industry research

Why you shouldn’t rush to extract teeth for All-on-X (most dentists won’t tell you this)

Industry investigations reveal dentists are ripping out healthy teeth because it’s more profitable. Here's what they're not telling you about the consequences and the better alternatives.

William Holmes

Last updated December 23rd, 2025

Here's the hard truth: the transformative All-on-X procedure you've been recommended could be a mistake — even if several dentists have told you it's your only option.

What they're not telling you is that those chipped, broken teeth you still have are likely perfectly healthy beneath the surface. And not only is it easier for most dentists to rip them out and bolt in a full new set of artificial teeth — in most cases, it makes them more money.

That's why none of them seem willing to give you a straight answer to one simple question: “Do I really need to rip out all my teeth?”

Because an honest answer opens a can of worms. Bone degradation. Receding gums. Implant complications. All the vulnerabilities that come with removing healthy roots.

If All-on-X is something you've been considering — no matter how bad you think your remaining teeth look — this might be the most important thing you read before making your decision. By the end of it, you'll understand exactly who the real beneficiary of All-on-X is (in most cases, it isn't the patient).

The uncomfortable truth

Here's what they’re not telling you…

Many patients walking into dental clinics are being recommended All-on-X procedures when their natural teeth could be saved.

This isn't speculation. In November 2024, a major investigative report revealed that some dental providers are “pulling healthy and treatable teeth to profit from implants.”

Oregon, USA now requires dentists to complete 56 hours of hands-on training before placing implants — a direct response to dozens of state investigations into botched surgeries and unnecessary extractions.

The question isn't whether All-on-X works. It absolutely does. For the right candidate, it can be life-changing.

But recent consultations show that about 70% of Australians enquiring for All-on-X would actually benefit far more from a full mouth restoration.

Before we can answer which solution is best for you, let’s first look at the harsh reality of why so many dentists recommend All-on-X…

There are two uncomfortable realities at play…

1. The Skill Gap

All-on-X was designed to be simple. That's its greatest strength — and its biggest limitation.

The steps are the same for almost every patient: extract the teeth, place four to six implants at specific angles, attach the new arch. It's a system. Dentists learn it, follow it, and get consistent results.

Restoration doesn't work like that.

Every mouth is different. The surgeon has to make dozens of decisions on the spot: which teeth can be saved, which need to go, where to place implants so they work alongside natural roots, how to shape crowns that fit the patient's unique bite.

There's no playbook.

It's improvisation at a surgical level that even most specialists aren't confident enough to do.

That's why you keep hearing the same recommendation. All-on-X is the standard script most surgeons are trained to follow. Restoration requires a level of skill and confidence that not every surgeon has — or wants to develop.

For many dentists, All-on-X isn't just easier. It's the only option they can reliably offer, despite the complications that come with ripping out healthy teeth.

2. The Financial Incentive

Here's something most patients don't think about: the dentist usually makes more money from All-on-X.

Not dramatically more — typically around 10–15% more than a full restoration. But when you're talking about procedures that cost tens of thousands of dollars, that percentage adds up. In Australia, for example, it can mean an extra $10,000 or more in the dentist’s pocket.

So picture it from the dentist's perspective: one option is easier to perform and more profitable. The other requires more skill, more time, and pays less.

For most of them, that’s more than enough of a reason to hide whether or not you really need it.

This doesn't mean every dentist recommending All-on-X is acting in bad faith. Many genuinely believe it's the best option. Still, it does provide some insight into why All-on-X has become the default recommendation — even in cases where a restoration might actually be the smarter long-term choice.

The unavoidable trade-off of extraction

Let's be clear: tooth extraction is sometimes absolutely necessary. When a tooth is severely decayed, infected, or damaged beyond repair, removing it is often the only option.

But every extraction — whether the tooth is healthy or diseased — comes with the same biological consequence.

Within weeks of losing a tooth, the jawbone begins to resorb. The body, sensing that the root is gone, starts breaking down the bone that once supported it.

Research published in the British Dental Journal confirms this process begins almost immediately, with the outer bone wall being particularly vulnerable.

Over months and years, this bone loss can lead to:

Facial structure changes
sunken cheeks, premature aging, altered facial proportions
Gum recession
exposing implant margins and creating aesthetic issues
Complications with the implants themselves
including a condition called peri-implantitis

None of this is to say extraction is dangerous or that implants are bad. They're not. They're a remarkable technology that has transformed countless lives.

The point is this: when extraction is necessary, you accept these trade-offs because there's no better alternative.

But when extraction isn't necessary — when healthy teeth are being pulled simply because it's easier or more profitable — you're taking on these consequences for no reason.

A 2025 editorial in the International Journal of Oral Implantology warned of exactly this “concerning trend”: dentists choosing implant replacement over tooth preservation without adequate justification.

The alternative most patients never hear about

There's a reason some dental surgeons recommend restoration — even when other dentists have said All-on-X is the only path forward. They've seen what's possible when you preserve what's healthy.

A skilled oral surgeon can evaluate a mouth that appears “hopeless” and identify which teeth are truly beyond saving — and which ones simply look bad above the gum line while remaining perfectly healthy below it.

