No doubt, for those reading this article in Perth WA, you’ve seen the TV ads that quote about wanting and loving that perfect smile with implants. Full-arch implant solutions may be the correct treatment option for the right person, but it is not the only option, and for some it is not always the best one. 

All-on-4 is a widely used full-arch solution that anchors a whole set of replacement teeth on four implants. It offers speed and fewer operations for patients who have lost most or all of their teeth. That simplicity helps explain why it has become so common in general practice and in marketing. 

However, that popularity has produced a problem. Some patients are being steered into removing healthy or savable teeth so they can have an All-on-4. Extraction of teeth and fabricating one full-arch prosthesis is often simpler and quicker for a busy clinic than a bespoke plan that saves individual teeth. The result ends up being more teeth are removed than are needed, higher treatment fees for the patient, and potential long-term consequences a patient might not have expected. Recent reviews and clinical reports show All-on-4 works well in the right hands (Prosthodontists), but complications and failures still occur and when they do, the consequences are significant. 

Why Saving Natural Teeth Matters 

Natural teeth do have significant advantages compared to dental implants. Teeth maintain the periodontal ligament, help preserve bone in a specific way, and integrate with the rest of your mouth’s function. When you keep useful teeth you maintain natural chewing, speech patterns and facial support. Saving a tooth can also spare you future maintenance, additional surgeries and ultimately cost. The efforts to preserve and stabilise teeth where possible, can produce outcomes comparable to dental implants. That makes preservation a reasonable and often preferable first option. 

Saving a compromised tooth often means a phase of periodontal assessment and treatment. Periodontal assessment will measure the stability of a tooth, the depth of pockets, bone loss, mobility and many other factors before deciding its prognosis. These assessments exist precisely to identify teeth that can realistically be rescued. If a tooth can be stabilised with treatment, it may be wiser to treat rather than remove it. 

The Cookie-Cutter Trap of Dental Implants 

All-on-4 is inherently appealing to dentists with a specialist interest in prosthodontics who want predictable, repeatable workflows. It is also appealing to patients who want a quick, one-stop solution. But that “one-size-fits-all” framework does not always fit individual mouths. Some teeth can be retained with targeted treatments, such as root canal therapy, crown lengthening, periodontal surgery, splinting, or selective extraction with a localised implant or bridgework. 

Keeping some of your natural teeth may mean fewer implants overall. For example, four implants might anchor a posterior bridge while your front teeth are maintained and cosmetically restored. That approach can reduce long-term maintenance and the number of prosthetic components that might fail or need replacement over time. 

Complications and the Long Term 

Implants are not maintenance-free, and they can fail. Prostheses can break, screws can loosen and bone loss can continue around implants, especially if underlying periodontal disease, or other risk factors are not managed. When an All-on-4 prosthesis fails, the salvage pathway is not a simply one. Patients in need of retreatment may face removal of implants, bone grafting and more surgery. These are real costs that impact the patient financially, physically and emotionally.  

When a Second Opinion Matters 

At Western Prosthodontic Centre, we are seeing more patients facing complications from unnecessary All-on-4 treatments. Because of the cookie-cutter approach taken by some dentists, more people are now coming to us for second opinions and often after being encouraged to choose a procedure they didn’t actually need. 

You should get a second opinion if someone recommends removing all your teeth. That’s not dramatic. It’s sensible. Second opinions are a standard part of good dental care. They help you understand alternatives. They expose cases where extractions might be premature. They also give you the chance to compare long-term costs, not just upfront prices. Dental experts encourage second opinions to guard against over-treatment and to ensure decisions match the patient’s health goals and risk profile. 

Red flags that justify another opinion include: a definitive recommendation to extract all remaining teeth without a detailed periodontal prognosis, pressure to commit quickly, or an emphasis on one branded solution as the only answer. If you feel rushed, ask for your x-rays and a referral to a Prosthodontist to weigh your options. 

How a Specialist Assessment Differs 

A specialist dentist or Prosthodontist will take more time to map the mouth. They will assess each tooth’s prognosis. They will consider staged treatment, access and then reassess at each stage. They will evaluate whether partial solutions such as implant supported bridges, conventional bridges, or hybrid plans that keep anterior teeth could give you the same aesthetic result with less overall intervention. 

Variables including pocket depths, attachment loss, bite forces, smoking status, systemic health and oral hygiene are factors that change a tooth’s prognosis dramatically. However, a tooth judged “questionable” can sometimes be stabilised and does not always need to be replaced just because that is the simpler option. Modern regenerative techniques can improve outcomes without resorting to full extraction.  

Questions to Ask Before You Sign 

As the patient you should ask direct questions. Get clear answers. Here are the essentials we recommend asking your provider: 

• Can any of my natural teeth be saved? 
• What is the prognosis for each tooth, in plain language? 
• What are the alternatives to full-arch extraction? 
• What are the short and long-term costs for each option? 
• What are the likely complications and what happens if the implants fail? 
• Can you share my X-rays and a written treatment plan so I can get a second opinion? 

If your dentist hesitates, offers generic reassurances, or discourages a second opinion, that is a signal to pause. 

Balancing Speed, Cost and Biology 

Yes, All-on-4 can restore a smile quickly. Yes, it often improves confidence and function for people with hopeless dentition. However, “quick” can come at a cost. Preserving teeth takes more time and more nuanced planning. It also requires skilled collaboration between clinicians and laboratory technicians. That extra time often reduces future complications and can save money in the long run. 

Consider the total cost curve, not just the sticker price. A full-arch extraction plus prosthesis might cost less in the short term than an extended save and restore pathway, but when you add the likelihood of future repairs, replacement prostheses, or retreatment after complications, the long-term cost can tip in favour of preservation. 

A Simple rule of Thumb 

Before you commit to removing all your teeth, get a specialist second opinion. Seek a prosthodontist to evaluate whether targeted treatment or a mixed solution is viable. Ask for a clear prognosis for each tooth and a long-term cost comparison. If anyone suggests removal as the first and only solution, pause and check. 

Closing: Your Smile, Your Choice 

A great smile is worth pursuing, but a great smile doesn’t always require the loss of every natural tooth. Take time, ask questions, get a second opinion and protect your options. Always remember that preserving your biology where possible is not old-school conservatism. It is careful, patient-centred dentistry. 

Not every dentist or specialist will recommend the same treatment, so it’s ideal to see a prosthodontist for a second opinion before commencing any treatment. A second opinion can save you time and money and help you achieve your goal.  

For more information on all our treatments for cosmetic dentistry click here. If you have any queries about mouth restorations, prosthodontics or require a second opinion, call us on (08) 9321 1632 or book an appointment.