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All On Four Dental Implant Procedure Review: Is It The Best? –Ramsey Amin DDS

The All on 4 dental implant procedure has become quite popular. You probably even hear about it on radio and TV advertising. Even many dentists don’t really understand it. It is sometimes advertised as the “smile and a day” procedure.   All on four is simply a treatment option for replacing all of your teeth on the upper or the lower with just four dental implants. It is possible to replace all of your teeth in just 1 day. In fact I have been doing this for the last 15 years.

You just have to be very selective that you are the right patient for this type of procedure. I don’t suggest that the final teeth are made on the same day because you will not be able to test the teeth for how they look, feel or bite.  There are many steps to achieve a really good result and a full mouth reconstruction.

The All on 4 Dental Implant Procedure Video Review

There is a lot of hype about all on four. What is perceived is not always the reality. In this video I will review several things you should know about total teeth replacement with “ALL ON FOUR”.

Some advantages are:

Some disadvantages are:

  • Under engineered–only four implants are supporting what  12-14 natural teeth would do.
  • Cost is reduced by making a “fixed hybrid.” These are essentially fixed dentures which have high maintenance and break very often.
  • No implants are placed in the molar areas of your mouth where the bite force is the highest

Here is a patient a decade ago:


Generally speaking, 6 dental implants on the upper and 4-5 dental implants on the lower are minimum number for stable long-term bone.

This should be combined with an all zirconia or metal ceramic bridge rather than a hybrid, which are plastic denture teeth fused to a base metal. Depending on the size your jaw and bite force, you may need up to 8 dental implants on your upper jaw and 6-8 on your lower jaw.

Sometimes bone grafting cannot be avoided and is necessary to obtain good long-term results for you. You may require sinus bone graft if your sinuses are farther forward in your mouth.

I would strongly suggest all porcelain teeth, preferably CAD milled Prettau, if you have enough space from top to bottom. Porcelain teeth don’t stain, chip and break like plastic hybrid denture teeth do. I would also suggest that all on four or all on 6 or 8 are held in by screws rather than cement, if at all possible, based on dental implant angulation. This video should clarify a lot of questions you may have.

The all on four dental procedure is really heavily marketed and is rarely the best option but **can work for some**.

Remember your teeth are your body parts. I truly believe a customized solution for your particular situation is best. Some dentists just plan all on 4 dental implants for all patients regardless of their unique situations.

It is the equivalent of trying to make your mouth fit the prefabricated teeth, rather than making teeth to fit your mouth.

If my mom or dad were to ever need to replace all of their teeth, this is not the way I would do it.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

125 thoughts on “All On Four Dental Implant Procedure Review: Is It The Best? –Ramsey Amin DDS

  1. Thank you for this video. It leaves me with some tough choices. I’m 31 and have been recently dx with psoriatic arthritis and most of my teeth have decayed or broken due to dry mouth and inflammation from PsA that I didn’t know I had for years. Before I start biologics or immunosuppressant medications I wanted to get these teeth taken care of. My question is could medical insurance cover any of the surgical extractions and implants in this situation as a preventative measure to keep risk of bodily infections low?

    Also, with being so young, it seems like I would have strong financial burdens for upkeep with the All-on-4 procedure, what alternatives would you recommend for someone my age with a diagnosis on a chronic immune disorder?

    1. Medical isn’t going to do anything unfortunately 😞

      Your medical condition can be managed but you do carry some risk. You are going to have to accept either dentures or some upkeep with full arch implants.

      Tough decisions for sure.

      Do you really need to pull all your teeth?

  2. Dear Dr. Amin,

    Thank you very much for your website and the information you share. I am 63 years old and underwent the ‘All on 4’ procedure a week ago, replacing my dentures on the upper (which I had for 14 years) and 8 front natural teeth on the lower (which were OK but had the possibility of degrading with age – gums used to feel a little sore internally and a couple of them were sensitive). I had very little bone on the upper and hence the zygomatic implants. The lower obviously had more bone hence the regular 4 implants. I have temporary acrylic upper and lower which will be replaced after 4 months or more (after the bone integrates with the implants) with zirconia ‘finals’.

    My ‘All on 4’ upper is supported by 6 implants including 2 zygomatic and lower by 4 implants. After a week of recovery the pain has almost gone and for the next weeks and months I will be on a soft foods diet to help the implants settle/stabilize. My temp upper feels better than the dentures (had a lot of trouble using denture paste etc. as I had no bone in my gums to support the denture) but the lower (it is only a partial with 10 teeth including 2 pre molars) feels very different – especially near the the front teeth. With my natural teeth on the lower gums I did not have any extension of the gums near the area around the tip of my tongue. Now the lower prosthesis has an acrylic protrusion that starts behind the base if the front 4 teeth and extends all the way to the bottom of the cavity below the tongue. This extension is supposed to give the acrylic prosthesis more strength. I do not mind the bulge of it but the bottom of it feels uncomfortable going to the floor of my mouth. Will really appreciate your opinion on whether it needs to be that way or whether the bulge and length of it can be reduced for comfort. (I asked at the dental office but they said I would feel better after it heals and seemed to not want to mess with it right now. Also, any other advice or cautions on foods I should not eat long term (when I get the finals) so the implants and bone are not compromised – given that I have a very thin layer of bone supporting the non-zygomatic implants on the upper.

    Thank you so much for your advice/opinion. Again, really appreciate your generosity sharing your experience with people. Shows how caring you are. Wish you the very best in your practice.

  3. I am so overwhelmed with a decision to make. My dental insurance is not the best. I am 64, when I was 16 I was in a car accident that broke my teeth. Right now I have a broken upper fixed bridge from # 6-11 and 11-13. 11 has a T-slot to hold up a fake #12 that is attached to 13. Teeth 8,9,10, and 12 are missing. 7 holding up with a small post and 6 is cracked but it has been cemented again with permanent cement and still hanging in there holding things up. The crown on 11 became loose and un-cemented so it broke off from 12 (fake tooth). This bridge is barely holding on at 6&7. 13 got weak because my bite changed and it finally broke completely off at the gum line but the tooth is still in the bone. I am considering an All on 4-6 or All on X, but 2-5,14 and 15 are still good just some have root canal and crowns. My bottom teeth are all good. Not sure what would be the best remedy. I have my x-rays and CT scan when I went to Clear Choice for free consultation and to compare to what my home dentist said. I was told I do not need any bone grafting or sinus lift. My concern is where to go to get my implants or if that is the best choice. I’m in northern California about 9 hr drive to your office. I have to consider finances to get something done. I’m confused with Acrylic, porous (is it cheap stuff), porcelain Zirconium or ceramic, MegaGen, Nobel BioCare, Sendax MDI System ( if even works on upper) and Implant Supported Dentures. Also the framework material like Pekkton, Polymer or Titanium. With what I read about your expertise in this field I am hoping you can give me some direction. I have thought about calling your office to get details for a consultation but not sure which way to go. Thank you so much in advance for your reply

    1. Thank you for your kind words. My suggestion is that you see somebody that you can connect with. There are many dental implant specialist probably in your area. As for final teeth I would suggest Prettau zirconia over anything else as of 2018. it sounds like you are a very detailed individual and of course you would like to have excellent results.

      Extraction of all teeth is not always the answer but a solid diagnosis and treatment plan will help to solidify whether or not this is the best option for you.

