There are two things that we need to focus on when we brush an All On 4 prosthesis. The first one is the type of material used (Acrylic or Zirconia) and the second is the condition of your gum tissue.
If you choose an acrylic All On 4, you have to keep in mind that acrylic is very soft compared to other materials like Zirconia. Any type of toothpaste with abrasives will damage your teeth considerably and you will lose the all around smoothness. This loss leads to more food and plaque building up around the surface of your teeth which can cause the development of Peri- Implantitis disease (an infectious disease that causes inflammation of the gum and the bone structure around a dental implant.). In order to prevent this,you will need to use a soft tooth brush without toothpaste. If you miss the freshness and taste of mint after brushing your teeth, you can soak your toothbrush in a non-alcoholic mouth wash for the same sensation.
If you choose a Zirconia All On 4, you can use a soft tooth brush and your tooth paste of choice. Since Zirconia or porcelain is a very strong material, the shape, surface & look will not be affected by the tooth paste as these materials are more bio-compatible with the oral cavity.
As for the gums, you will need to brush them with a soft toothbrush especially the space/surface between the All On 4 prosthesis and your gums. Do not forget the inner part of your mouth (tongue and roof). The movement of the tooth brush will naturally go from side to side (left to right) to remove all the debris that could get trapped around the prosthesis.
Secondly, it’s very important to use the super floss. You will need to pass the super floss between each implant tooth. This is definitely time consuming, but is the most effective technique with the least chance of damaging the thin tissue around your dental implants. If using the super floss becomes too difficult you can also use a floss threader.
Lastly, if the super floss becomes complicated to use, then a water pick would be your last resort. Gum tissues around dental implants are not the same as gum tissues around regular teeth. The gums around dental implants do not attach with the same intensity as the gums around our natural teeth.
With that being said, when using the water pick one needs to take extra care not to damage the gums around the dental implants. We highly recommend a minimal amount pressure to only be applied in the opposite direction of the gum around the dental implant. Otherwise, too much water pressure applied to the gum tissue can damage the implants and Peri-Implantits could develop.
We recommend to brush twice a day and to floss after every meal or snack.
Professional cleanings with a certified dental hygienist knowledgeable in dental implants is required every 6 months to maintain your All On 4 prosthesis. Extensive full mouth reconstruction cleanings are not the same as regular prophylaxis cleanings. Special instruments are used in order to prevent damage around the titanium abutments. If the titanium abutment gets scratched or damaged the implant will be more susceptible to Peri-Implantitis.
Once a year your All On 4 prosthesis will need to be removed and deep cleansed. We use an ultrasonic cleansing instrument to remove any build up around the prosthesis especially on the lower arch/jaw and special dental scalers are used to clean each implant individually. From time to time we may need to replace the screws that attached the All On 4 prosthesis to your dental implant abutments otherwise mechanical problems can occur. This is typically done during this yearly deep cleaning appointment. Just like a tire change on your car, you may need to “replace the nuts” with the All On 4 prosthesis. This is a normal occurrence and is considered preventative maintenance.