This case is a full arch lower fixed denture supported by four implants.  This case had to be done quickly because the patient needed to travel to another country for the holidays.  This is a PMMA temporary restoration that will give the patient an idea of what to expect with the final restoration and a chance for me and my lab technician in the Bronx and Westchester office to evaluate the dental implant restoration and make adjustments to the final restoration.

I  rarely do "all on four," however this particular patient was an ideal candidate. I do not favor placing implants at severe acute angles, and so that is one of the main reasons I do not advocate using only four implants.  Also the implants must be placed in the correct position to allow for a fixed restoration that does not sit on a substructure and then also have a superstructure.  Those restorations are very difficult for the patient to keep clean, and food debris and bacteria are excessive and malodor is common.  In a situation such as this, where the patient had adequate bone to place 5 x 13 mm implants in all the sites, in the canine and second bicuspid areas to allow for adequate support while also allowing for conventional bridgework to be fabricated.  I do for the most part, all on six implants as well as all on eight, depending on the case and the patient needs and wants.  Treating every case as an all on four is like having only a hammer in the toolbox, everything becomes a nail.