Proper Shape Of Gums All on 4 Bridge

This one picture says it all. This is a temporary fixed all on 4 denture conversion bridge using 4 zygomatic implants. It doesn’t so much matter the type and number of implants as it does the shape of the underside of the bridge.

Temporary (not final) showing ideal convex contours

The bridge is convex in all aspects. If it is concave it can catch food and be harder to clean.

Sometimes I have no option but to make some areas concave in order to give better support of your lips. I try to avoid it though.

Proper diagnosis and planning of the bone leveling is what often determines this. It is determined BEFORE surgery…not when starting to make teeth.

Most bridges should have 5-6 implants but this is a special case.

Ramsey A. Amin, D.D.S.

Diplomate of the American Board of Oral Implantology /Implant Dentistry

Fellow-American Academy of Implant Dentistry 

36 thoughts on “Proper Shape Of Gums All on 4 Bridge”

  1. Hello Dr Amin
    I have been wearing temporary all on 4 fixed dentures for 5 months. They are intraoral scanned digital. Very painful when the retainer screws are torqued. 5 sets have been made from the scan all are non fitting and have a pulling pressure around the implants when they are tightened. The gums and teeth on the right side is about 1/8 inch out past the arch, my lip gets caught on the top of the canine when I smile big, and the teeth in that area rub on the inside of upper lip. The teeth across the arch ( canine to canine ) are to wide. My arch is tapered U shape and these are more square shape. When I was young I was in a accident and my upper jaw is slightly tweaked to the left. Would this make a difference in the digital program processing a accurate denture, or could this be the reason that all of these sets of test teeth do not fit. Could the program be correcting the tweaked jaw back to the right, and pushing the teeth past the right side arch?When I am eating, even soft food and bite it hurts and I feel a squeezing pulling. It feels like the implants are flexing under pressure. Will this be different with the final zirconia teeth. My dentist has been doing dentures for 25 years but the digital program is new to him. He is at a loss as to what is causing this problem. He said that be doesn’t think the position of the gums and teeth make a difference because the access holes in the dentures are in line with the implants and can be screwed in. I feel like even though they line up once they are torqued and pressure is applied they are flexing or stretching because the position of the prosthesis on my arch is not correct. Having all 5 sets of these teeth fitting the same is strange, could it be incorrect information that is in the program? I am afraid if this mystery is not solved soon, this will damage the implants. Wearing the prosthesis is painful and removing them is painful because I over close my jaw and the implants hit! What do you think the problem could be? Thank you for any suggestions jan

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  2. Hello Doc love your posts. I had all on 4 surgery 4 weeks ago. I have the temps in now for 5 months and then start with the test teeth before my final zirconia’s are made. My only issue is with these temp teeth how thick the pallet plate feels on the backside. Will the final teeth have less of this bulky plate that is making it difficult to speak correctly?

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  3. Hello Dr. Amin, I really appreciate the amount of information you provide on your website. Obviously, you care about, and want to educate everyone with dental issues and not just your patients. I wish I had found you earlier. I had upper and lower full arch implant supported dentures about two years ago. I had to travel some distance from home because I needed a zygomatic implant on one side, and there was not a local surgeon able to do that. Fortunately, I do have Zirconia dentures and they don’t seem bulky at all, and work pretty well. After some initial issues with bulkiness of the temporaries and some problems with biting my tongue, lips, and cheek, things are better. The problem I have is that there is a gap between the denture and gum on the side where the zygomatic implant is located. Light, water, and air pass through freely and sometimes I can feel air leaking through when I speak. Someone suggested the abutment protrudes too far for the denture to fit the gum properly. Is this possible? Also, my teeth are noisy and click together when I chew. I have to be conscious of this when eating around others as they can hear it as well. Any thoughts? Thank you in advance for your response!

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    • Thank you for your kind words and happy Thanksgiving 🍁

      The air gap underneath the zygomatic implants it’s probably OK as long as there is not passing into your sinus through your mouth. The gap space underneath the bridge is not ideal, but it is much better to have it in the back, than in the front where it can affect speech.

      If it does not bother you too much, I would leave it alone. If not, the zirconia bridge would need to be remade in order to close in the space because your bridge is not acrylic so it is not easily repaired.

      As for the clicking when you talk, this could be due to your “vertical dimension “ being slightly over opened this is something we try to work out in the temporary phase.

      My best advice would be to see your dentist who made the teeth and review these things.

      https://burbankdentalimplants.com/gap-space-under-my-implant-bridge/

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  4. I just had the All on Four implants on the top arch done. I will have the temporaries for 4-6 months before the permanent ones are instalked. My bite seems off, as though when I bite down, the bottom right teeth are interfering with the biteresting. I noticed there is a plastic like half palate on the undersude of the top arch…could thus be the oroblem where it is too thick and needs to be shaved thinner so that the bite rests evenly on both sides if the bottom teeth? It is driving me crazy.

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    • If you had a standard denture conversion then your teeth are probably very bulky versus a digital print or mill of the teeth. Hopefully another prototype will be made for this one will be heavily adjusted so that you are ready for the final teeth. It is nice to be able to size everything before going to the final. Definitely have a discussion with your restoring dentist about these things before going to the final. Sometimes they can be thinned out and sometimes they cannot depending on surgical position of the implants and your jaw position.

