Key takeaways
- All-on-X means a full arch of fixed replacement teeth supported by a small number of implants; the X is however many implants your case needs.
- It usually suits people who have lost, or are about to lose, most of their teeth in an arch, and the decision should start with what can be saved.
- Ask about temporary versus final teeth, what the final teeth are made from, who makes them and how they are maintained.
You have probably seen All-on-4 or All-on-X advertised as new teeth in a day. The idea behind it is sound and has helped a great many people, but the advertising tends to skip the details that matter most. This is a plain explanation of what the treatment is, how it compares with other options and the questions worth asking.
What All-on-X means
All-on-X describes a full arch of replacement teeth, upper or lower, supported by a small number of dental implants. The X stands for the number of implants, which is often four but can be five, six or more depending on the bone available, the size of the arch and the design of the final teeth. The replacement teeth are fixed in place, so they stay in the mouth for eating, speaking and sleeping, and are removed only by the dental team when maintenance is needed.
The approach works because a small number of carefully positioned implants can share the load of a full set of teeth when the bridge connecting them is rigid and well designed. Positioning and design are therefore the heart of the treatment, not the number of implants on its own.
Who it tends to suit
Full-arch treatment is usually considered for people who have already lost most or all of their teeth in an arch, who are wearing a denture they find loose or uncomfortable, or whose remaining teeth cannot be predictably saved. It is a significant decision, because it often involves removing teeth. That is why a careful assessment of what can be kept should always come before a plan to replace. In some cases, full-mouth rehabilitation that keeps natural teeth is the better path.
Fixed bridge or implant denture
An implant-supported removable denture, sometimes called an overdenture, is a different option. It clips onto implants for stability but can be taken out at home for cleaning. Here is how the two generally compare:
- Feel: a fixed bridge feels closer to natural teeth; a removable denture is more stable than a conventional denture but still comes out.
- Cleaning: a fixed bridge is cleaned in place with tools designed to reach underneath; a removable denture is taken out to clean, which some people find simpler.
- Implants: a removable denture can sometimes be supported by fewer implants.
- Palate: on the upper jaw, both can often be designed without covering the roof of the mouth, but this depends on the case.
Neither is right for everyone, and a good consultation should compare both with you rather than presenting only one.
What happens on treatment day and after
Many full-arch treatments place the implants and attach a set of temporary teeth on the same day, which is where the teeth in a day idea comes from. Those first teeth are usually a provisional set designed to be worn while the implants integrate with the bone. After healing, a final set is made to more exacting standards of fit, strength and appearance. Whether same day teeth are possible depends on how stable the implants are when they are placed.
What the final teeth are made from
Final full-arch bridges are commonly made either from zirconia, a very strong ceramic, or from acrylic teeth over a metal framework. These materials differ in strength, appearance, resistance to staining and how often they need professional cleaning. There is no single right answer, and the choice should be explained to you along with the reasons for it.
Why the people who make the teeth matter
The final bridge is a handmade piece of work, and its fit, shape and bite determine how it feels and how long it lasts. At Palm Beach Dental Specialists, full-arch treatment is planned from the final smile backwards, and our on-site laboratory makes the restorations in house, so the specialists and technicians work on the same plan in the same building.
Questions worth asking before you commit
- Which of my teeth can be saved, and why are the others being removed?
- How many implants are planned, and where will they go?
- Will I leave with temporary teeth, and when will the final teeth be made?
- What will the final teeth be made from, and why?
- Who designs and makes the final teeth?
- How will I clean them at home, and how often will I need professional maintenance?
- What happens if a tooth on the bridge chips or the bridge needs repair?
You can read more about our approach on the full-arch implants page.
