All-on-4 dental implants are a popular replacement for natural teeth worldwide. But the procedure is lengthy and has multiple steps. This article is your guide to All-on-4 recovery tips for decreased complications post-operatively.
This article lists hygiene instructions for All-on-4 aftercare at each stage:
1. For the first two weeks after the dental implant surgery
2. From the 3rd week to time of prosthesis placement (after 3-6 months)
3. After receiving implant denture prosthesis
Cleaning fixed, implant prosthetics. Video Courtesy – TePe Oral Health Care USA
All-on-four dental implants replace missing teeth in an upper or lower arch that has no teeth.
If you wonder why they are called All-on-4, it’s because four dental implants support all 14 teeth of the arch.
They may be artificial teeth, but they require aftercare to ensure proper healing and ultimately a high success rate.
All-on-4 Dental Implants
How Do I Care for Newly Placed All-on-4 Dental Implants?
So your dentist cut through the gums, placed the dental implants in Turkey, and sutured them back.
You are through the first procedure, but it is time to be extremely careful with the healing tissues.
The first 1-2 weeks are critical because this is when your body reacts to the surgery and a foreign object (titanium implant).
Your dentist will provide comprehensive instructions for this period which includes the following do’s and don’ts: 
How to care for newly placed All-on-4 Dental Implants?
After the surgery, the dentist gives you a gauze pack to bite on.
You have to bite on it firmly but gently for 15 to 30 minutes to ensure that bleeding stops. It is the amount of time needed for the blood to clot.
First 24 Hours Post Operative
✅ Apply cold packs to the face where the surgery was performed.
Swelling is what causes most of the discomfort. Cold packs allow blood vessels to constrict, so less blood leaks from them.
24 to 48 Hours Post Operative
✅ Apply hot packs.
Heat promotes healing by increasing the supply of blood and nutrients to the surgery site.
First 48 hours
✅ Along with cold and heat packs, keep your head elevated when lying down.
Use pillows to elevate your head when sleeping. It will minimize swelling and bleeding.
Regardless, some swelling will still occur during the postoperative period due to the surgery. It’s part of the body’s recovery process.
So don’t be worried.
During First Week
✅ Take ample rest.
Don’t do any activity which requires hard physical labor, such as lifting heavy boxes.
Such actions raise blood pressure and cause bleeding through wounds.
Drink plenty of water and fluids such as fruit juices to stay hydrated.
No-chewing. Take liquid foods only for 1st week, such as applesauce, soups, and yogurt. Do not eat hot foods.
Second Week Onwards
✅ Start soft chew foods such as bananas, mangoes, tofu, oatmeal.
Below is a list of examples of soft foods that are safe to eat after dental implant surgery:
|Soft Food Options
|Boiled softened veggies
|Boiled rolled oats
|Rice and gravy
Avoid eating crunchy and crispy foods such as chips and wafers.
The crumbs from these foods can lodge in the surgical area and cause infection.
Rinsing Mouth with Saltwater Solution
Add one teaspoon of salt to 1 cup of water to make a saltwater solution at home.
You can rinse your mouth 3-4 times a day. It is an excellent disinfecting method after oral surgery and promotes healing.
But you must be careful when spitting because too much pressure can tear open the wound. Spit very softly.
Post-op care is essential to avoid complications.
Your dentist may also suggest using Chlorhexidine – an anti-microbial mouthwash twice a day. 
If your dentist has prescribed you antibiotics, take them on time without fail.
✅ Smoking & drinking
Avoid smoking after your surgery.  Smoking constricts the blood vessels.
Less blood reaches the gums when blood vessels are constricted, which means less oxygen and fewer nutrients.
Alcohol consumption can also cause implant failure.  You must refrain from alcohol usage during the healing period.
✅ Avoid using straws when drinking fluids
The use of straws creates a suction force in your mouth.
It may not seem much to you, but this force is enough to open a healing wound and cause bleeding.
✅ Do not use a prosthesis
If you use removable dentures or any other prosthesis before the surgery, DO NOT use them after surgery.
It will irritate the gums and lead to complications like bleeding and swelling.