    Can you please advise whether it would be advisable to sacrifice six healthy (not pretty) teeth in order to do an All on 5 or All on 6 for the lower jaw.
    Most dentists in the past advised preserving natural teeth when possible, but if I don’t agree to the full arch, I would need a total of seven implants (which would replace six failing implants which are 8 years old. FYI I am 84, hope to live to 95. Just sorry I am on the wrong coast.

    1. see other reply I just sent you. I have a 90 year old on my schedule this week for full upper lower implants. Removal of remaining teeth is NOT always the right answer! There are so many great options!

  5. I’ve been dreading this for 10 years but I can no longer hide the mess I created by neglecting my teeth. Every tooth on my upper jaw needs to go, as they’re either broken, missing, or rotten. Only one tooth on the bottom jaw is missing and I can live with that, but I need to get the ball rolling and step out from the mess I’ve created for myself. The self inflicted pain I’ve inflicted on myself makes me feel like I’ve created a secret life of lies and disgust. I’m a parent, so I can’t really enforce positive dental habits when I have let my teeth go for 15 years to embarassed to fix them. My daughter is 8, and I need this fixed so I remain a positive and uplifting role model to her. Cant disappoint her, not to mention I believe it’s leading to underlining health issues related caused by stress the burden carries. I have some how have hid my problem enough to gain promotions at work, long lasting relationships, and good parent… but also my teeth prevent me from furthering my career or personal relationships. I never talk about it, with anyone and have been just so embarrassed with myself I couldn’t show them to even a professional dentist that can help. It’s hard to take a leader serious and listen when he couldn’t even brush his teeth for a decade and a half. They’re so bad and I haven’t seen a dentist in so long I wouldn’t even be able to be identified if I was in a serious accident. Dental records wouldn’t even be an option. I know my teeth are the stepping stone to a better life, it just took me too long to confront my fears. This is a huge step for me, and after watching many videos, you seem to understand the process more with 6-8 on one vs quickly half assing 4 to get the job done faster. I already waited so long to seek help, what’s a little more time. I just have some questions and Im seeking your professional advice.

    1. I have insurance untied health care, but I’m a realist, $12 a month wouldn’t cover a procedure of this magnitude. I’ve decided to request a borrow from my 401k, but need some kind of document for the procedure or estimate. I believe I can borrow between $15-$20,000 for hardship or first time home owner. This still doesn’t seem to come up with half the cost. My credit is shot from student loans and poor life decisons in my pre parental days, and I’m curious to what kind of financing options there is to help, assuming I get the max withdrawal or 20k. Do I need CO-signer or where do I start here. I also heard about student dentist that can do the work cheaper or free. Is that true?
    2. I know it’s a process so I was curious as to what kind of temporary solution can be involved between visits. I assume all my top teeth would be pulled and now I’m leaving with only my gums. Is there a denture or something that would allow me to show myself in public or at work. I know people can’t think i don’t have dental problems, but I found ways over the years to minimize how bad it really is. Or do I take Leave of Absense during the procedure?

    I haven’t smiled my smile since I was 18 years old, and can’t bare to live like this anymore. If it weren’t for my daughter, I shutter to think what I may have done to myself. So it’s time to man up. I’m 36 and just want a normal like. What do I do? Help.

    I’m located in Darien, IL. Didn’t catch where you’re located but even if you could recommend me to a colleague or facility you trust that would be amazing. Sorry this was so long, but with almost two decades of secrets and despair, I have no idea where to even get started. Need this fixed and soon or I don’t think I’ll make it much longer.

    1. Thank you so much for your details and being so open online. These types of things help other people. There is a lot more to just “teeth” then just “teeth.” There is a tremendous amount of emotion attached.

      At your young age of 36 you are exactly right… Having a well engineered dental reconstruction is going to be important for the long-term because there will be maintenance.

      I can’t overemphasize to have this done right the first time with a highly experienced dental implant provider. I would rather see you wait a bit longer to afford to do this the right way. It sounds like this is only your top teeth as opposed to a double jaw situation. There are times where take someone all the way to the stage that gets them to a very durable temporary called a PMMA and they stay in that temporary for a while until they can afford to do the rest of the treatment. Often in my practice in Burbank, California, I extract the remaining teeth, place the implants in place a same-day prototype temporary fixed bridge. This increases cost a bit, but gets you nice teeth quickly but they are not intended to be in place more than about 6 months. Many clinics offer this as the final restoration and people and is very unhappy with broken acrylic Bridges rather than solid zirconia Prettau.
      On the financial page of my website and there are some information of other avenues to help with financing. Dental schools provide these types of restorations but they are not done by students as these are considered very difficult procedures. The dental school will take a very long time to complete and there prices are not that much different because this is a very high overhead procedure.

      A leave of absence would not be necessary. Most my patients would return to work within 1-2 days even those with immediate load same-day teeth utilizing zygomatic dental implants into the cheekbones.

      I wish your closer to me and we could figure out how to make this work but it days to be within your budget. You might want to consider having a full upper denture made for now and then transitioning to dental implants later on.

      You deserve better than this and there is a way to get your smile back! Good luck!

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  6. We need someone like you in or around Lynchburg, Va. My mother in Nov 2016 had cancer in her left jaw. Went to UVA and had a 12 hour removal and reconstructive surgery making a jaw bone from her tibia bone in her leg and using tissue and blood vessels from her leg. He had to remove all her bottom teeth and made the jaw so could have implants. But she is losing so much weight because she can not eat meat. I am wondering if some how this could be filed under her health insurance for the implant plate due to health risk of not being able to eat? Could you give us your advice and referral for implant specialist you may know in her area. She has been so depressed about this. Please help us? Or give us direction.

    1. Usually when it is related to cancer you can get Medical to pay for it! This is not often the case for most seeking this procedure.

        1. Lisa,

          Whilst Dr. Amin’s thread is to assist with dental information, I hope you won’t mind my jumping in to suggest that your Mother see a dietician. In the meantime, prior to recommencing her normal diet, there are many nutritious meals which may be served without meat and which would afford your Mother adequate protein and vitamins. I have been vegan for many years and for the majority of that time, have enjoyed excellent health. Regards.

    2. Upon reading and viewing your various publications regarding the many issues, complications and facts related to implant procedures, I recognize how important it is for patients looking into implant related restoration to educate themselves before accepting any plan of action without carefully inspection and weighing of its pros and cons. Over the course of 66 years, I’ts become evident to me that a poorly designed dental treatment plan, offered at a lower than average cost, normally result in further tooth damage or loss along with a doubling of the original restoration cost. To get the best bang for your buck, make sure your dental restoration treatment plan is designed and compleated by a Dentist whos reputation for excellence offers you the best possiable outcome. Each dollar you save today by seeking out short cuts in your dental restoration work, eventually will double or triple your dental bill in the long run.

  7. Thank you for such concise information on the All-On-Four technique.

    Currently, I have most of my teeth but also have periodontal disease. Suffering right now with abysmal toothache.

    I am considering having extractions and temporary teeth (hate the ‘D’word). Subsequent to this procedure, when all has settled down, I shall then aim to have implants. And I have taken on board that ‘All on Six’ may be the minimum implants necessary,

    What a pity I am in UK and you are in the US. Such a vast amount of experience and clear, honest info to the patient. Thank you.

