All on-4
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The All-on-4 treatment involves placing only four dental implants - two in the front of each jaw and two tilted posteriorly at a 45 degree angle. This technique allows for fixed teeth to be placed even in patients with minimal bone volume, as the tilted posterior implants make use of available bone. Studies show a 98% success rate for All-on-4, and it provides patients with a permanent set of teeth similar to natural teeth, avoiding the need for removable dentures. The procedure is typically completed in one or two appointments, with temporary teeth placed immediately and permanent teeth in a follow up visit 6-8 months later.
All on-4
- 2. What is All-on-4 Treatment All-on-4® is a revolutionary approach developed over a decade ago by Paulo Malo and MALO CLINIC team, which allows the rehabilitation of totally edentulous patients with the placement of only 4 titanium implants in each jaw, through a quick and minimally invasive procedure. The Implants act as a foundation for MALO CLINIC Bridge, which allows the placement of a fixed set of teeth, in all similar to natural teeth. This technique stabilizes bone levels, keeping the jaws healthy. By tilting 45° the two posterior implants, the All-on-4® allows even those patients with virtually no bone to have fixed teeth without need of bone transplant. The result is a fixed (non- removable) natural looking dentition, indistinguishable from natural teeth.
- 3. What is All-on-4 Treatment The All-on-4 clinical solution has been developed to maximize the use of available bone and to allow for Immediate Function™. Using only four implants in edentulous jaws, the solution takes advantage of the benefits of tilting the posterior. Implants to provide a secure and optimal prosthetic support for a prosthetic bridge, even with minimum bone volume.
- 4. Criteria for All-on-4 Patients treated with the technique and therefore included in the retrospective analysis met the following criteria: Jaw bone profile for the placement of at least 4 implants of at least 10 mm in length in either healed or immediate extraction sites. Good general health with acceptable oral hygiene. Implants achieved stability at insertion.
- 5. All-on-4 Implant Procedure Flap: All-on-4 using conventional flap procedure with traditional planning and a standardized All-on-4 Guide for predictable and optimal positioning of the implants. The All-on-4 clinical solution can be performed in two ways: Flapless: All-on-4 with NobelGuide™ using flapless technique, computer- based planning and a customized Surgical Template to correctly drill and position the implants. 1 2
- 6. Implants You Can Use For All-on-4 Parallel implants: NobelSpeedy™ Groovy NobelSpeedy™ Replace Brånemark System® MkIII Groovy NobelReplace™ Straight Groovy Brånemark System® MkIII, TiUnite® Brånemark System® MkIV, TiUnite® Replace® Select Straight Tapered Implants: NobelReplace™ Tapered Groovy Replace® Select Tapered
- 7. Implants You Can Use For All-on-4 Other Items You Will Need: All-on-4 Guide Products needed for the restorative procedure are located in the Product Catalog found at the back of this manual. Manuals: For a full description of the implant placement, prosthetic procedures and all instruments needed, please refer to the relevant manual for the selected prosthetic components and/or implant system.
- 8. Treatment Planning General Considerations: Ability to achieve primary implant stability (35 – 45 Ncm insertion torque). No severe parafunctions. Indicated for totally edentulous maxilla with a minimum bone width of 5 mm and a minimum bone height of 10 mm from canine to canine. Indicated for totally edentulous mandible with a minimum bone width of 5 mm and minimum bone height of 8 mm in between the mental foramina. To diminish the cantilever, tilt the posterior implants to a maximum of 45°. If the angulation is 30° or more, it is necessary to splint the tilted implants. The All-on-4 clinical solution has been developed to maximize the use of available bone and to allow for Immediate Function™. When planning an All-on-4 treatment using a flap technique, be sure to consider the following factors:
- 9. Treatment Planning General Considerations (continued..) For tilted posterior implants, plan the distal screw access holes to be located at the occlusal face of the 1st molar, 2nd pre- molar or 1st pre-molar. The All-on-4 treatment does not require a wider opening of the mouth than a normal straight position of the implants due to the angulation of the posterior implants. If there are extraction sites, clean them thoroughly. It is advisable to place implants between extraction sockets. Specific Considerations – Implants: If possible, the posterior implants should be 4.0 or 4.3 mm. Note: The 30° Multi- unit Abutment is only available for Regular Platform (RP). The 17° Multi- unit.Abutment is available for Narrow Platform (NP) and Regular Platform (RP) When placing posterior implants with an internal connection, make sure that one of the tri-channel lobes on the implant is pointing distal or slightly buccal.
- 10. Treatment Planning Specific Considerations – Implants: If possible, the posterior implants should be 4.0 or 4.3 mm. Note: The 30° Multi- unit Abutment is only available for Regular Platform (RP). The 17° Multi- unit.Abutment is available for Narrow Platform (NP) and Regular Platform (RP) When placing posterior implants with an internal connection, make sure that one of the tri-channel lobes on the implant is pointing distal or slightly buccal.