After 1-2 weeks, your dentist will call you to remove the sutures.
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My Sutures Are Removed; How Do I Care for My Mouth Till I Receive My All-on-4 Implant Dentures?
It’s been two weeks since your dentist placed an implant, and your sutures are gone — good job on your aftercare.
Aftercare for the All-on-4 procedure does not end after suture removal.
The implant needs to fuse to the bone over the next 3-6 months through a process called Osseointegration. 
The success of implants depends on how effectively the bone & implants integrate.
At the suture removal appointment, your dentist will guide you with tips on maintaining good oral health during the Osseointegration period.
Tips for mouth care till you receive an All-on-4 dental implant denture
Some essential All-on-4 post-op tips are:
1️⃣ Do not apply load on the gums by using a removable prosthesis.
Optimum bonding between the bone and the implant occurs when implants do not have any pressure on them.
2️⃣ At this point, you can eat a wider variety of foods than the previous two weeks.
But, you still have to follow a soft diet because of the ongoing fusion between implant and bone.
3️⃣ The longer you leave the jaws undisturbed, the better the chances of successful dental implant surgery.
You must remove the following foods from your diet because they interfere with osseointegration: 
❌ Alcoholic beverages
❌ Chewy foods such as gummy bears
❌ Spicy foods such as cayenne peppers
❌ Foods with high acidic content, such as citrus fruit
❌ Sticky foods such as toffee, chocolate, and caramel
❌ Extremely hot or icy beverages which could shock the tissues
❌ Crunchy foods such as popcorn, granola, chips, nuts, and candy
❌ Sugary items such as soft drinks, candy. Increased blood sugar level interferes with healing.
4️⃣ You can add solid foods such as pasta, meats, and vegetables but make sure that they are fork-tender.
Your food must be easy to cut and chew for you.
5️⃣ You can go back to a regular diet once the jaw bone fuses with the implant. The time taken for this process varies from person to person.
6️⃣ Ideally, you should avoid smoking and alcohol during this period.
Smoking slows down the multiplying cells of the jaw bone, which is very important for effective integration.
Daily hygiene and care keep the gums and mouth clean. The goal is to prevent harmful bacteria from collecting on the gums.
Your dentist may suggest oral rinses with mouthwash twice a day to promote recovery.
How to Care for My Newly Placed All-on-4 Dental Implant Denture
You must have heard that dental implants last for a lifetime, practically speaking. Implant success requires work, just like everything else in life.
Your new all-on-four implant denture requires daily care for its maintenance.
Don’t be alarmed; the oral hygiene routine is manageable and is essential for overall health.
You can follow important all on 4 care tips: 
Brush Twice a Day
Like your natural teeth, you will need to brush your implant denture with a soft bristle toothbrush.
When you use your teeth to eat and drink various foods and beverages, the teeth can accumulate debris and stains.
Brush daily to maintain that aesthetic smile and the health of your gums.
You can use either electric or manual soft bristled toothbrushes for cleaning.
The only factor is to brush thoroughly and carefully two times a day.
Floss Once Everyday
The food gets trapped under the denture in an All on 4 implant system.
A special kind of floss called super floss is advised for full arch implant dentures.
Its ends are rigid, and the middle part is abrasive.
The tough ends allow the floss to be pushed under the denture.
The central abrasive part cleans the denture.
Use Your Dentist’s Suggested Mouthwash Twice Every Day
Mouthwashes have antibacterial properties.
Bacteria are generally present in your mouth, but some foods especially promote the growth of harmful bacteria, such as sugary, acidic, or carbonated foods.
Using mouthwash twice a day ensures that harmful bacteria do not multiply on gums or the implant denture.
Mouthwash & Dental Floss
Mouthwash and dental floss are the essential everyday care activities to prevent gum disease and implant failure.
Ideally, you brush and floss after every meal, but it is time-consuming and can become exhaustive eventually.
To maintain healthy implants, you should follow a routine that includes brushing twice and flossing at least once daily. 
There are alternatives available to regular floss and toothbrushes, which many dentists recommend for implant hygiene. Check the list below:
Water flossing is a method in which a jet of water removes food debris & plaque. 
