Price of All On 4 Plus® with Ceramic-Porcelain Teeth

Written by Dr Alex Fibishenko

The perception is that porcelain teeth are better, but like everything else, it really depends on the individual situation.

Porcelain is a ceramic material that comes as a paste and can be shaped and manipulated by a technician before it is made into a solid through a sintering process. Once sintered the material is shiny, extremely hard, and durable, but it is also more brittle the thicker it gets so it needs to be supported by a substructure like Zirconia.

When it comes to individual dental implants, zirconia with layered porcelain is ideal because the size of the restoration is small and the porcelain can be matched precisely to the existing adjacent teeth by a competent technician. Also, because the adjacent natural teeth are still present, they absorb the shock of the bite and so the fact that porcelain is brittle is not as relevant.

When we do a full rehab with All on 4 Plus® it is not just individual teeth that are missing but the entire set. The gum structure is completely lost and also needs to be replaced, which makes the size of the restoration is bigger. In those situations, the Porcelain teeth need to be supported by a much larger substructure of Zirconia, which makes it heavy. It is far heavier than acrylic teeth with titanium support.

Comparing Porcelain Teeth on a Zirconia substructure to Acrylic Teeth on a Titanium Frame is like comparing Steel to Carbon Fibre. Which is better depends on the individual situation?

Zirconia is heavy and like steel, it performs better in weight-bearing situations whereas Titanium- Acrylic Hybrid is like carbon fibre, and because of its lighter weight it performs better in almost all other kinds of situations.

A hybrid prosthesis with acrylic teeth supported by a titanium frame is strong because of the metallic frame, and the acrylic teeth make it lighter and more forgiving. This means that the prosthesis is able to absorb the forces of the bite and reduces the impact on the supporting implants. But these properties also mean that it undergoes wear and tear over time.

Zirconia on the other hand is stiffer and far less forgiving, and as such it more readily transmits the impacts of the bite to the supporting implants, especially since there are no other teeth remaining to absorb the impact of the bite, which may affect the healing or integration of the implants.

However, Zirconia is also more durable and unlikely to have significant wear over time. In certain patients such as heavy grinders or those with a heavy bite, acrylic teeth may not be strong enough. One in 6 patients will experience chipping and breakages of the teeth, which can be easily and painlessly repaired, but it can be annoying. It is in these kinds of situations we may recommend Zirconia. Its often impossible to predetermine which patient is that one in six, and this is why we offer Zirconia only as an upgrade option for those who experience excessive wear or breakages, or for those who might elect to have this for other reasons.

The Final Acrylic Teeth with A Titanium frame is included in the cost of All on 4 Plus treatment, as are any repairs within the first 2 years. The cost to upgrade to Zirconia is $9,950 for patients who underwent surgery at All On 4 Plus® Centres. It is only the difference in the cost between the two methods and significantly lower than the typical cost of Zirconia.

The most rational choice is to have Acrylic Teeth with a Titanium frame initially because its more forgiving on the implants, and then depending on how it wears over time determine whether Zirconia is in any way appropriate in the future.

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