Restoring All on 4 Cases: Suggestions for Less Expensive Options?

Find out the lab fees and overhead and decide what the appropriate fee should be. I think the bare minimum should be his conversion prosthesis and a back up made of acrylic or composite material reinforced by metal. The porcelain part is the expensive part..so you can have the patient wait longer before they get to that more expensive point.

There are two aspects to the restoration cost 1. the frame and 2 whats ontop of it (the teeth). With regards the frame there are several options 1. temporary titanium cylinders with stock titanium bars laser welded between them (least expensive) 2. wax and cast 3. Cad/cam milled Now what goes on top will vary the cost. The least expensive is denture teeth and acrylic processed over the frame. The laser welded stock method can only be restored this way. A cast frame or cad/cam milled frame can have denture teeth processed on it or have porcelain fused to it or (most expensive way and most esthetic) individual crowns made to be luted over the frame.

Dr C We have restored over 1000 of these cases and in most cases the lab fee and restorative doctors fees combined are about about 75% of the cost of the surgery. I know that lab fees vary from region to region but the cost of restoring the case is not usually a prohibitive factor. Are restoring doctors using a flat multiplier to set their fees? If so this may be where the issues are coming from. Chair time is about 4 1/2 hrs for the restoration and we encourage doctors to charge based on time.

With all due respect to Dr Kurtzman, I disagree with him on the issue of wielding to temporary copings as a restorative option. The walls of the titanium copings are not thick enough to give proper support to a wield joint. Experience has shown that this technique is only slightly more successful than building an all acrylic prosthetic and does not create the rigid cross-arch stability necessary for long term success in a tilted implant technique.

Have your lab prepare the abutments from cast to ucla abutments from the original implant company. Stock abutment are cheaper if they can be shaped to line up to alow cementation, or a combination can be used if needed. Cement acrylic frame supported overdenture onto the abutments using implant cement to allow removal for repairs when needed as repairs will be needed just as for any acrylic overdenture. This will allow for easy upgrade in the future if the patient desires to do so. Good lab and good communication with the teck doing the case is a must for a good outcome. If the lab is confused about what you want find another lab.

The major cost of the "All on 4's" (in my practice) is the CAD/CAM bar and the cost of the implants I use. You can use the less expensive brands out there. You can use that technique with most implant brands out there. The bar is going to be more than $2,000. Consider not immediately loading the cases and using locator abutments and a removable option. There will be people on the site that are completely against not splinting maxillary implants, but I have about 500 cases with 5+ years in function that will prove otherwise.

I am currently working on research utilizing alternative materials that would bring the cost way down, but time will tell on the wear of these cases.

Oh, and before the mini mafia chimes in... You can place 200 minis and make them a fixed denture. Actually, some will also tell you that bone grows up the minis, so that is another option to consider....

I have done 27 All-on-4 cases since 2007. This is what I do, and it has been very successful: Step 1: CT scan $350 Step 2: I use either the patient's old denture or make a new one: (done with IV Sedation) Removal of teeth and alveoloplasty $165 per tooth + $320 Placement of 4 implants and abutments $8400 Conversion of denture to fixed-hybrid (temporary) $2100 Step 3: After 4-5 months healing, CAD-CAM titanium milled bar with acrylic and denture teeth processed over it. It is easily repairable if anything breaks, and it is beautiful. My fee to the patient is $6500. It involves about 1 hour chair time for me and about 2 hours chair time for my assistant. The total lab cost is $2700. So the total fee to the patient is $17,000-18,500. Of course, not everyone can do this, but it is affordable for many people. I have heard of fees of $35,000-40,000. I think that is crazy.

Daniel, What do you find is the lab charges for the conversion? The fees seem in line with what is going on out there. Dan