      1. Dr. Amin,
        May I just ask whether the route I am contemplating (imminently) is sensible .. That is, for extraction and replacement teeth prior to implants. Thus allowing time for me to accept all work that must be undertaken. I cannot delay dental appointment and initial treatment – which I know will be extractions. At present, I simply want to alleviate this pain which encompssses side of my face, ear and throat. Likely an abscess, I don’t know.

        Thank you for this thread.

    1. The big question ! It seems to make sense to me to have the teeth pulled , then wait to heal before the 2nd step . It seems a lot to go through all at once and what about gum recession afterwards…Thoughts , suggestions?

    1. Wow…that fall sounds scary!!!

      Please contact Sophia or Angie at the office. They can help you schedule an appt with me.


  8. Dentist told me my 26 yr old son’s front teeth are in poor condition. 6 teeth (in one row) affected. Its either dental implants or extraction and replaced by dentures. For dental implants she mentioned about implanting on 4 teeth linked by a ‘bridge’. I’m not sure if this is the so-called ‘All on 4’ bridge thing. Of course the cost is pretty steep – about roughly 16-17K US dollars. She preferred this method quoting his age as a reason. What i hope Dr Amin is whether you can give advise on what would be the next best course of action should we be unable to afford this implant method thing? Partial dentures? Full dentures? Removable or fixed? Any advice would be greatly appreciated.
    Thank you very much.

    1. It sounds like just the four front teeth will be replaced with implants which is a far better option for someone his age than a full arch replacement with an “all on four”

      The cost sounds within range. This is a highly complex procedure to have done the right way the first time. This area of the mouth is particularly prone to long-term bone loss.

      I suggest you seek out an expert to treat upper front teeth in a young man like your son. Of course there are other options that are less costly but this is often the best. Should he decide to have implants later in life it will only become more costly and more complicated because of likely substantial bone grafting that will be needed.

  9. when one is dirt poor and still in their mid 40s the choices become limited to what is the cheapest route to avoid the embarrasment of dentures that slip out and the concept of bone loss and facial deformation becomes a serious worry…especially if one is single.. im suffering because im afraid of that toothless shrunken face look that people get when they opt for removable dentures…no insurance will cover or assist with anything but standard dentures.. we sure can pat for the mistake we make years later…

  10. Dear Ramsey
    I play the clarinet and sing as part of my job so the position of my teeth is very important and makes a huge difference to me being able to do my job properly.
    I had the all on four procedure done on my lower jaw however it feels like my teeth are in a totally different position so the teeth or rather the acrylic feels restrictive to me using my tongue properly and the teeth feel further in my mouth. Facially I feel my lower lip is not supported in the same way which makes it feel odd when I smile.
    Too be honest the lower lip and shape just do not look the same as before. I had a pointed lower arch which has been replaced by a rounded arch. Why the dentist decided to alter the shape of my mouth I have no idea but this has knock on effects to how my mouth and face looks and works.
    He said he has no mould of my teeth as they where as it was destroyed making the one in my mouth so there is no reference to how it was. There are however 3 D ex rays. I was wondering can these be used to make a mold? If they can at least I do have a reference from which to explore getting this right.
    I have watched my mouth change and this has had a devastating effect on my confidence. Could I possibly send you before and after photos of my mouth . Maybe you could give me some pointers in ways I may go forwards? I would be grateful if these photos were kept private though.
    Kind regards

    1. I have full dentures upper and lower and bc of cost I got 2 implants on bottom bc bottom dentures don’t stay without implants. They stay for the most part with enough poligrip both stay. I dred it sometimes but I also did the bone grafts. If can save your teeth then do it bc it can’t redone. I had all crowns and eventually my teeth started to fail so I knew it was quick fix but I don’t think the tops were that bad. I got 3 opinions as well. Now I’m used to them. Make sure you guys do your homework that’s all I’m saying

    2. Hello Dr. Amin,
      I hope you have a solution for me…I searched your blog for any information on the care and cleaning of the “All-on-4” dental implants and I may have missed it. I must say that I can’t complain because after the implant procedure was done (5 on top and 6 on the bottom), temporary dentures were placed in my upper and lower jaw to allow healing. I followed their directions almost 100% of the time. I didn’t chew anything I couldn’t mash with my fork for approximately 4 months and after the implants were tested for stability, new impressions were made. After the permanent ones (not porcelain) were placed, I had to go in a few times for “adjustments” but I can’t complain about much. I’ve asked the oral surgeon, my dentist, and the lab about oral hygiene but they only said to avoid using toothpaste and just keep doing what I am doing. The oral surgeon recommended that I return to his office for a deep cleaning once a year. He will remove them and clean them in his office at no charge. Is once a year enough??? These teeth fit pretty tight and I struggle to even get a “Super” floss under them. Toothpicks aren’t flexible enough and “Soft Pics” just seem to rip my gums up. At this time, I am using the Waterpik 3 to 4 times/day using a mixture of 1 oz mouthwash in the “tub” of water. If my teeth feel dirty, I just need to use a toothbrush to clean them with water. It really doesn’t do the trick. I’ve cheated a few times and used toothpaste to get that stuff out but worry that I am going to ruin them. Do you have any secrets to keeping these teeth clean?

      1. The problem oftentimes comes down to design and whether or not the inner surface of the bridge is made completely convex or concave. Oftentimes we are forced to make some areas of the bridge concave in order to support your lips while other areas can be made convex which is more cleansable. All this has to be considered in the design right from the beginning. Please view this blog post about 3-D design of full arch Bridges whether they are all on 4 or more implants. The video is really good at showing you what I am talking about.

        If some of the concavity can be taken out in your bridge, the bridge can be removed and recontoured to allow for more space for cleaning and the use of super floss. Ideally the material is real porcelain or solid zirconia which is far smoother than an acrylic hybrid.

        Please leave additional comments on that post which is more appropriate in your unique situation

        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry

  11. I would also like to mention I paid £10,000 for my initial surgery and was then charged another £5,000 for the final prosthesis.
    When the implant didn’t fit properly
    I was made to feel like I was creating problems.
    With no impression kept I had to have a wax version put in my mouth for a few hours and had to decide if it felt right.
    This happened three times at least.
    Surely records should be kept Incase things go wrong?
    I was told the impression Gets destroyed when the teeth are made.

    How do I get over the stress of this.
    I was told nothing that truly represents the experience and reality of this procedure
    Which leaves me feeling scared and uncertain as what to expect in the future.
    Night after night I go over this
    Every time I look in The mirror
    I am reminded.
    This seems to be the most poorly regulated medical procedure out there.
    I had eight teeth removed with only the front two teeth loose.
    I now feel that surely there was another way.
    I was told it was better to do it this way as it would be harder to perform this procedure in the future.
    I was not given alternatives I wa stood this was the only alternative to a denture.
    I was led to believe that what I was getting would feel like my own teeth
    And weirdly it was not called a denture but implants which was very confusing

    i now don’t play my clarinet very much which is not very good as I teach the instrument.
    What this dentist has done to me has been devastating.
    I have a very reel sense that I have suffered a sort of negligence
    Through mis information lack of information and no care plan
    How can dentists get away with this
    How is it this procedure is not properly regulated and that dentists do not have to follow a proper care plan

    1. I was very troubled when I read your comments. Dentistry is supposed to improve peoples lives not the opposite.
      Unfortunately, the public believes that replacement of all teeth with all on 4 or any other type of dental prosthesis is “easy.” It is far from that! There are thousands of details that go into every decision that I make before restoring someone within “all on 4, 5, 6, 7, 10” whatever the number is…

      The contours of natural teeth and the contours of a full arch of replacement teeth are very different. Sometimes people’s bone skeleton relationship do not allow for proper lip/skin/facial support unless part of the bridge is bulked out. This does not mean everything and everyone has to be bulky and “hyper contoured.”
      This can be controlled by how the implants are positioned and the 3-D design of the implant teeth. Every single patient I treated go through a series of prototype’s and temporaries to mimic the final. This would allow you to test drive everything before going to the final. I review all of this up front with an extensive exam and photography with virtual 3-D planning.