Teeth that are discoloured, worn, or chipped can often be restored with crowns. Gaps from missing teeth can be filled with strategically placed implants or bridges.

The result is a treatment plan that addresses the patient's concerns without sacrificing functional teeth that could serve them for decades to come.

This approach requires exceptional surgical skill. The surgeon must work with the mouth's existing architecture rather than starting from scratch. Every implant must be placed with precision. Every crown must be crafted to integrate seamlessly.

But in the hands of a highly experienced practitioner, restoration treatments can last 20 to 30 years or more — matching or exceeding the lifespan of All-on-X, without the irreversible step of removing healthy teeth.

Dr. Huy: A different approach

Dr. Huy, one of Vietnam's most respected oral surgeons, operates on a simple philosophy: preserve what's healthy, replace only what's necessary.

When patients arrive at his clinic having already received multiple All-on-X recommendations, Dr. Huy doesn't automatically agree with the consensus. He conducts his own comprehensive evaluation. He examines each tooth individually. He considers not just what's visible above the gum line, but what's happening beneath it.

In many cases, his treatment plans look nothing like what patients expected.

Instead of full extraction, they might receive a combination of implants for genuinely missing teeth, crowns to restore damaged ones, and targeted treatment for any underlying gum issues.

The result is a smile that looks and functions beautifully — built on a foundation of their own natural teeth wherever possible.

“There is nothing better than the teeth you were born with. The way natural roots integrate with the bone, the way they respond to pressure, the way they maintain the jaw structure — implants are remarkable, but they're a replacement for what's lost. Not an upgrade to what's healthy.”

Dr. Huy, Head dentist and implant specialist, Thùy Anh Dental Clinic

His confidence in this approach comes from over 15 years experience and dedication to his craft. With thousands of complex restorations completed, Dr. Huy has seen patients who were told extraction was inevitable go on to keep their natural teeth for the rest of their life.

The misconception about restoration

On the surface, restoration can seem like the complicated option. A patchwork of crowns, implants, and bridges — some see it as a “Frankenstein” approach compared to the clean simplicity of just starting fresh with All-on-X.

But most concerns about restoration come from misunderstanding how it actually works when done properly.

1. “Restorations don't last”

If you've had dental work fail before — crowns that fell out, bridges that didn't last — you might be skeptical that restoration is even worth considering.

But here's what most people don't realise: failed restorations almost always come down to the quality of the work, not the approach itself. Rushed procedures. Cheap materials. Dentists focused on volume over precision.

When corners are cut, restorations fail. It's not that crowns and bridges don't work — it's that poorly placed crowns and bridges without attention to proper occlusion don’t work.

When restoration is done properly — with precision planning, high-quality materials, and a surgeon who refuses to cut corners, like Dr. Huy — it lasts decades.

2. “I'll end up with a mismatched smile”

This is another misconception. With a skilled practitioner, you work together to decide exactly which teeth to crown — including healthy ones you may want to improve for cosmetic reasons.

The process involves an intricate smile design where every tooth is matched for colour, shape, and proportion.

The result isn't a patchwork. It's a consistent, beautiful smile that patients are just as satisfied with as All-on-X — often more so, because it's built on their own teeth.

3. “Won't I just need All-on-X later anyway?”

A proper restoration should last decades. But even if you're among the small percentage of people who eventually need All-on-X down the line, the restoration work actually helps you get there.

Here's why:

The implants placed during a restoration can be repurposed. If after 10 or 15 years some crowned teeth fail, a surgeon can place a couple more implants and build a full arch using the implants that are already there.

But if you jump straight to All-on-X now, you've skipped to your final option. There's nowhere else to go. And if those implants fail over time — which does happen — the success rates for re-implantation are significantly lower.

Restoration isn't just about preserving teeth. It's about preserving options. You buy yourself decades of function on your natural roots, and if you ever do need a full arch later, you're in a better position to get one.

When All-on-X is the right choice

To be clear: this is not an argument against All-on-X.

For patients with severe periodontal disease, extensive decay, or insufficient healthy teeth to anchor a restoration, All-on-X can be genuinely life-changing. It offers stability, aesthetics, and function that traditional dentures simply cannot match.

The concern is not with the procedure itself. It's with the over-application of the procedure — the tendency to recommend full extraction as a first resort rather than a last one.

The right question isn't “All-on-X or nothing?” It's “Have I explored whether my healthy teeth can be preserved?”

How to know which option is right for you

Every mouth is different. Every patient's needs are unique. But there are some general principles worth considering:

All-on-X may be appropriate if:

Most or all teeth are severely compromised by decay or gum disease
The remaining teeth cannot provide adequate support for a restoration
You're already wearing dentures and want a more stable solution

Restoration may be worth exploring if:

You have teeth that look bad but don't cause pain or functional issues
You've been told you need All-on-X after only a brief consultation
Multiple dentists have recommended extraction without thoroughly explaining why restoration isn't possible
You have healthy teeth mixed with damaged or missing ones

The only way to know for certain is to consult with a surgeon who has the skills to offer both options — and no financial incentive to push you toward one over the other.