All-on-4 Dental Implants: Replacing Failing Teeth from Advanced Gum Disease with a Fixed Bridge
Dr. Sonia Butta • Impladent® Dental Clinic, Malad West, Mumbai • CBCT-Guided All-on-4 Placement with Immediate Provisional • Stable Fixed Lower Arch Restored
PATIENT DETAILS
Age: 58 Gender: Male
Medical History: Diagnosed with advanced generalised periodontitis involving the entire lower arch, with progressive tooth mobility over the past three years. Type 2 diabetes, well controlled on oral medication. Former smoker, quit two years ago. No known drug allergies, no history of prior implant therapy. The patient is a 58-year-old business owner who wanted a fixed solution rather than a removable denture.
CASE PRESENTATION: All-on-4 Dental Implants for Failing Lower Teeth
A 58-year-old male patient presented at Impladent® Dental Clinic in Malad West, Mumbai, with the chief complaint of loose lower teeth, bleeding gums, and pain while chewing. His gum disease had been present for several years and had progressed despite repeated scaling at other clinics. Over the last year, several lower teeth had begun to shift, and he had started avoiding hard foods altogether.
On clinical examination, the patient showed generalised gingival inflammation, pocket depths of 7 to 9 mm, and grade 2 to 3 mobility in most of the remaining lower teeth. Radiographic and Cone Beam Computed Tomography (CBCT) imaging confirmed bone loss of more than two-thirds of the root length around most teeth. The front of the jaw retained good bone volume, while the back of the jaw had reduced height above the inferior alveolar nerve. The lower teeth were judged non-salvageable.
“The patient was evaluated by Dr. Sonia Butta, prosthodontist at Impladent®. Based on the diagnostic findings, he was confirmed as a suitable candidate for a fixed All-on-4 full-arch restoration. The plan included extraction of the failing teeth, CBCT-guided placement of four implants with the two back implants tilted to avoid grafting, and an immediate provisional bridge, followed by a definitive fixed bridge.”
All-on-4 Dental Implant Journey — From Failing Teeth to a Fixed Bridge
| STEP 1 Initial Consultation | STEP 2 CBCT & Diagnostics | STEP 3 Gum Health Stabilisation | STEP 4 Extraction & Implant Surgery | STEP 5 Immediate Provisional Bridge | STEP 6 Osseointegration | STEP 7 Final Fixed Bridge |
| Patient presented with mobile lower teeth, bleeding gums, and painful chewing | 3D imaging confirmed good front bone and limited bone height at the back | Blood sugar review and infection control before surgery | Failing teeth removed and four implants placed in one session under local anaesthesia | Fixed provisional bridge attached within 24 hours of surgery | Four to six-month healing phase for the implants to bond with the jawbone | Custom definitive bridge fitted, restoring stable, fixed chewing function |
| “In advanced gum disease, the question is no longer how to save each tooth but how to give the patient a stable foundation. All-on-4 lets us remove the infected teeth and place a fixed bridge on four well-anchored implants, often without bone grafting.” Dr. Sonia Butta, Impladent® Dental Clinic, Malad West, Mumbai |
The All-on-4 dental implant patient journey: diagnostic workup, extraction and CBCT-guided implant placement, and a fixed full-arch bridge.
DIAGNOSIS
Advanced generalised periodontitis of the mandibular arch with non-salvageable dentition (grade 2 to 3 mobility, pocket depths of 7 to 9 mm, bone loss exceeding two-thirds of root length). Adequate anterior bone volume with reduced posterior bone height above the inferior alveolar nerve. No uncontrolled systemic disease. ASA II classification due to controlled type 2 diabetes. Confirmed candidate for All-on-4 immediate-load full-arch rehabilitation.
Advanced gum disease destroys the bone and ligament that hold teeth in place, so teeth loosen even when they have no decay. At this stage, repeated cleaning cannot rebuild the lost support, and keeping infected, mobile teeth only prolongs pain and further bone loss. The front of the lower jaw usually keeps denser bone for longer, which is what makes the All-on-4 concept workable. Four implants, two placed straight at the front and two tilted at the back, can carry a full fixed bridge without grafting.
