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    Table Clinic

    (T11) All-on-x for Aesthetics: Ethical and Medicolegal Considerations

    Purpose of the Study: The procedure of replacing teeth with implant-supported fixed-full-arch prostheses, commonly known as ‘All-on-X’, has gained popularity over the last two-decades and has become one of the most recommended and expensive options for full-mouth rehabilitation. All-on-X is frequently advertised on television and social media as an option for achieving well-aligned teeth and a ‘perfect’ smile. This elective procedure is one of the most financially rewarding for the clinicians. Currently, there are numerous clinics that specialize in providing this service, particularly throughout the United States.

    Methods: All-on-X offers patients the best experience for replacing natural dentition compared to any removable-prostheses. With the advent of technology and materials, it can provide great aesthetics that satisfy patients’ desires. There are definitive indications for All-on-X to replace non-restorable teeth (i.e., terminal dentition) or completely-edentulous arches. However, with the increased awareness of the population from All-on-X advertisements, many patients begin to seek and consider this option to replace their mal-aligned, carious, or chipped teeth as a ‘quick fix’ one-time procedure rather than going through the lengthy process of dental and periodontal disease control and full-mouth oral-rehabilitation with restorative or orthodontic treatment1.

    Results: All-on-X, however, is a complex and invasive procedure, and it is not without complications2. It is the responsibility of the clinician to educate patients about the surgical and prosthetic risks of replacing ‘salvageable or restorable’ teeth with implants that outweigh the benefits. Extracting teeth that can be restored to optimal function and esthetics is neither ethical nor the standard-of-care, and there have been reported cases of malpractice lawsuits and litigations.

    Conclusion: All-on-X should be indicated primarily to rehabilitate the mouth and restore function, and secondarily to provide necessary esthetics. It should not be indicated or even offered as a treatment option solely for esthetic purposes; this should be clearly stated in advertisements and clinical presentations to patients.

    Articles: 1. Broers DL, Brands WG, Welie JV, de Jongh A. Deciding about patients' requests for extraction: ethical and legal guidelines. J Am Dent Assoc. 2010 Feb;141(2):195-203.

    Books: 2. Misch CE, Resnik R. Avoiding Complications in Oral Implantology. St. Louis MO: Elsevier, Inc; 2018.