Full arch implant reconstruction with a fixed restoration for your patients provides a tremendous boost to their quality of life. It can also be a long process with multiple procedures and significant costs if there is a need for onlay block and/or sinus grafting. We understand this and have implemented a new treatment protocol in our practice called All-On-4™ (Nobel Biocare) to address your patients concerns and provide them with an exciting and more accessible treatment option. The All-On-4™ procedure allows for a fixed restoration in both the maxilla and mandible on just 4 implants, without the need for grafting in most cases, and with immediate function. This has resulted in a tremendous savings for the patient, much less surgical trauma, very short treatment times, and phenomenal patient acceptance and satisfaction.
The protocol is based on the concept of tilting the distal implants up to as much as 45 degrees to decrease the distal cantilever while allowing the implants to be longer and engage more cortical bone, such as the piriform rim in the maxilla. Previous prevailing thought was that severely tilted implants would have a higher failure rate, and while this is still true of single implant restorations, newer research by Dr. Palo Malo in Portugal has shown that tilting the distal implants in a multi-unit system actually loads the implants more axially than a vertical implant. This also allows for a smaller cantilever which decreases overall forces, while avoiding the maxillary sinus and the inferior alveolar nerve. This provides for a fixed prosthesis in the maxilla without sinus lift grafting and in the mandible without posterior onlay block grafting.
The patient shown below presented with a hopeless maxillary dentition and was referred for implant reconstruction. When a treatment plan which involved bilateral sinus lift grafting was presented, the patient decided to go with a traditional maxillary denture due to the costs associated with grafting and the need for 6 to 8 implants. When the All-On-4™ protocol became available the patient agreed to treatment immediately.
The patient then underwent ONE procedure for the placement of the 4 implants and the attachment of special angled abutments from Nobel Biocare. At the same appointment, his previous maxillary denture was converted to a temporary fixed prosthesis with the help of personnel from Ward Dental Lab.
The patient came to the office in a denture and left with a fixed restoration in time to eat lunch with his wife on his new prosthesis. He returned to the office at one week and excitedly reported that it was great to feel and taste food on his palate again. The patient will wear the temporary prosthesis for 4 to 6 months and remain on a soft diet during the integration period and ultimately have a new fixed final restoration.
This was all accomplished at one surgery that resulted in no swelling, almost no discomfort, allowed the patient to function immediately, and for less than half the cost of previous treatment options. There is even the option in many cases of removing the teeth and completing the All-On-4™ at the same time.
It has been very gratifying to see the smiles on the faces of the patients we have treated with this exciting new treatment and we look forward to providing this option to your patients here at Oral & Facial Surgeons of Michigan.