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All-on-4 Case: Fixed Teeth for a Patient Who Could Not Wear Dentures (Gag Reflex)

Wearing dentures isn’t the solution for everyone, especially for those with a sensitive gag reflex. In this case, the patient was unable to use removable dentures, which severely impacted their quality of life. Our dental team proposed All-on-4 implants to create a new, fixed set of teeth without a palate, restoring their happiness and daily function.

Case study: All-on-4 for a patient with a strong gag reflex – Smile and Shine Dental Clinic Bangkok

Summary: This patient could not wear an upper removable denture because it triggered a strong gag reflex. Dr. Nalat’s team replaced the denture with All-on-4: a fixed full arch of teeth on four implants, with no plastic plate covering the palate. Fixed temporary teeth were fitted on the day of surgery, and the final teeth about four months later.

The patient’s concern

  • A gag reflex every time the upper denture was put in
  • Unable to wear the removable denture at all
  • Eating, speaking and confidence were all affected

Why All-on-4 was chosen

The goal was a set of teeth the patient could actually use every day. All-on-4 suited this case for three reasons:

  • No palate coverage: the bridge does not cover the roof of the mouth, which is what triggered the gag reflex
  • Fixed in place: no loose denture and no taking teeth in and out
  • Comfortable: the patient can return to normal eating and speaking

Treatment steps and timeline

  1. Assessment and CT scan: the scan showed enough jawbone for implants without grafting.
  2. Implant surgery with immediate loading: four implants were placed and a fixed temporary bridge was attached the same day, so the patient left with fixed teeth.
  3. Healing, about 4 months: the implants bonded with the bone while the patient used the temporary bridge.
  4. Final teeth: the permanent bridge was fitted, stronger and more natural-looking than the temporary.

The result

The patient now eats and speaks normally with fixed teeth, without discomfort or gagging, and smiles with confidence again.

Is All-on-4 an option if you cannot tolerate dentures?

Removable upper dentures stay in place partly by covering the palate. For people with a sensitive gag reflex, that coverage can make a denture impossible to wear. A fixed implant bridge such as All-on-4 or All-on-6 leaves the palate open. Whether it is suitable depends on your bone, gums and general health, which is assessed with an examination and a CT scan.

Questions about this treatment

Do I get teeth on the day of surgery?

In this case, yes. When the bone is strong enough, a fixed temporary bridge can be attached on the day the implants are placed. The final bridge follows after healing, usually after about 3–6 months.

How much does All-on-4 cost at Smile and Shine?

All-on-4 starts from 210,000 THB per arch with Korean implants and an acrylic bridge. See the dental implant cost page for all systems and options.

Can a removable implant denture help with gagging?

An implant overdenture can be made with less palate coverage than a conventional denture, but a fixed bridge such as All-on-4 avoids palate coverage completely. Dr. Nalat will explain which option fits your case.

Photos and video shared with the patient’s permission. Treatment results vary from person to person.

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