- 11. Treatment Planning Specific Considerations – Prosthetics: No extensions over one-tooth on each side for the immediate all- acrylic bridge, which should have a maximum of 12 teeth. If the patient’s removable prosthesis is in good condition, it may be used to fabricate the immediate all-acrylic bridge. For proper esthetics and function, the final bridge should have 12 teeth.
- 12. All-on-4 with NobelGuide™ The All-on-4 with NobelGuide™ enables you to use CT scan data as the basis for surgical planning in a 3D computer environment. From your computer-based planning, Nobel Biocare provides you with a Surgical Template to guide you safely during flapless surgery. To take advantage of Immediate Function™ and place a highly esthetic prosthetic reconstruction at the time of surgery, non-engaging 30° Multi-unit Abutments RP are used for the posterior implants. The dental laboratory fabricates an acrylic jig for transferring the ultimate position of the angled abutment from the model to the patient.
- 13. All-on-4 with NobelGuide™ The All-on-4 with NobelGuide™ enables you to use CT scan data as the basis for surgical planning in a 3D computer environment. From your computer-based planning, Nobel Biocare provides you with a Surgical Template to guide you safely during flapless surgery. To take advantage of Immediate Function™ and place a highly esthetic prosthetic reconstruction at the time of surgery, non-engaging 30° Multi-unit Abutments RP are used for the posterior implants. The dental laboratory fabricates an acrylic jig for transferring the ultimate position of the angled abutment from the model to the patient.
- 14. Implants You Can Use For All-on-4 With Nobelguide™: Software you will need for All-on-4 with NobelGuide™: Procera® Software for Computer-Based Planning Parallel implants: NobelSpeedy™ Groovy NobelSpeedy™ Replace Brånemark System® Mk III Groovy NobelReplace™ Straight Groovy Tapered implants: NobelReplace™ Tapered Groovy
- 15. Implants You Can Use For All-on-4 With Nobelguide™: Other items you will need: Surgical Template ordered in Procera® Software Products needed for the restorative procedure are located in the Product Catalog found at the back of this manual. Manuals: NobelGuide™ Concept Manual For a full description of the implant placement, prosthetic procedures and all instruments needed, Please refer to the relevant manual for the selected prosthetic components and/or implant system.
- 16. Treatment Planning General Considerations: When using NobelGuide™ computer- based planning, a CT scan using a Radiographic Guide is required. Please refer to the NobelGuide™ Concept Manual for details. Ability to achieve primary implant stability (35–45 Ncm insertion torque). No severe parafunctions. Indicated for totally edentulous maxilla with a minimum bone width of 5 mm and a minimum bone height of 10 mm from canine to canine. Indicated for totally edentulous mandible with a minimum bone width of 5 mm and minimum bone height of 8 mm in between the mental foramina. The sites must be fully healed. To diminish the cantilever, tilt the posterior implants to a maximum of 45°. The All-on-4 clinical solution has been developed to maximize the use of available bone and allow Immediate Function™. When planning an All-on-4 with NobelGuide™ treatment, be sure to consider the following factors:
- 17. Treatment Planning General Considerations (continued): If the angulation is 30° or more, it is necessary to splint the tilted implants. For tilted posterior implants, plan the distal screw access holes to be located at the occlusal face of the 1st molar, 2nd pre-molar or 1st pre-molar. The All-on-4 treatment does not require a wider opening of the mouth than a normal straight position of the implants due to the angulation of the posterior implants. However, as with all Nobel- Guide™ treatments, it is important to compensate for the extra height needed for NobelGuide™ components and instruments
- 18. Treatment Planning Specific Considerations – Implants: If possible, the posterior implants should be 4.0 or 4.3 mm. Note: The 30° Multi-unit Abutment Non- Engaging is only available for the Regular Platform (RP). Specific Considerations – Prosthetics: No extensions over one-tooth on each side for the immediate all-acrylic bridge, which should have a maximum of 12 teeth. If the patient’s removable prosthesis is in good condition, it may be used to fabricate the immediate all-acrylic bridge For proper esthetics and function, the final bridge should have 12 teeth.
- 19. Checklist Prior to Surgery Correct Implants, Guided Components and Instruments Operation Specification Surgical Template Surgical Index Prosthetic Components and Instruments The jig construction for placing 30° Multi-unit Abutments Non-Engaging, which includes: 1. Impression Coping Open Tray Multi-unit 2. Guide Pin 3. Abutment Holder 4. Jig Stabilizer 5. 30° Multi-unit Abutment Non- Engaging 6. Abutment Screw
- 20. How Are All-on-4 Dental Implants Different From Dentures? Are permanent teeth that are brushed and cleaned like natural teeth Do not have to be taken out Do not need adhesives Are comfortable because they do not press down on your gums Allow you to experience the hot and cold of your food, as well as the taste Allow you to bite with increased force (up to 70% more), so you can eat all of your favorite foods again Prevent bone deterioration Restore your facial features All-on-4 implants are a permanent set of teeth that look and feel like natural teeth. All-on-4 dental implants:
- 21. How Do All-on-4 Dental Implants Compare To Traditional Implants? The All-on-4 dental implant technique utilizes only four implants per arch, whereas traditional implants utilize anywhere from six to eight implants, or more, in each arch. The implants of the All-on-4 procedure are also placed at an angle, which allows for increased contact by using the natural support of your bone. In addition, the All-on-4 procedure requires no bone grafting for most patients, which is common in traditional implant procedures. Therefore, All-on-4 dental implants save time, money, and discomfort.
