What is the cost of All-on-4 dental implants in Singapore?

All-on-4 dental implant treatment protocol is gaining popularity around the world and is beginning to catch on in Singapore. There were a lot of skepticism about this protocol when it was first introduced as it required a significant change of mindset to accept that four implants angulated divergent from one another could predictably support a fixed prosthesis. Now that there are scientific publications in refereed journals documenting their success, it is beginning to gain traction. Cost is one of the major advantages of this protocol. By using fewer implants and by avoiding bone grafting, significant costs were saved. So, how much does it cost to do an All-on-4 dental implant prosthesis?

Upper Jaw

It is a lot easier to estimate the cost of an All-on-4 treatment plan than traditional full mouth implant treatment. This is because of a diametric philosophical change in approach to treatment planning. Traditionally, we design the final prosthesis first and then from there, decide where the implants need to be placed. And if there is insufficient bone to support an implant in that spot, bone grafting is done to augment the site so that the implant can be placed in the ideal position and in the ideal angulation. This makes a lot of sense as the ultimate objective is to have a beautiful and functional prosthesis and the implants are merely the supporting structures. In the All-on-4 protocol, the prosthesis is supported by four implants; two placed in front of the maxillary sinus pointing forward, one on the right and one on the left, and two placed behind the sinus pointing backwards in similar fashion. This positioning and angulation allows for a rigid cross-arch stabilization. This approach is akin to placing the implants where there is bone available, and designing a prosthesis around them.

Lower Jaw

In the lower jaw, where the constraints are usually due to the presence of a nerve in the back, two implants are placed near the centre in front and another one on each side of the jaw just in front of the mental nerve, pointing backwards. This way, the tops of the implants which connect to the prosthesis are well spread out for a stable support and relatively long implants placed in a tilted direction allowing for maximal bone-to-implant contact.

Regardless of upper or lower jaw, the average cost is about $25000-$35000, depending on the prosthesis design. For a hybrid denture design, i.e. using acrylic prosthesis, the cost is nearer the low end of the spectrum while full porcelain bonded to metal prosthesis or zirconia prosthesis will cost nearer the high end of the range. The difference in cost can also be attributed to the brand of implant used. Although, strictly speaking, All-on-4 is a trademark of a particular brand, it is a term that has come to be used quite ubiquitously by all other brands, just as Xerox has come to mean photocopy. Using the original brand will cost more while using generic brands will save some cost.

Zygomatic All-on-4

In some upper jaws, there is not enough bone to even anchor four implants in the upper jaw. All-on-4 can still be done using four zygomatic implants. Zygomatic implants are long implants that averages about 5cm long (compared with the average dental implants which is 1cm in length). The zygoma is the cheek bone and the zygomatic implant enters the upper jaw in the region of the premolar or molar region at a 45 degree angle to engage the base of the zygomatic bone, which is also the outer roof of the maxillary sinus. Two implants can be placed into each side to support a prosthesis. Zygomatic implants are more technically challenging to place and may even require a general anesthetic in a day surgery operating room. As such, All-on-4 zygoma implant treatment cost about double that of conventional All-on-4, i.e. about $50000.

Overall, the cost is much less than if grafting and multiple conventional implants. The added advantage is immediate restoration with a temporary prosthesis. This eliminates the need for a period of wearing a removable prosthesis ie a denture. The main limiting factor is that not all patients are suitable for All-on-4. However, with proper case selection, All-on-4 does offer fully edentulous patients a more affordable fixed prosthesis delivered with minimal surgery and reduced time.