it requires laboratory procedure. Additional fee will incur.
  • Zirconia based porcelain bridgework - This bridge is usually requested by patients who want more tactile feel of the tooth-like material. This bridgework requires additional fees and is recommended to patients with high discerning aesthetics.

Take A Step Closer to Achieve A New Smile

Many of our patients in Sydney, contact us with a problem and are happy to find there are a number of cosmetic dentistry treatment options available. Call us on (02) 8074 1722 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.

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

Thank you for taking the time to find out more about the All-on-Four procedure. We hope this gives you an idea of what we can do for you if you are having any difficulties or need help with your teeth. Remember, there’s always hope.

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