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  5. My all on four finals are not fitting properly and are causing pain , I have had them for five months, the first two months felt ok but since then they feel very uncomfortable. What could be wrong .?

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  6. I had 7 implants put in for a fixed implant arch over a year ago. The doctor was having issues making an arch that fit and ended up not using the front two support implants. He made me an arch that he was finally able to screw on but they feel horrible and my speech is so bad. I paid $32,500 for just the top so I would have the quality and I feel this is as good as he can make and now I’m stuck with them….any suggestions?

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  7. Hey Doc.
    I have the all on four implants for about a year now. Because of the covid 19 I still have my temporary teeth. I have developed a decent size gap on the right side upper. I don’t have any pain but it is very uncomfortable. Does the gap itself cause the gum to become a little irritated? Some days it feels fine and can just feel the gap with my tongue. Other days it is really uncomfortable. Can I be irritating the gap with my tongue?
    Thanks Doc.

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  8. Hi Doc Amin , I have all 4 hybrid plastic maxilla , the final bridge doesnt fit well. When my dentist screw the right side, he can not screw the left amd vice versa. Had 3 xrays but still he can’t figure out what was wrong.
    Then after a week , I came back , he tried to screw the 3 left (extremely painful that thwybhave to give me nolotil medicine ) and the 3 right then xray but it shows gap. He then tried to screw one more round on the right and one more PAINFUL round screwing on the left and then xray again. I still shows gap on the left and almost none on the right. The left which has gap on the xray the flange is digging into my gums painfully. While on the right which shows almost no gap in the xray , the intaglio is not even touching my gums.
    Please help me how to figure out ws was wrong ? Thank you in advance .Just incase you want to see my hybrid plastic on 4 maxilla
    Here is the link : https://youtu.be/HSRPI4lZjbU
    Thank you very much in advance Doc Ramsey.

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    • I saw the video. Unfortunately it doesn’t tell me too much. It sounds like the tissue is being over compressed a bit. Hard to say. It needs to fit passively not forced in

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  9. Thank you, Ramsey Amin. You’ve done full sets zirconium for almost a decade and my dentist has done none. I’ve tried to research about the best options for me. Every article comments on zirconium:s heavier weight. I envision my mouth and jaw drooping down from the weight.😊. Thank you for sharing your expertise. Not everyone has it.

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  10. My prosthodontist/dentistnis recommending zirconium all on four upper and lower to replace acrylic All on four. I’ve read that zirconium is very heavy and that is troubling me because of having a sensitive character. I know. Get over it. However, what can I expect in terms of the issue of heaviness.

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    • I have done these for almost a decade now…. I have never had a patient complaining about the weight. You will get used to it within 24 hours or less

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  11. Hello Dr. Amin, I recently had a full set of all on four implants (from Clearchoice) it has been four months so far , with several problems arise. First problem was the way the gums were made, they weren’t even causing food to lounge more in some areas than others, then a couple of weeks later having a tooth fall off the temps. To must recently the top back part of the upper temps breaking from the last implant that was surgically inserted . ( gum and back tooth broken completely off) when I was eating lunch. All have not been repaired except for the tooth that was cemented back, . How should I address my dentist so I can fix the problems that I mentioned?? I have always been someone who hates to complain but I’ve spent way too much money to not be happy with my smile!!! Thanks for your response.

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    • Ugh..it sounds like his teeth are hybrid plastic denture teeth. Is that correct? I’m guessing there not zirconia or a more upgraded premium material?

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  12. This looks like a huge amount of acrylic. Am I correct in assuming that you are only demonstrating the curve of the prosthesis?

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  13. Dr. Amin. I recently had 6 implants (with zygomas) placed on top and 4 in the bottom … after 2 weeks when most swelling subsided… i noticed a change in my cheekbone volume and height of my nose… my cheekbones look more prominent and my nose when i look in the mirror… my nose holes look more prominent as well. My mouth looks sunken in even with my provisional hybrid giving it a look of someone with dentures. I went for my first follow up today and i was told by my oro maxillofacial surgeon that my face will continue to change in the course of 6-7 months. I’m very worried because I didn’t want my facual features to change… is this something that can be fixed by readjusting the final hybrid?

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  14. Very intelligent information _ you are just so good in every aspect of your work/ your attention to detail followed by your explanations just blow everyone else out of the game/ you never cease to amaze me, I admire your dedication and ability/ you are unique 😁 it saddens me that I do not live in america/ the time factor involved is the only thing holding me back at this stage in coming to see you ..kindest regards julie….

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  15. Hi Dr. Amin, what is your input about fiberglass posts? I’m still needing a bridge from 5-13. 6,11 +13 will be extracted and replaced with implants and will hold up my bridge. They want to extract 5+7and implants on them, too. But they are still good teeth, just root canals and crowns right now. I came across the fiberglass posts idea on the internet and thought maybe I could save money on 5+7 by getting the fiberglass. The Allon4 is still a thought, just don’t have the money. Thank you so much

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    • just make sure that you are not “salvaging” teeth that will fail on you within 5 years only to end up pulling them out! Fiber posts are good but more importantly is a diagnosis and treatment plan and the ability to actually do the technique

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