The gentle but constant stream of water is aimed at the intersection of implant dentures and gums.
The water must be felt on the other side of the denture, e.g., when aimed from the tongue side, the water must flow out on the cheek side.
A sulcus or an end tuft brush can help clean and massage the gum area in contact with all on 4 dentures.
An electric toothbrush is an effective alternative to a regular brush. It cleans food particles and plaque as effectively as a manual toothbrush. 
Remember to clean your tongue and cheeks with a soft brush to remove harmful bacteria. It also helps in eliminating foul odors due to food remnants.
Visit your dentist regularly for inspection. Your dentist may schedule maintenance visits every 3-6 months to check your oral health status. 
Remember, the better you care for your all on four implant dentures, the longer they are expected to last.
All-on-4 implant dentures are a blessing for those who lost their natural teeth.
But, maintaining implant dentures requires serious commitment from your end.
A strict oral hygiene regime – Brushing, flossing, and mouth washing – is the minimum requirement for the success of implant dentures.
A strict oral hygiene routine for all-4 includes
- Brushing twice a day
- Rinsing the mouth with an antibacterial mouthwash twice a day
- Flossing at least once a day
It is also best to refrain from smoking and excessive alcohol consumption once you start the dental implant treatment procedure.
The swelling usually reaches its maximum within the first 72 hours post-surgery, after which it slowly decreases.
You can minimize the swelling by using cold packs intermittently for the first 24 hours, keeping the head elevated and taking prescribed medicines (Antibiotics and analgesics).
All-on-4 implants take 3-6 months to heal after placement in jawbones.
The period depends on your general health and the care you provide during this period.
Also, commitment to staying away from smoking and other tobacco products is required for implant success.
Below are some of the foods that you can eat after all on four dental implant surgery:
|First 2 weeks
|3rd week onwards till prosthesis placement
|Water, Coconut water, Fruit juices
|Mashed vegetables, Oatmeal,Soft Bread
|Milk, Tea/Coffee, Smoothies
|Soft tofu, Pureed stews, Quinoa
|Broth, Custard, Ice cream
|Eggs, Cheese, Hummus, Polenta
|Protein shakes, Milkshakes, Yogurt
|Bananas, peaches, pears, mangoes
|Meal replacement shakes
|Spaghetti, Rice, Pasta, Broiled fish
|Vegetable and cream soup
|All items from the ‘first 2 weeks’ list
Food category to avoid includes:
- Spicy foods
- Crunchy and crusty foods
- Chewy foods
- Hard foods
- Extremely hot and cold foods
Below are some of the foods that you should avoid All on four dental implant surgery:
|Food To Avoid Post Dental Implant Surgery
|Crusty pieces of bread
|Corn on the cob
|Raw vegetables and apples
|Steaming hot foods
|Taffy and gum
|Tomatoes and oranges
|Chips and pretzels
|Hot peppers or hot salsa
Yes, it does. Food particles stick in the space between the implant denture and the gums.
It is even more troublesome in people who don’t maintain good oral hygiene or have poorly fitting dentures.
Swelling and redness of the gums, pain under the denture, inability to eat, and fungal infections are risks of improper hygiene. 
If unattended, chronic food lodgement may lead to infection resulting in loosening of implants.
Toothbrushes with hard or stiff bristles can traumatize the gums and harm the implants.
Abrasive toothpaste and other gritty products such as baking soda can damage implants.
So, avoid these products at all costs for implant cleaning.
Each person is different. Your psychological state decides how well you accept the treatment.
There is no fixed time range, but a well-made denture should feel comfortable in a few weeks.
It is important to continue to wear the denture after placement even if there is discomfort.
The mouth needs time to get used to the new prosthesis.
Communicate this discomfort to your dentist and adjustments can be made if necessary.
Tobacco slows down the healing process, dries out the oral cavity, and increases the risk of infection.
All these factors taken together can lead to implant failure if you smoke after dental implant surgery. 
Super floss is readily available to local pharmacies and your dentist’s clinic.