- 22. How long is the All-on-4 dental implant surgery? The surgery takes approximately 2.5 hours per arch. What is the success rate with All-on-4 Dental Implants? Published studies show a 98% success rate using All-on-4 dental implants. Who is the ideal candidate for All-on-4 Dental Implants? The ideal candidate for the All-on-4 dental implant procedure from The Implant Center at Dental Associates is someone who is currently wearing dentures or who will need dentures in the future. Age doesn’t matter but dental implant candidates should be in good health.
- 23. Where will my replacement teeth be made? The Implant Center at Dental Associates does everything in-house. Your new teeth will be crafted by certified lab technicians on-site. In fact, every part of your procedure, from consultation to follow-up care happens under one roof. Will my results look natural? Absolutely. The All-on-4 dental implant technique gives you permanent teeth that look, feel and function just like real teeth. No one will know you have implants unless you tell them. Why don't I get my permanent set of teeth the day my implants are placed? As with any surgery, you need time to heal. However, you will not leave our office without teeth! A temporary set of teeth will be placed on your implants. Once the healing process is complete, your permanent teeth will be placed at a follow up visit approximately six to eight months after surgery.
- 24. What if I just need implants on my bottom arch? What if I someday need All- on-4 dental implants on both arches? All-on-4 implants can be placed on just the upper or lower arch. Your implant specialists will evaluate your circumstance and if he or she feels you might eventually need replacement teeth on both the upper and lower arches, he or she might suggest performing the procedure on both arches at the same time. This provides better results while also saving time and money. Your doctor will work with you to determine what best meets your needs both health wise and cost wise. What type of cleaning is required after an implant is placed? Dental implants should be treated like your natural teeth, daily brushing and flossing is recommended. Our team of specialists and dental hygienists will review oral hygiene instructions with you and will recommend the most appropriate oral hygiene treatment plan to fit your needs. Are there any additional costs/fees to expect? All fees will be discussed prior to surgery during the consultation appointment.
- 25. Benefits of All-on-4 Implant Stability Even In Minimum Bone Volume By tilting the two posterior implants, longer implants can be used in minimum bone volume, increasing bone-to-implant contact and reducing the need for vertical bone augmentation. The tilted posterior implants can be anchored in better quality anterior bone, reducing cantilevers and thus improving support of the prosthesis. Good clinical results Biomechanical measurements show that tilted implants, when part of prosthetic support, do not have a negative effect on the load distribution. The tilting of implants has been used in clinical practice for over a decade and has shown good results.
- 26. Benefits of All-on-4 Implant Planning With Nobelguide Treatment Concept All-on-4 treatments can be planned and performed using the NobelGuide treatment concept, ensuring accurate diagnostics, planning and implant placement. The NobelGuide Software allows for detailed diagnostics such as identification of available bone, virtual implant placement according to the anatomical situation and prosthetic needs, and ordering of an individualized surgical template. NobelGuide supports minimally invasive flapless techniques as well as surgical access through mini-flaps and full flaps, while the surgical template ensures guided and therefore exact implant placement.
- 27. Benefits of All-on-4 Implant Prosthetic flexibility With an All-on-4 treatment, patients benefit from an immediate implant- supported restoration, as a provisional prosthesis is screwed onto the implants right after surgery. Final solutions for All-on-4 treatments include both fixed prostheses, such as NobelProcera Implant Bridge Titanium with acrylic veneering, or individual NobelProcera crowns cemented to the bridge framework, and removable solutions, such as acrylic overdentures on a NobelProcera Implant Bar Overdenture. Increased efficiency Efficient treatment flow results in shorter treatment times and improved patient satisfaction.
- 28. Price of the Treatment The price may vary for each country or region, and normally it is divided in two phases The first phase involves removing any remaining teeth, and placing the four dental implants along with an immediate temporary bridge secured to the four implants. This phase may cost between $10000 to $15000, dependent on the above factors. Few months after the above phase, once complete healing and bonding of the implants to the bone has taken place, a final bridge is usually fabricated. This bridge typically consists of a metal framework, which strengthens the system, and often has a few more posterior teeth. This phase may cost between $10000 to $17500, dependent on the materials used and the type of teeth (porcelain or acrylic) developed. The total price (if both superior and inferior arches are considered) could possibly reach $57000. (Source-Wikipedia)