Complications With Temporary Teeth in All-on-4 and All-on-6 Procedures
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When discussing All-on-4 and All-on-6 (full arch dental implant restorations) it’s important to keep in mind that during the course of the treatment a patient typically wears two types of prosthesis or teeth that are anchored by the dental implants. These two types of teeth are temporary or provisional teeth and final/permanent teeth.
Temporary teeth are given to the patient during the initial healing phase of the treatment (first 3 months after surgery) and anywhere from 1-3 months thereafter as the doctor optimizes the patient’s bite, esthetics and overall look and feel of the teeth in preparation for the final or permanent teeth.
Both temporary and final teeth can have a number of potential complications associated with them. As a rule of thumb, temporary teeth are more likely to have complications because they are typically made from less durable material. The purpose of today’s discussion is to address in detail potential complications associated with temporary teeth in particular.
What are complications with temporary teeth?
You may be wondering what can go wrong with a temporary crown and what are the disadvantages of temporary teeth. While there’s no need to worry, it’s helpful to understand a few potential complications:
- Teeth fracture
- Teeth loosening
- Teeth discoloration
- Bite misalignment
- Sealant plug coming out
- Esthetic concerns
- Speech difficulties
- Air escaping under the teeth
Let’s look at all of these potential issues in more detail.
| Complication | What can happen | Typical solution |
| Teeth fracture | The temporary prosthesis may crack or break | Replace the temporary prosthesis |
| Teeth loosening | Teeth may move or “click” while chewing | Re-tighten the prosthetic screws |
| Teeth discoloration | Porous material may absorb stains | Replace the prosthesis after initial healing |
| Bite misalignment | Upper and lower teeth may not meet evenly | Retrain the bite or redesign the prosthesis |
| Sealant plug loss | The VPS plug may come out of the access channel | Replace the sealant plug |
| Esthetic concerns | Teeth may look too large, small, wide, or narrow | Digitally redesign and reprint the teeth |
| Speech difficulties | Bulkiness may temporarily affect speech | Allow time for the tongue to adjust |
| Air escaping | Healing gums may create a gap under the prosthesis | Rescan and redesign the fit after healing |
1. Teeth fracture
One of the most common potential issues with temporary teeth is fracture of the temporary prosthesis. This can happen at any point from the initial placement of the teeth until the final/permanent teeth are delivered.
The timing matters:
- During the first 3 months: Fracture is less likely because the patient is usually eating a very soft, mushy diet.
- After implant healing: The risk can increase once the patient begins eating regular foods and placing more chewing force on the prosthesis.
Why cantilevers are more vulnerable
It is important to think back to the concept of cantilever, which I spoke about in the previous blog post. To recap, a cantilever is the part of the prosthesis without support—the teeth extending past the last implant in an arch.
This area can be more susceptible to fracture because:
- It has no implant directly underneath it for support.
- It can flex more during chewing.
- It is often where the molar teeth, or main chewing teeth, are located.
- Temporary teeth are made from a strong plastic material without further reinforcement.
It should also be noted that in an All-on-6 setup, as opposed to an All-on-4 setup, cantilevers are virtually non-existent. The risk of temporary teeth fracture in an All-on-6 setup is therefore minimal. Cantilever fractures are seen more often with temporary All-on-4 teeth than molar fractures with an All-on-6 setup.
What happens if temporary All-on-4 teeth break?
If you’re searching because your temporary All-on-4 broke, there’s no need to worry. The problem can usually be resolved quickly and painlessly by placing another temporary prosthesis.
If the doctor has access to the digital file and the ability to 3D print the prosthesis in the office, a replacement may be produced the same day. By and large, temporary prosthesis fracture is a minor inconvenience and a fairly easy complication to manage.
2. Teeth loosening
Temporary teeth are anchored to the dental implants using very small prosthetic screws that thread through the teeth and engage the implants underneath. Depending on the number of implants, there may be four to six prosthetic screws per arch or jaw.
Because the prosthesis is made from plastic while the screws are metal, there can be some mechanical movement and flexing in the setup.
Over time, especially when a patient chews with a lot of force:
- The temporary prosthesis can flex.
- The prosthetic screws can gradually loosen.
- The teeth may begin to move.
- The patient may notice a “click” when chewing.
Why loose temporary teeth should be checked
Fixing this problem is typically very easy—the screws simply need to be re-tightened.
However, loosening should not be ignored. Continued movement can eventually contribute to screw fracture and make the problem more complicated. It is therefore important to see your doctor at the first sign that the prosthesis is becoming loose.
This issue is much less likely with the final teeth because the final prosthesis contains a titanium metal bar that engages both the prosthetic screws and the implants. This creates far less flexion and screw loosening. This is one of the important differences to understand when comparing all-on-4 temporary vs permanent teeth.
3. Teeth discoloration
Discoloration is a fairly common issue with temporary teeth because they are made from a porous plastic material that can trap stains within the porosities.
Common contributors include:
- Coffee
- Red wine
- Smoking
- Aggressive brushing
- Abrasive toothpastes
Aggressive brushing with abrasive toothpaste can also wear away the glazing compound on the temporary teeth, opening the porosities within the material even further.
When can stained temporary teeth be replaced?
It is not recommended to change the temporary teeth due to discoloration during the first 3 months after surgery. If possible, this type of procedure should be avoided so the implants are not disturbed during the initial healing phase.
After that period, a stained prosthesis can be replaced with a fresh one during a short appointment, provided the doctor has the ability to 3D print and process the replacement prosthesis in the office.
