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Dental Implant AP Spread for Upper “All on 4/X” Teeth

Dental implants should be spread out from each other when replacing a full mouth.  Just like the legs of a chair, the farther they are spread out the better stability.

In implant dentistry this is called “AP spread” which means anterior/posterior  spread.  Just as important as the number of implants is the position of the implants.

What happens? Sometimes on the upper jaw it is not possible to spread the implants out as far for an all on X/all on 4 dental implant Prettau zirconia bridge.  This is usually because the sinuses are too large and really far forward rather than being towards the back.

If the implants are all squished up in the front, this leads to a longer cantilever on the back than what I would typically want.  Ideally the implant should be under the bridge without an extension…like a diving board.  Usually this is not possible and a short diving board cantilever is necessary.  A way to remedy spreading out the implants on the upper jaw is to either do a sinus lift bone graft or placing zygomatic implants.  This gives implants towards the back  molar areas where you have the heaviest bite force.

Upper jaw has sinuses that carry very far forward making only 4 implants very under engineered. The image shows for regular dental implants in the front of the mouth and zygomatic implants for the back of the mouth. Sinus bone grafting can be an alternative to zygomatic implants.

In the image you can see two different chairs.  Obviously one would be more stable to sit on than the other.  Having more legs is always great, but the leg positions is just as important as the number of legs.  Most chairs only have 4 legs and can be very stable.  In the mouth I prefer the upper jaw to have 6 implants.  The bone on the upper jaw is so much softer than the lower jaw so the rules are not the same.

The green dots are the implants. The image on the left has 4 implants while the image on the right has 6 implants that are more spread out

Many dentists believe that all on 4 implants on the upper jaw is all that you need.  The reality…if one of them fails it becomes “none on 3.” No spare tire.   The entire bridge would have to be remade….all is LOST.  This is most important in the UPPER jaw.

The better the spread of the implants also gives me a higher chance of providing immediate loading which means you get your teeth installed on the same day or by the next day at the very latest!

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

3 thoughts on “Dental Implant AP Spread for Upper “All on 4/X” Teeth

  1. Dear Dr. Amin,

    Thank you so much for educating the people.

    With the All-On-6 procedure for the upper jaw, do you individually place each implant with a special bridge? Or are the implants stand alone in the upper jaw? Please explain.

    Also, if a patient has two good front teeth in the upper jaw, is it necessary to extract these teeth to complete this procedure?

    1. Thank you for your comments. If you are missing all the teeth on one Arch then 6 six implants will suffice for most people if they are all connected as a single roundhouse, horseshoe-shaped Bridge a paragraph the only time stand-alone implants are used is in people who are missing some teeth could you paragraph I hope this makes sense

      If all you have is only two teeth remaining on the entire upper jaw it often does not make sense to keep those two as they can become a hindrance to the prosthetic and surgical outcome. Generally in that situation removal of those final two teeth would also yield a better cosmetic result and more stable bone around the tops of the implants over time. each situation is unique. I would suggest that you connect yourself with a very skilled implant dentist with a lot of experience because dental implants are not permanent.

  2. Great explantion / using the chair types re stability or lack of/ it actually made me laugh,/
    as i was already aware of the importance of foundatoins and stability/ yet so many dentists still do all on 4 / surely they must now foundations and overall stability are essential?? Love your work and your methodology ,always have always will,/ you are certainly at the top of you profession ,or to add a bit of humour one could say” top of the food chain” 😉😁👌…….
    Kindest Regards… Julie..

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About Ramsey A. 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.