      Implants are unfortunately not teeth. They have contours that are not like teeth especially if you have significant bone loss and require a gum and bone replacement with pink ceramic. This pink ceramic can be made very smooth and fitted it can also be made way too thick for given situation.

      Perhaps you can just have the Bridges redone by a more experience dental implant provider?? Unfortunately a lot of what I do is redo cases for patients that chose to have treatment done in a less costly manner but were unimpressed with the final results or had complications.

      I appreciate your comments. Let me know if there is anything I can do to help.

      Very respectfully,
      Dr. Amin

  12. I had an all on four implant procedure done with a dentist in the uk in 2014. Unfortunately he did not give proper consultations leading up to the procedure so I was not aware how different my mouth would be.
    I am a clarinetist so the positioning of my teeth is very important. I was told it will just be like your own teeth, this of course is not true. When I came to have the final prosthesis fitted not only was it not what I expected it did not fit and the angle of the teeth made it unfit for purpose. The teeth sloped inwards and the amount of plastic in my mouth restricted my tongue. The teeth seemed in a completely different position in my mouth. We spent a further year trying to get this right but he did not keep the impression of my teeth so there was nothing showing the shape of my lower teeth or where they sat in my mouth. He did not take photographs so there was absolutely no record from which to work.
    I still wake in the night feeling angry. I feel that his patient care was extremely negligent and I am very worried as he seems to have no aftercare plan.

    my advise to anyone planning this procedure is to do your research and make sure your dentist has a proper care plan. Make sure you ah e proper consultations before you get this procedure done find out how he keeps records of your mouth before and after. Keep reference of the position of your teeth because he may not!!! Take photographs.

    I have been left feeling like I have been through a very expensive procedure with results that have changed how my face looks and the teeth are nothing like your own teeth. I wake up worried about my mouth nearly every night and the anger is still there.

    He told me, and I can hardly believe he said this, if we told people everything nobody would get it done! Surely you have a right to know all the pros and cons before you make a decision

  13. I read one of the comments where her teeth feel bulky and not natural at all ! I just want to put this out there because I am in total shock of the feel of my new teeth also 🙁
    I watched video after video and no one ever explained the true feel of these things ! ( at least what I ended up with)
    I now know that many many doctors are taking advantage of people by promising one thing and totally giving something else! ( and they end up with a pocket full of money while we look for a better answer!)……. I think you are an awesome person for putting this help out there, ( I, unfortunately, found you after the fact)…… I would like to suggest that more people start doing videos on their own personal true experience ( as I definitely plan to do)
    Again! Thank you for this site and all your help ?

    1. Thank you for your very kind words. There is so much to this process of replacing all teeth and unfortunately very few people do it really well. unfortunately many patients choose treatment based on cost alone and think that an all on 4 with one dentist is the same as an all on 4 with another dentist….. Definitely not the case

    2. Yes; that was me.
      And I agree; no one prepared me for how unnatural this would feel, and it’s been two years.
      I just had a CT scan done to see if I’m a candidate for a permanent bridge. But my dentist didn’t give me confidence that the permanent piece would be significantly less heavy and bulky than what I have now. My hope is that it will be the width of natural teeth without the hard ridge, but now, I don’t know.

  14. Why do so many dentist do the implants one day and make you wear removable dentures, then come back 4-6 months for the permanent bridge to be put in? How much better is it to wait for healing with removable dentures then to use a temporary permanent bridge during healing?

  15. Great site. You are an extraordinary Doctor to provide knowledge to dental patients who do not live near you. Just like to add this page may use an edit.
    “Sometimes “advertised as smile and a day” Should be “advertised as smile in a day”.
    Unless it was done on purpose because the phrase is copyrighted in that case, very clever I knew what you meant.

    Now a little about me. Had a crown on #7 for 25 years until it fell off from decay. Tooth had good structure so it was hollowed then a ceramic tooth was made to fit in it. Sort of like a crown in reverse. I guess because ceramic is not ideal material for bonding to natural tooth that way it also fell out. I decided implant would be my best option. Bovine powder was used for the graft after extraction on 10/22/16. On 10/25/16 I developed a fever of 102.3 it has since come down after starting amoxicillin.
    My question is could the graft fail now due to the fever?

    Thank you for such an informative site. You are doing a great service.

    1. your dates are strange because they are in the future! I’m guessing me meant to say 2015. Occasionally someone will develop a coincidental fever or some will develop a “surgical fever” if treatment was substantial. I would not worry about it too much at this time. Typically the amoxicillin though it started before the procedure. This blog post on antibiotics may help you understand when antibiotics are appropriate.
      Thank you for your very kind words. I do enjoy doing this and only wish I had more time!!!

      1. Dr. Amin, I should worry about my own edit. LOL. The dates were confusing because I used the wrong dates. I thought we were in Oct already instead of 09/22/16 for the extraction and graft then 09/25/16 for the fever. I was searching the net for possible fever cause for the very recent procedure and found your site. Thank you again for this great site. Not only is it great for patients I would say it keeps fellow Dentists on their best too. You are the best.

  16. I have a one-on-four upper and I am so uncomfortable by the weight and bulk of it in my mouth. Even though the palette is uncovered, my tongue can only rest on the hard artificial material. It doesn’t feel that much better than a traditional denture.
    My question: would a permanent solution be less cumbersome? Would I still have that ridge of hard material covering my upper gums and behind my teeth?
    Also, is it possible to upgrade to a permanent solution without having to start from scratch?

    1. It sounds like the design you have is very bulky. I find that many patients that have this done have not been prepared for what to expect. In my practice I design every one of these cases myself. Each mouth is so different in the transition from the palate to your natural tissue is one of the most overlooked area. Replacing of all the teeth is like replacing body parts. Making the teeth is more often more difficult and more costly than the surgical implantation itself. Yes it could be redone but you will likely need to start from scratch. I would suggest you find someone who is highly trained in this process and do not shop based on cost if you want this to be done properly.

      Very respectfully,

      Ramsey Amin DDS

  17. Dr Ramsey,
    I am 24 years old and have been suffering from gum disease for the last 2 years. I have been seeing my gums and bone rapidly recede away especially on the front lower teeth. To the point where I now have no “papilla” between my teeth and have generalised bone lose horizontally of about 15% throughout my mouth according to my periodontist. We are working to treat the active periodontitis and stabilise my pockets so that I can keep my teeth. However my smile is very unaesthetic and I am considering that once my periodontal situation is stabilised to get a full mouth reconstruction so I can smile again and talk to people comfortably and stop feeling so depressed!