TREATMENT
- Pre-operative Assessment: Clinical examination, CBCT imaging, digital impressions, and medical fitness review including blood sugar control
- Infection Control: Gum disease management and medical stabilisation before surgery
- Extraction of Failing Teeth: Removal of all non-salvageable lower teeth in the same session as implant placement
- All-on-4 Implant Placement: Four titanium implants placed under local anaesthesia, with two posterior implants tilted to use available bone
- Immediate Provisional Bridge: Fixed temporary teeth attached shortly after surgery so the patient is never without teeth
- Osseointegration & Monitoring: Four to six-month healing phase with periodic clinical and radiographic review
- Definitive Fixed Bridge: Custom CAD/CAM bridge fitted once implant integration was confirmed
DETAILED DESCRIPTION OF TREATMENT
After confirming the diagnosis, Dr. Sonia Butta recommended extracting all remaining lower teeth and loading four implants immediately with a fixed provisional bridge. The patient’s diabetes was reviewed before surgery, and his blood sugar was confirmed to be well controlled, since poor control slows healing and raises infection risk around implants.
Patients with full-arch tooth loss often ask about All-on-4 vs All-on-6 before treatment. In this case, four implants were recommended because the back of the jaw had limited bone height. Tilting the two posterior implants let them anchor in denser bone toward the front, so no grafting was needed and the treatment timeline stayed shorter.
Surgery was carried out under local anaesthesia in a single session. The failing teeth were removed, the infected tissue was cleaned out, and four implants were placed following the CBCT plan. All four implants achieved good primary stability, so a fixed provisional bridge was attached within 24 hours. The patient left the clinic with fixed teeth rather than a denture. The treatment cost was also discussed before surgery, since dental implant cost for a full arch depends on the number of implants and the final bridge material.
“With All-on-4, the patient walks out with fixed teeth and the implants heal quietly underneath. The key is respecting the healing period and keeping the gums clean, because the same bacteria that caused the gum disease can affect implants if hygiene slips.”
Dr. Sonia Butta, Prosthodontist & Implantologist, Impladent® Dental Clinic
Post-operative instructions included a soft diet for six to eight weeks, prescribed antibiotics and analgesics, and chlorhexidine mouth rinse twice daily. Mild swelling settled within the first week, with no signs of infection. After four months, imaging confirmed that all four implants had integrated. A digital scan was taken and the definitive bridge was fabricated using CAD/CAM technology, with tooth shape, shade, and bite customised to the patient.
POST-OPERATIVE ASSESSMENT
The patient was reviewed two weeks after delivery of the final bridge. He reported stable, comfortable chewing with no looseness or pain, and the bridge felt secure when eating. The bite was checked and fine-tuned against the upper teeth. He was taught implant-specific cleaning, including a soft interdental brush and a water flosser, and placed on a three-monthly professional cleaning schedule given his gum disease history.
At the six-month review, clinical and radiographic evaluation showed healthy gum tissue and stable bone levels around all four implants, with no signs of inflammation or peri-implant bone loss. The patient continues on a long-term maintenance plan with annual radiographs and regular cleaning, and his blood sugar control remains under his physician’s care.
This case shows why timing matters in advanced gum disease. Holding on to mobile, infected teeth costs more bone with each passing year, and the earlier a stable fixed solution is placed, the more predictable the outcome. Where front jaw bone is adequate, All-on-4 gives patients fixed teeth in a short timeline, often without grafting.
CONTACT — IMPLADENT® DENTAL CLINIC, MALAD WEST, MUMBAI
| Surgeon: | Dr. Sonia Butta, BDS (Bom), MClinDent (London), Prosthodontist |
| Co-Specialist: | Dr. Glenn Mascarenhas, BDS (Bom), MClinDent (London), Founder & Prosthodontist |
| Clinic: | Premier Tower, 201/301, Marve Road, Orlem, Malad West, Mumbai, Maharashtra 400064 |
| Phone: | +91 022 31912633 | +91 022 31424745 |
| Website: | impladent.in | Dental Implants in Malad, Mumbai |
Impladent® is a premium dental clinic in Malad, delivering advanced dental solutions with a commitment to precision, safety, and excellence in patient care.