4. Bite misalignment
Bite misalignment is another fairly common issue with a temporary prosthesis, but the good news is that it is generally easy to correct. Bite misalignment can mean:
- The patient bites primarily on the right or left side.
- The upper and lower teeth do not come together evenly.
- The back teeth touch on both sides while the front teeth do not.
- Certain teeth make contact before the others.
This is most likely to happen immediately after surgery and can occur for a couple of different reasons.
Adjusting to a new bite
Some patients have been missing teeth for a very long time and have simply forgotten what their “correct bite” feels like. They may initially be unsure how their upper and lower teeth should come together.
In many cases, patients can retrain themselves by:
- Standing in front of a mirror.
- Slowly guiding the lower jaw into the correct position.
- Practicing the bite for a few minutes each day.
- Continuing this exercise during the first few weeks after surgery.
When the temporary teeth need to be redesigned
In other cases, the patient’s bite habits are not the problem. The teeth may have been designed in a less-than-ideal position during the digital design phase or may have been misprinted.
The correction is usually straightforward:
- A new digital scan of the temporary teeth is taken.
- The lab technician makes small adjustments on the computer.
- A redesigned digital file is created.
- A new set of temporary teeth is printed.
The new teeth typically fit much better, resulting in an improved bite and greater patient satisfaction.
5. Sealant plug coming out
A set of small prosthetic screws holds the temporary teeth to the dental implants. These screws pass through the temporary prosthesis within channels called access hole channels.
Think of each access hole channel as a small tube that may range from approximately one-eighth to one-quarter inch in height.
The channel is filled with a soft, easily removable plastic material called VPS. This material serves two main purposes:
- It helps prevent food from becoming impacted inside the channel.
- It creates a smooth surface over the screw access opening.
It is somewhat common for this VPS seal or plug to come out with temporary teeth. This occurs much less frequently with final teeth because a different, harder and stickier material is used.
Fortunately, the solution is very simple: the sealant plug just needs to be replaced.
6. Esthetic concerns
Esthetic concerns occur when a patient is not entirely satisfied with how the temporary teeth look after surgery.
A patient may feel that:
- The smile looks “too gummy.”
- The teeth appear too big or too small.
- The teeth look too narrow or too wide.
- The overall appearance of the smile is not what they expected.
These concerns can definitely be addressed.
How temporary teeth can be redesigned
Making esthetic changes to the temporary prosthesis involves redesigning the teeth digitally after the patient’s needs and preferences have been discussed.
The process may include:
- Reviewing what the patient would like changed.
- Redesigning the temporary teeth in digital format.
- Printing a new set of teeth.
- Placing the new prosthesis.
- Allowing the patient to evaluate the appearance over the next few weeks.
This process may take two or three tries until the patient is completely satisfied with the esthetic outcome.
Why timing matters
It is not recommended to make these changes during the initial 3-month healing period. The less manipulation applied to the implants during this time, the better.
Every prosthetic change during the initial healing period can negatively affect implant healing and should therefore be avoided when possible.
Once the implants have healed and approximately 3 months have elapsed from the surgery date, these changes can be made and the process of achieving the ideal smile can continue.
7. Speech difficulties
Getting used to new teeth is not simply an esthetic issue; it is also a functional adjustment. Patients have to become accustomed to a new bite and may also experience temporary All-on-4 speech problems while adjusting to speaking with the new teeth.
A typical full-arch prosthesis includes:
- The teeth
- Artificial gums
- Additional material required to form the full prosthesis
Because of this, a temporary All-on-4 prosthesis can feel a little “bulkier” than natural teeth. This is especially noticeable in the upper anterior area and can occasionally affect speech.
Over time, patients can usually retrain their tongue to work with the new prosthesis so that speech is no longer affected.
Why the tongue may feel “constricted”
Another cause of speech interference is the feeling that the tongue suddenly has less room.
Patients who have been missing the majority of their teeth for a long time may have become accustomed to having extra space in the mouth. Placing a full set of teeth back in one day can therefore make the tongue feel unexpectedly cramped.
I often compare this to moving from a spacious 3-bedroom house into a studio. The surroundings suddenly feel much smaller.
Over time, the tongue generally becomes accustomed to its new surroundings and no longer feels as “cramped,” but this adjustment can take some time.
8. Air escaping under the teeth
The full-arch prosthesis consists of both teeth and artificial gums. These artificial gums rest over the implants and the patient’s natural gum tissue.
Temporary teeth are made on the day of the initial surgical procedure when the implants are placed. At that point, the natural gums are still swollen from surgery, creating a very tight fit between the natural gum and the artificial gum of the prosthesis.
As healing progresses:
- The surgical swelling decreases.
- The natural gums shrink into their healed position.
- A small gap can develop between the natural and artificial gums.
- Air may begin escaping through the gap during speech.
- Food may also become trapped underneath the prosthesis.
How the gap is corrected
Overall, this is a fairly easy issue to manage.
After approximately 3 months of healing, once the natural gums have resettled into their new position, a new digital scan can be taken. The temporary teeth are then redesigned to account for the new position of the natural gum.
Once the gap is closed, air escape and food impaction can be virtually eliminated.
Who to turn to for quality All-on-4 or All-on-6 dental implants?
Who to turn to for quality All-on-4 or All-on-6 dental implants?Curious about all-on-4 temporary vs permanent teeth? Wondering what are the side effects of temporary teeth, if any? You’re in the right place! Dr. Tsvetov is here to answer all your questions, from the aftercare steps and tips to details about the procedure. Feel free to get in touch, no matter where you are in Temecula!