Treatment with All-on-4® can completely restore one or both dental arches, giving you back a full set of functional and natural-looking teeth. If many of your teeth are failing or if you are missing a number of your original teeth, you may be a good candidate for this approach.

With All-on-4,  patients receive dental implants that secure their new teeth in place. This allows patients to chew, bite, and smile as they would with their original teeth. In many cases, All-on-4 can replace every one of a person’s missing or failing teeth in a single day.

Dr. Israel Puterman has extensive experience and advanced skills in All-on-4. As a periodontist, he is an expert in the soft tissue aspects of dentistry, and he has years of training through the country’s most prestigious residency program for implant dentistry. Over almost a decade in practice, he has used All-on-4 to help patients achieve life-changing improvement in their comfort, confidence, and ability to enjoy their favorite foods.

Before & After Gallery

The Purpose of All-on-4

A full set of teeth can give you an aesthetically pleasing smile and a fully functioning bite. All-on-4 offers patients this type of outcome even if they have significant dental damage or are missing the majority of their teeth.

The All-on-4 treatment uses dental implants: artificial tooth roots placed below the visible surface of the gums. Dr. Puterman can strategically place as few as four implants to connect to an entire arch of new teeth. Replacing the tooth structure from the root to the crown returns strength and stability to the teeth.

All-on-4 has several advantages over traditional dentures:

Bone conservation. A person’s body will shrink bone in the area of a missing tooth over time. This can create an unattractive gap between the dentures and gums. All-on-4 helps prevent this bone loss and change in appearance.

Comfort. Dentures may fit less comfortably over the years due to changes in the underlying bone and gums. They may trap food particles or move as you eat or speak. All-on-4 connects teeth securely to the gums so that they do not shift around.

Convenience. Dental implants give All-on-4 teeth significantly greater strength than dentures, so you should be able to eat a wider variety of foods. You can also follow the same hygienic routine with All-on-4 teeth as with your natural teeth. Unlike dentures, you do not remove your All-on-4 teeth to clean and maintain them.

Dr. Puterman’s Approach to All-on-4

More and more doctors have begun offering All-on-4 as the treatment has grown in popularity. However, its effectiveness depends upon the practitioner’s technique. Patients should choose a doctor with the required skill and experience to get the outcome they want.

General and restorative dentists make referrals to Dr. Puterman because of his expertise and approach to treatment. As a patient, your experience will begin with a consultation at Dr. Puterman’s practice, during which he will:

  • Conduct an examination and CT scan. 3D imaging helps Dr. Puterman determine whether you have enough jaw bone to support the implants or if he will need to augment the bone with grafts.
  • Plan your care. Many patients can have teeth extracted, receive grafts, and get their All-on-4 implants in a single visit, which allows them to have a complete set of new teeth in a single day. Other patients will have two separate procedures—one for extraction and grafting and one for implant placement—to allow grafts time to heal.
  • Determine the number of implants to place. You may receive four, six, eight, or more dental implants to support your new teeth.

Dr. Puterman will also take time during the consultation to answer any questions you may have. Patients often ask whether All-on-4 is painful. In Dr. Puterman’s experience, people are generally surprised by how comfortable they find the treatment and recovery.

What Patients Can Expect with All-on-4

Dr. Puterman will work in tandem with your restorative doctor to plan and place your new teeth. A team-based approach ensures that you receive excellent care from specialized practitioners. Your restorative doctor will take impressions and coordinate with a dental laboratory to create your new teeth.

On the day of your procedure:

  • You may receive sedation to keep you comfortable throughout the All-on-4 treatment. Dr. Puterman is one of the few providers in Bethesda and Washington, DC who is licensed to use either oral or IV sedation.
  • Dr. Puterman will extract failing teeth, use bone grafts to strengthen areas in need, and place the dental implants.
  • The restorative doctor will fit a set of provisional teeth to the implants, giving you a complete set of new teeth.

Most patients only require anti-inflammatory medications and no pain medicine after the procedure. To speed the recovery, Dr. Puterman may employ treatments such as L-PRF, a natural fibrin approach that surgeons also use in plastic surgery, neurology, and wound healing.

Your implants should heal over the next 3-4 months, and your restorative dentist can adjust your provisional teeth during this time if necessary. You should limit the amount of pressure that you place on these teeth so that the implants have time to strengthen. Once the implants have stabilized, the restorative dentist will replace your provisional teeth with permanent teeth, completing the treatment.

“Recently I had six implants placed by Dr Puterman. I must say that the final result is well beyond my expectations. This is certainly due to highly skilled professional Dr. Puterman himself and the pleasant members of his staff. There has not been one moment that I felt anxious, because his team is capable to make you feel relaxed. The surgery was done with great precision and without any discomfort and after the surgery I had no pain, swelling, bruises nor bleeding. I only used an ice pack on my cheeks. Therefore, I want to recommend Dr Puterman to anyone who needs or wants to place implants. I wish to thank Dr. Puterman for the incredible and great job that he has done.”

-Daniel G.

All-on-4 can replace the entire upper and lower arches of teeth, completely restoring their aesthetics and functionality. Patients can find out if they are candidates for treatment by scheduling an appointment with Dr. Puterman. Call (301) 652-0939.