    Do you think I could be a candidate for All on 6 implants even with my bone loss situation ? The bone loss is even and I have lost about 20% of the height of the bone (in the direction of gum recession). Is it possible that I can get bone grafting to build back up the jaw bone and get a procedure such as all on 6 ? I would like to avoid all on 4 due to the reasons you have already stated. Due to my young age and previous gum disease status I would be looking for a highly personalised treatment to try and get the most long lasting implants possible and best function possible. Will I still have gaps between my teeth and lack of papilla between my teeth as I currently do with my natural teeth ?

    Are implants/bridges even a possibility for someone like me? Or would someone in a situation like myself be resigned to wearing dentures? I dread the though of having dentures in my mid 20s !
    Also I am from the UK, do you treat patients from abroad? I would be looking to come to an expert like you once I have saved enough money. I am aware that it may be difficult to answer my questions without seeing me, but could you try and give a general answer based on the information I have provided?

    Faizaan Rana

    1. It may not be worth rebuilding all the bone back because he may end up with something that does not look as attractive. Sometimes leveling the bone downward a bit will allow 4 a much better restoration such as a Prettau zirconia style restoration. With the person as young as you,, but should be a last resort. If you’re roots are long, try to keep your teeth rather than extract them and have implants but if there is no other option then bone leveling may help you save money and have a better, longer lasting dental implant situation.

  18. This is an unbiased and accurate review of the all on 4 technique and i believe it to be an accurate description of the pros and cons, well done

  19. When you get the all on 4 or 6 or 8 is the temporary denture a fix denture that can only be taken out by you or another dentist? And then in 3-4 months when you are healed you come back for the temporary one? Or will the temporary one be a removable denture?

    1. this is highly variable in depends on your particular dentist. In my own practice I would highly advise that a temporary that is fixed in place be worn in order to test drive a full arch fixed restoration such as all on 4 or the Prettau dental implant bridge.

    2. Why do so many dentist do the implants one day and make you wear removable dentures, then come back 4-6 months for the permanent bridge to be put in? How much better is it to wait for healing with removable dentures then to use a temporary permanent bridge during healing?

        1. When having the best of materials like what you use how long can someone expect them to last? I am 53. I went to a well known oral surgeon here in Florida. I was told I had plenty of bone. He said he would use 6-8 on top and bottom. He also said that if I ever had any problem that it would be taken care of at no charge. I would have to go to my other dentist for the bridge work which I think I would rather have it at done in one place. It just might be worth taking a trip to see you! I seen another post from someone that does not live close to you and you sent a private message to someone closer to them that you would recommend. By any chance is there someone in Florida?

  20. what is the cost of fixed dental implant bridge and can you just brush them with out removing the and can food get in between the teeth.

      1. Ilooking for the fixed dental implant bridge that you don’t have to remove and were food does not get in side and discoffort

  21. I agree with your statement. The all-on-4 treatment IS not the best option for replacing dentures. It is heavily marketed. No one that I have met ever said that they love their dentures, most especially their lower ones. As you are aware, once a tooth is extracted, bone loss begins. A floating lower denture is not very comfortable, let alone an upper denture with the palate covered with gooey fixodent.

    If my mom or dad will ever need to replace all their teeth, the All-on-six is definitely what I will have them do.. gour is NOT enough.

    two people I know are already having issues with their all on 4’s!

  22. If you get a prettau on the bottom jaw with 6 implants what happens if something breaks? Or an implant fails – is this money in the garbage? No one seems to have the answer to this. I hear what you are saying with the all on 4 – I would rather have 6 implants on my bottom jaw but after spending money I worry about failure of something

    1. if it is designed properly, the bridge can be removed typically by just unscrewing it. A bad implant can be removed or treated and the monolithic zirconia Prettau dental implant bridge can still function on 5 dental implants. When the only have for implants and one of them fails it becomes “none on 3” rather than “all on 4”

      Implants are removed and treated for bone loss in about 5-10% of patients. It is better to design them to be strong then to lose all of your money and time because of under engineering

  23. I have only three good (natural) teeth in front on top, the rest of my top teeth are bridges or crowns all in need of repair. I was planning on going in for the all on four, but now I’m not sure. What would you recommend? Do you think individual implants and crowns are better than the all on four? Thank you so much for your advice?

  24. Which is better the all on 4 or Implants Supported Porcelain Bridge, Full Arch (with 4 implants or is it the same thing?What about the overdenture? Whats your opinion on going to Mexico for this?

    1. I am also wondering iif this is good or if the ones listed above are better”All on Six” System with fixed Porcelain bridge – MegaGen Thanks

      1. HI Brenda,

        As I mentioned in this post, the all on 4 is a very under engineered design. If even one implant fails you’re going to lose everything that you paid for.

        Design your bridge with more than 4 implants is going to be key especially if it is in your upper jaw. These type of procedures are not done in 1 day like the commercials say. They require many visits and are the most complex restoration that a dentist can make. Traveling to Mexico may save you some money, but I have seen some disastrous results. It ends up causing more to retreat a situation than if it was just done right the first time.

        I would suggest a minimum of 5 implants on the lower in 6 implants on the upper with a porcelain monolithic zirconia bridge such as the Prettau. You can also make smaller segmented Bridges rather than a roundhouse bridge depending on your unique situation. Find the expert in your area to do this for you.


        Ramsey Amin DDS

    2. HI Brenda,

      As I mentioned in this post, the all on 4 is a very under engineered design. If even one implant fails you’re going to lose everything that you paid for.

      Design your bridge with more than 4 implants is going to be key especially if it is in your upper jaw. These type of procedures are not done in 1 day like the commercials say. They require many visits and are the most complex restoration that a dentist can make. Traveling to Mexico may save you some money, but I have seen some disastrous results. It ends up causing more to retreat a situation than if it was just done right the first time.

      I would suggest a minimum of 5 implants on the lower in 6 implants on the upper with a porcelain monolithic zirconia bridge such as the Prettau. You can also make smaller segmented Bridges rather than a roundhouse bridge depending on your unique situation. Find the expert in your area to do this for you.


      Ramsey Amin DDS

    3. HI Brenda,

      As I mentioned in this post, the all on 4 is a very under engineered design. If even one implant fails you’re going to lose everything that you paid for and the time it took.

      Design your bridge with more than 4 implants is going to be key especially if it is in your upper jaw. These type of procedures are not done in 1 day like the commercials say. They require many visits and are the most complex restoration that a dentist can make. Traveling to Mexico may save you some money, but I have seen some disastrous results. It ends up causing more to retreat a situation than if it was just done right the first time.

      I would suggest a minimum of 5 implants on the lower in 6 implants on the upper with a porcelain monolithic zirconia bridge such as the Prettau. You can also make smaller segmented Bridges rather than a roundhouse bridge depending on your unique situation. Find the expert in your area to do this for you.


      Ramsey Amin DDS

  25. I need to get an idea of cost for All on 8 for my upper.
    Porcelain vs non-porcelain etc.
    Also I need 3 implants on my lower.
    My bone structure is still in tact.


