Anesthesia Options for All-on-4 Dental Implants

All-on-4 teeth in a day procedure is a surgical treatment that allows patients to replace their failing, decayed or missing teeth in a jaw all in a span of a single day with the help of dental implants. The procedure generally takes about 2.5-3 hours.

As with any surgical procedure, there are multiple anesthesia options for patients to consider.  These options include local anesthesia, IV sedation (twilight sleep), and general anesthesia.   Let’s take a closer look at these options and their pros and cons.

Do you have to go under anesthesia for the All-on-4 procedure?

When talking about anesthesia, the first thing to establish is why it is needed – to manage a patient’s anxiety and fear about the procedure and to also manage pain and discomfort throughout the process. Different anesthesia options address these needs in varying ways. So, let’s look at these options in more detail.

1. Local Anesthesia

If you’re wondering if dental implants are done under local anesthesia, the answer is yes—this option involves numbing the patient for the procedure using local anesthetics. It numbs the areas of the mouth where the surgery will take place. While it effectively manages pain, anxiety control requires additional oral medication, such as Triazolam. However, this is what you should keep in mind: 

• Pros: This type of anesthesia has several benefits, including cost (no additional cost is involved for the patient) and safety (local anesthesia procedures are safer since the patient is not being put to sleep with intravenous or inhalational medications with their inherent risks).  
• Cons: This approach risks potential failures of local anesthesia injections (shots to numb up the area may not work well for all the patients) and anxiety/fear may not adequately be managed by Triazolam pill in some patients. In short, local anesthesia is a suitable choice for All-on-4 patients who are comfortable with dental procedures and don’t mind being awake during the 2.5–3-hour treatment.

2. IV Sedation

IV sedation, or “twilight sleep,” involves administering anesthetic medications through an IV. Patients typically breathe independently without the need for a breathing tube (endotracheal tube). Most commonly this procedure is used for wisdom teeth removal and colonoscopies, both of which are fairly quick procedures (30-45 minutes). In most cases, such as wisdom teeth removal, the surgeon handles both the anesthesia and the surgery, managing the patient’s comfort and the procedure simultaneously.

• Pros: IV sedation allows the patient to enter into a deep state of sleep. Therefore, the patient’s fear and anxiety are well managed. Together with local anesthetics to numb patients up when they are asleep, patient’s pain and discomfort are under control as well. Finally, IV sedation is relatively affordable, especially compared to the higher cost of full general anesthesia with a breathing tube.
• Cons: From the safety standpoint, even though the IV sedation is a safe procedure, the longer the surgery takes, the more challenging it becomes to keep the patient asleep.  The medications that are used are typically short-acting, so multiple anesthetic medication injections are needed throughout the procedure. The surgeon/anesthetist needs to split time between keeping the patient asleep and doing the surgery, which doesn’t allow enough time and opportunity to focus on the surgical procedure at hand.  Trying to place multiple implants into stable bone at very precise locations throughout the jaw is challenging enough. When the surgeon has to divert attention to anesthesia as well, it becomes even more challenging. In addition, the longer the patient is asleep, the more chance there is for anesthesia complications, whether related to breathing or cardiac issues. 

Since patients metabolize medications differently, a certain dosage of one medication can have different effects on different patients; some of them may need more medication than average to keep them asleep during the procedure. The more medication is administered, the higher the chance of potential complications as well.

Therefore, purely from the safety standpoint, IV sedation is not an appropriate option for All-on-4 type of procedures. Although it works really well for Wisdom Teeth extractions or a single implant placement and colonoscopies, the time needed and the precision needed to perform full arch dental implant placement makes IV sedation impractical for this surgery.

3. General Anesthesia

This is the type of anesthesia where the patient is put to sleep much like in a hospital—with a breathing tube that ensures continuous airway support during the procedure and a dedicated anesthesiologist who is managing the patient’s well-being during the procedure while the surgeon does the surgery.

• Pros: Safety is ensured by having two doctors present in the room at the same time—dedicated anesthesiologist and the surgeon. Patients can be put into a much deeper state of sleep safely due to the presence of the breathing tube which protects against the loss of airway (patient’s ability to breathe). The anesthesia remains consistent and steady throughout the procedure, unlike IV sedation, which can cause fluctuations in the patient’s consciousness due to the need for repeated doses. As a result, your surgeon can fully focus on the treatment, without needing to attend to anesthesia needs of the patient.
• Cons: Price is the biggest obstacle since having a separate anesthesiologist during the procedure costs additional money.

What is the most commonly used anesthesia for All-on-4 dental implants?

Despite the cost, the best, most common, and most reliable method for anesthesia during the All-on-4 procedure is general anesthesia. Local anesthesia can be used for select patients who are not anxious, on the lower jaw (which is easier to numb than the upper jaw). Similarly, IV sedation is not a good choice for this type of procedure for the reasons outlined above.

Who to turn to for All-on-4 dental implants and pain management?

You’ve come to the right place! Dr. Tsvetov is here to address all your concerns about pain management and help you decide whether All-on-4 or All-on-6 dental implants are the right choice for you. Wherever you are in Temecula, count on him to help you achieve a smile you’ll love for years to come. Get in touch with us today!