    1. This is a massive question that cannot be answered without seeing you. Even though your bone is “intact” it does not mean that things will be simple or difficult. There is a lot more to it than just the bone. I would suggest you find somebody who does a lot of full mouth dental implant reconstructions. I recommend you for looking to have 8 implants placed on your upper jaw. You cannot believe how many all on 4 restorations I ended redoing because one implant failed causing it to become “none on 3.”

      The upper jaw is always more complicated and costly than the lower jaw. They can vary from possibly as low as $20,000 for some non-porcelain options to $60,000 depending on the need for grafting and temporaries. Sinus grafting is often commonly needed for the upper jaw but sometimes it can be avoided by a purposeful tilt placed on the rear most implants as long as you’re sinuses don’t come too far forward. This post on digital treatment planning for Prettau dental implant bridge may help you understand some of the variables involved.

      Sometimes doing segmented small Bridges is better than a roundhouse single unit but it will depend on your unique situation.

      I hope I have helped you at least a little bit

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  26. Thanks for your information. I have recently contacted Dr in Las Vegas about an all on four procedure. He claims to do the entire procedure in a three day visit. He has his own milling plant on site and they make the bridge there immediately. I am very skeptical and would like your opinion of his work. He claims to be the only dentist in the world able to accomplish this procedure in a three day visit……..complete and permanent.
    Look forward to your opinion

    1. For the last 16 years I have provided this teeth and a day procedure. It is an excellent procedure….. But, I would never deliver a permanent bridge within 3 days. I only deliver a temporary bridge.

      The problem is, there is no way to test things such as cosmetics, function, TMJ position, etc. There is also substantial surgical swelling which makes contouring the bridge to your gums almost impossible. This could leave gaps or extra gum between your bridge and your natural gum…. Although it is possible, I don’t think the result is as good as waiting for short period of time. You may end up with your expectations not being met. The temporaries allow the time to work out all the details so that you and your dentist have made sure that all is as perfect as can be.

      Maybe if technology evolves more I would consider it but I would not do this on my own family as of 2015.

      I’m sure I have confused you more than ever now!!

      Happy Thanksgiving

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. He is so right in what he is saying , please don’t have it done as it’s impossible to have all your teeth and be permanent in 3 days ,your mouth and gums need weeks if not months to settle,I’ve just had all on 4 top and bottom£30.000 and am now really worried that I haven’t had enough implants placed

    2. For the last 16 years I have provided this teeth and a day procedure. It is an excellent procedure….. But, I would never deliver a permanent bridge within 3 days. I only deliver a temporary bridge.

      The problem is, there is no way to test things such as cosmetics, function, TMJ position, etc. There is also substantial surgical swelling which makes contouring the bridge to your gums almost impossible. This could leave gaps or extra gum between your bridge and your natural gum…. Although it is possible, I don’t think the result is as good as waiting for short period of time. You may end up with your expectations not being met. The temporaries allow the time to work out all the details so that you and your dentist have made sure that all is as perfect as can be.

      Maybe if technology evolves more I would consider it but I would not do this on my own family as of 2015.

      I’m sure I have confused you more than ever now!!

      Happy Thanksgiving

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  27. Thank you, Doctor. I am going for a Clear Choice interview today. Your video was very helpful in giving me some ammunition when I walk in.
    Much appreciated.

  28. I’m probably not on the right blog, seen you had something concerning gum grafting, but couldn’t find it again. Quick question in addition to previous, I agree with you 300% about all on 4 being under engineered (short term solution)… In order for additional implants I would more then likely need a certain amount of bone grafts, can this be accomplished while I wear the all on 4 bridge and can my new zirconia and current implants be utilized in the upgrade lets say to 6-8 implant foundation? Thanks


    1. Hi Rick,
      I just sent you a reply a second ago.

      You can transition to a better bridge such as the prettau and wear the current all on four in the meantime. This will take some excellent planning and skill On the the part of your dentist. The grafts can be done simultaneously and may work better with you already in a fixed bridge.

      The all in four is weak. Zirconia is very strong AS LONG AS IT IS THICK ENOUGH AND FITS PASSIVELY. If not, it will break. Watch out for cheap imitations! Go to someone that really knows what they are doing. These are tough cases.


  29. Interesting topics and opinions, thanks for being online.I have a all on 4 completed and have mostly been happy (21/2 years and rolling), zirconia is ready for install now, an upgrade to myself. Haven’t had to go back for breakage now for 10 months (have had 3 incidents either tooth broke off or bridge broke in two), now that its time to go back I have been having a bit of infection in one of the front implants, it appears to be stable, no or very little swelling, but “several threads” are showing above the bridge, gum loss I suspect at a minimum. I remember I had a horrible amount of bone loss in this area to start with.
    I may be guilty of too hard or too much brushing on the gum line and the channel of the bridge, waterpik daily. I guess what I’m getting at is if the infection is due to implant exposure is there any way to clean and graft gum over existing implants that are accessible? Thanks, Rick

    1. Hi Rick,

      This post Will help you understand what is likely happening around your implants. The best way to avoid bone loss around an implant is to have the implant have tons of bone on the outer wall of it. This strengthens the system.


      This is going to be a tough situation to deal with especially if threads are showing.

  30. dear dr amin i sent you an email two dys ago did you get it i am patiently waiting for your comment, i have a blog i set up and so many people including children have denteno genisis imperfecta, and do not know what to do about it, my mom had it so she took control and did what was needed for me as a child through pedodontists ect, had all teeth that chew covered with metal and front teeth bonded, i was very young when i went into the hospital for this treatment, the only thing she never agreed with was the braces, but the prostodontist said he would not work with us if we didnt do it, the orthodontist, said he had worked on several children with this, it was awful braces were so painful had to be put up under the gums because no enamel, finally my mom took me to another orthodontist, who said they must come off immediately, hardly any roots with these teeth , and small little baby teeth, they never really grow, and no canals, calcified. she had to move back everything he did, needless to say i got a new prostodontist too, finally got everything done, got all teeth crowned and was done i felt beautiful it was completed after my graduation from high school, i was like a little bird finally set free from 18 years of hiding my smile,i have helped a few people on my blog by telling my story no braces! not for these teeth anyway, but after my car accident thats when the trouble started, and i decided to get implants, i wasnt an easy case,as i later learned the bone in a denteno genisis patient is also like that of a child it stays thin and small to hold baby teeth it doesnt get fatter like adults so implants are not just the answer to this situation more extensive work is needed like bone grafts or sponges or all the new techniques out there , i went to the school in boston had a hip graft, and implants were placed , and earlier implants that i already had were reinforced also with the bone harvested, this is no easy procedure, today they have more newer ideas like sponges and other things, so anyway i am just waiting to hear from you than you so much for taking y;our time to help me

    1. Hi Heather,

      I never got your first email. Only this one. Sorry!!

      What is your question???

      You told your story, but I don’t know what you are asking.

      Your case is complex and I am certain the bone grafts are needed.

      Please cut and paste your entire story when you ask your question.

      Sorry and thanks for posting!!

  31. This is very interesting; thank you for posting . I recently had the all on four top and bottom ( I got six implants top and 4 bottom , the original plan was to have permanent top and bottom detachable. Now I am being offered permanent bottom also, but with less warranty and the teeth went from, monolithic milled teeth, to pmma overlay teeth….. What exactly does that mean?
    Thank you so much .

      1. I’m now going into month 8….. Still in tmps, sounds like I traded the screwed in bottoms! For all tmp teeth!!!!! They are basically cut down screwed in dentures! I hate them! Everything I eat sticks to them!!!! I have to brush immediately after I eat!!!!! These absolutely do not feel like my natural teeth! ( as I was told ) in already thinking about upgrading to better teeth! But at this point! Don’t really trust this dr anymore ! What would u suggest I do????

        1. You need to have a conversation with your dentist about expectations and be very clear with what it is you are actually getting. Keep in mind that dental implants are not teeth, they are replacement teeth that are trying to be made to mimic your original.

  32. i want to say also i am very far from you as it looks like you are in California so there would be an expense of flying there, i am such a mess,i really need help i dont know if you would consider using me as a teaching thing or something to keep cost down but if ryou could let me know what you think , i just liked that you seemed honest and upfront so i hope i get an email from you or something to let me know , i am considering going to the school here in florida to see what they say and someone told me about going to brazil as it is way cheaper just dont know where to turn as i have a child to take care of too, she is only two. i use to think i was finally pretty and got my self confidence back when i was 18 when i finally restored all my teeth but now i am in temporaries they are literally falling apart because they are temps but no one can do me i have seen so many here and i even flew to ny and was turned away again by a famous dentist and i didnt tell him i needed a payment plan, he just didnt want to be bothered. everything is money people dont care anymore.

  33. you probably wouldn’t be interested in helping me because everyone turns me away since i have been through so many procedures with dentists who start stuff with me then don’t finish because they cant handle my case so they give me some lame excuse to dump me. i put a lot of money into my mouth to try to fix it including braces which actually damaged me more than helped because i have denteno genisis emperfecta. i had full mouth crowns and was in a car accident which damaged a few so thats when all my problems started ,could not match what was in my mouth and some teeth were failing so needed to go the implant route, so from there one mess after another now since the economy failed i have been short of money and i had a baby and a miscarriage so that took money and my time to heal and now my child is two i am trying again to fix my mouth i dont have a lot of money need some kind of payment plan my mother said she would help all she can. she has denteno too but has false teeth and hates them. was going to get all on four but saw your video and is leary now . i was told i am not a candidate for that . i have many implants , already went through four failing in lower front, had removed, was very bad , had a bone hip graft done then replaced all four, they are failing again due to the implants themselves having an issue, so need removed i am in much pain everyday as my lower is a mess

    1. This is a very complex question that cannot be answered without a detailed examination and X-rays.

      The all on four is very under engineered especially if you’re considering this for the upper jaw. Long-term results are not promising.

      Consider doing something better by having more than just four implants.

  34. excellent presentation. Very refreshing to hear what you said that reinforced what I believed was true about “All On Four”

  35. I would first like to say that you video was very informative and helpful in my plite to have a good dental outcome. I would like to find out more on your 7 or 8 on one implant for the bottom. At this time I am working on the top teeth. I am going through my restoration work now and have three implants in and more to go. I would just like to know if it is better to do all individual implants or a all in one. I am not rich but I do enough overtime to pay for what is needed. I now am spending approximately 2300.00 per tooth. I am 52 and I want to get a lifetime of use out of the new teeth, this is my delema. I would like to know what you think would be my best option?
    Thanks again for your help and support…..

    Gary Brinton

  36. I would first like to say thank you. There are not many dentists out there with the knowledge that you have that are willing to donate some time to answer questions by the public…. Anyway to cut to the point, I am a 24 year old male and I need a total mouth restoration. When I was a teenager I didn’t have the best oral hygiene habits and my adult teeth suffered as a result. In early high school I visited a pediatric dentist and had extensive work done on ALOT of my teeth. Mostly fillings and metal crowns (rear molars), and on my front teeth I also had fillings. Well my front teeth fillings were white at the beginning, now after about 7-8 years they are completely yellowed and look absolutely horrid. Additionally a lot of the fillings I had done have since withered away and are pretty much non-existent. I went to a local dentist in my area and she suggested a slew of work. A total of 2 single implants (I believe one of them would have been a 2 or 3 tooth bridge), 9 root canals (plus crowns), and a slew of other work. The total tag for the plan was north of $50k. Well I didn’t have the funds available at the time (4 months ago), and of course I wanted multiple opinions, but my main objective was to get a figure so I could get my finances in order to be able to tackle the project. Well I am now close to having my financial situation in tact and able to do this, so I am shopping around for the procedure.

    Recently while researching online, I ran across a dentist 3 hours away from me offering what’s called a FrontRow only procedure. It consists of a complete makeover of teeth #6-11, and he says it’s compelted with Porcelain crowns. After reading your blog, I thought you may have an opinion on this procedure. My main question is whether this is a “too good to be true” procedure or not. If you would like to take a look at my situation, I have copies of my x-rays, and mouth pictures, as well as the treatment plan the local dentist recommended if you can/would like to give a personalized opinion. I live a little south of Tampa, Florida.

    1. Hello David,

      It sounds like you need a whole lot of dental work. In order to have a healthy, strong and attractive front teeth, the back teeth must be taken care of. If you just focus on the front row of 6, you are bound to have problems in no time at all.

      Unfortunately no type of dentistry lasts forever. Having the best type of dentistry you can afford and maintaining it is going to be the key. Your diet, oral hygiene and the condition of your natural teeth below the crowns is going to be the main determining factors for how long all this will last.

      I’m hoping you have eliminated smoking, soda and any other bad habits.

      At age 24, I be very hesitant to remove all of your teeth and replace them with an all on 4 or even a Prettau dental implant bridge. If your teeth can be saved in a predictable fashion with limited dental implants that would be best for now. Keep in mind this will be constant maintenance project for the rest of your life. I would suggest you find a really good dentist and have a completely treatment plan to help to keep your teeth for a lifetime.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  37. my all on four broke a year after placement….it happened because ***one*** implant failed. $30,000 down the drain…I wish I had come to you.

  38. I got my snap on dentures two years ago and have been going through complete hell ever cents. My dentist that I’m going to now has not been able to get the denture to fit right it is my lower denture they only place to implants and everything gets underneath it that I eat food anything gum it moves all over the place it’s just been horrible. My question is do I need to more implants or is two implants suitable for a 36-year-old woman. I would love to hear back from you I spoke with your right-hand lady for whoever she has and she was awesome. She answered every one of my questions told me I should blog you’d answer back. That maybe You could refer me to somebody that’s in Utah that really knows her stuff about dentures or I could have a mold of my mouth done and sent to you and you could do my denture.I would love to hear back from you. I just need somebody that knows what they’re doing I can’t go on another two years in that same situation that I’ve been In. I’m embarrassed of my mouth I don’t want to go out in public. Please help

    1. Hello Kathy,

      2 implants is just not enough. If your 75 years old and he had been wearing dentures for years and years and you just needed a little bit more support, then I would say 2 dental implants is enough.

      An implant over denture with only 2 implants will always lift and rock. I would suggest converting your existing denture by adding at least 4 more implants and having a fixed porcelain bridge such as the Prettau dental implant bridge. I would avoid the all on 4 procedure for somebody your age.

      Prettau dental implant bridge

      good tips on finding a dental implant dentist:
      How to Choose an Implant Dentist

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

    2. This is his webpage about the procedure (I hope I am allowed to post this, I just need an opinion, not trying to advertise or anything like that.

  39. Dear Dr.,
    I’m 29 years old and yesterday, I had an Ossifying Fibroma removed from my mandible and teeth 19 & 20. The tumor had encompassed these teeth and a large portion of my buccal plate (left side) could not be saved.

    The surgeon told me to come back in 3 months for grafting and implants. Could you explain to me why grafting wasn’t done right away? Why wait 3 months? Maybe to make sure it heals well since the loss was due to a tumor…. Also, once he does the grafting will he wait to place the implant screws so the bone has time to grow? He is an oral surgeon and I know it can take a team of dental professionals to get the job done, but so you have any advice for me.

    Thank you in advance 🙂

    1. I had already had the biopsy performed 6 weeks prior and the ossifying fibroma came back benign. Why wait another three months to graft?

      1. Your situation is unique enough that it is probably best to stage things rather than try to combine anything. I hope it is going smoothly for you. Sorry for the delayed reply. Your comment got picked up into the spam filter.

  40. I really like this post!!! I am a dentist also. I have seen so many all on 4 Bridges fail. I’m sure this is the calm before the storm as so many of these low-cost clinics are doing these. We will both be doing a lot of redo cases to help these patients that had all on 4 dental implants that did not work

    1. Hi Vince,

      Unfortunately, I have seen the same problem. For the last 30 years we have been using tried-and-true techniques using the proper number of implants now many people think you can just cut corners and use less anchors. Our biology has not changed, and dental implants are still made of titanium.

      Dr. Amin

  41. Dr. Amin – I am so glad I found your web site. The information is so helpful. I only wish you were located in my area (Georgia).

    I am 55 years old. recently went for a consultation at ClearChoice for the All-on-Four. I was told that, while I have very limited amount of bone, they could still do it for my upper. They also told me that it was likely that I wouldn’t have enough bone left if I wait a year to do the procedure. While I know and have been told by several dentists that I have limited bone, I am skeptical that a year could make such a big difference. Do you have any opinion on this?

    Thanks again for all of your help!

    1. Hello Bobby,

      Bone loss is progressive in nature. Until the bone get all the way down to the very base it typically continues to shrink on a yearly basis. The sooner you have the procedure done, the higher chance of success and the less chance of complications occur.

      If you have very limited bone I would not suggest the all on 4 dental procedure. All on 4 is great if and only if you can use super long and wide implants in all locations. If your bone is limited this means that you’re for implants are going to be tiny. I would suggest a minimum of 6 implants on your upper jaw especially if smaller implants need to be done. Think about it, you are trying to replace 14 teeth that have more than 20 roots with only FOUR dental implant roots.

      This is why suggest the implants must be very large but you must have enough bone to be able to use large implants only use 4 implants.

      Also be sure to consider what type of teeth you will be getting. The clear choice dental implants that are typically provide plastic denture teeth on a metal framework. You will replace this many times over. I would suggest porcelain fused to metal or monolithic zirconia such as Prettau. Of course this is more costly but it will save you in the long-term. Most of these Bridges chip or break within the first 2 years and then continues to do so.

      Prettau Dental Implant Full Mouth Bridge

      The Process of “Permanent” Fixed Dental Implant Teeth -5 Steps to Replacing All Your Teeth

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  42. great video, thanks. Extremely informative.
    Want to know how you feel about 6 implants on top, asking for zirconium piece, but do you approve of using a bar?

    1. Thank you Shari,
      6 implants on the upper jaw with a zirconia fixed bridge is excellent. A bar is only going to provide you with an overdenture. 6-8 implants on your upper jaw is going to provide you long-term support for the naturally soft bone of the upper jaw. Remember that the lower jaw is much more dense and therefore less implants can be used. I’m strongly opposed and almost all situations to and all on 4 situation on the upper jaw.

      I would suggest having a Prettau zirconia bridge on 6-8 implants for your upper jaw. This is an excellent prosthesis that when done correctly is likely to out last any dental restorations on the planet.

      these web links should help you:

      Prettau Dental Implant Full Mouth Bridge

      The Process of “Permanent” Fixed Dental Implant Teeth -5 Steps to Replacing All Your Teeth

      Fixed Dental Implant Bridge vs. Implant Denture – What is the REAL Difference?

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  43. Hi Dr. Amin,

    I recently had a endodontic retreatment on a tooth (#12). My first root canal was in 2007 by a general dentist. A little over a year later I started developing an abscess in my gum above the tooth. Since then I put off taking care of my situation with any dentist. My face swelled up almost double in size so I had to visit a dentist at that point. Having no insurance whatsoever with a minimum wage job has been my only excuse.Two months ago I went to a dentist close to me that was considerate of my financial situation and referred me to the endodontist. I return to the dentist after the retreatment next month for, “A follow up is to remove the original crown and look for any decay. Possibly needing surgery on the tip of my root”. I know what needs to be done but having no one to rely on for help makes it more difficult. I’m very confused about what I should do. I’m putting trust into this dentist and don’t know if its the right choice.

    1. hello Ashley,

      You may want to consider having dentistry done in a local dental school. This may save you about 25%. The dental school typically only performs pretty basic work because it is done by students. Just expect to be there for a very long time for each appointment which will average between 3-4 hours to have just one tooth done. Given your situation, this may be a good option for you to get more bang for your buck. Most major cities have a dental school.

      Good luck,

      Ramsey Amin DDS

  44. Hi
    How expensive is a sinus bone graft and is it guarantied for the implant to be secured? What can you have placed while the bone graft heal? And how do I find a good bone graft/implant dentist in New Jersey ? I live in secaucus. Thank you

    1. Hello Catherine!

      Nothing in medicine or dentistry can be guaranteed to work…that is against the law to promise a patient. That being said, sinus bone graft done by a skilled dental implant practitioner is likely to be successful. This allows very long implants to be used which are much more stable than short implants.

      Depending on the type and size of sinus bone graft that you need, the cost can vary from $500-$5000. I would suggest finding a dentist who has similar qualifications and is a Diplomate of the American Board of Oral Implantology. I only say that because these dentists have been board-certified in their peers have examined them through rigorous process to make certain they are good.

      Here’s a link that will help you


      Very respectfully,
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  45. The “All-On-4” dental implants totally changed my life. I wish I would’ve come to your office sooner. The teeth keep breaking and I’ve only had them for 18 months. They looked good when they first started, then they just started to change and stained like my old denture teeth. I also have pain around one of the four implants in a bad smell around it.

    I see why you are kind of against it. I wish I would’ve read your information first and come and see you. I live in Los Angeles. Any advice?

    1. Hello Georgia,

      I am sorry it has such a negative experience with the all on four dental implant procedure.
      It seems like once a week now I am seeing patients were having their bridges break. Yes they are just denture teeth attached onto metal. If the problem is only with breakage, I could replace your all on four bridge to a Prettau monolithic zirconia bridge.


      It sounds like you have problems with the bone though. You are likely going to have to remove the bridge to access the implant that has the problem. Hopefully the bad implant can be treated with a bone graft. If you lose just one of four of the anchors, you’re going to lose the whole bridge.

      You’re welcome to come see me in my office since your so local.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  46. great website by the way. I’ve learned so much here. thank you for all of your time you spend on this site. I see you’ve been doing this for many years now! keep up the good work

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About Ramsey Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.