The All-On-4 Concept

From the perspective of the surgeon, All-On-4 ties together some concepts that have years of research. The biggest concepts put to use are tilting implants, immediate load of placed implants, and cross-arch stabilization to promote implant integration.

The concept of tilting implants is one of the first things that throws most of us for a loop. We’ve all heard the quotes from such legends as Dr Branemark regarding the dangers of tilting implants – something that has been taught as gospel since the early days of implants telling us that titled implants cause bone loss. What is less likely to be known is the research done on thousands of tilted implants in a variety of studies sponsored by most every major company that contradict these beliefs showing that when done correctly, and when part of a larger process (linked to other implants with a structure) you can have long term results similar to those of axial implants.

Tilting of posterior mandibular and maxillary implants for improved prosthesis support. Krekmanov L, Kahn M, Rangert B, Lindström H. Int J Oral Maxillofac Implants. 2000 May-Jun;15(3):405-14.

Most every major implant manufacturerer (Nobel Biocare, Straumann, Astra, etc) have at some point done long term studies on immediate load. In most all of these studies it has been found that bone quality is either equal to or superior to those of implants that have not been loaded.

Implant-Retained Mandibular Overdentures with Immediate Loading: A Prospective Study of ITI Implants (4 implants) Gatti et al IJOMI 2000

Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants. Eliasson A, Palmqvist S, Svenson B, Sondell K. Int J Oral Maxillofac Implants. 2000 Jul-Aug;15(4):505-10.

Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading. Cooper LF, Rahman A, Moriarty J, Chaffee N, Sacco D . The International Journal of Oral & Maxillofacial Implants[2002, 17(4):517-25]

Using the latest in CAD/CAM dentistry we have helped to restore thousands of these cases all across the United States by providing extremely accurate, passively-fitting milled Titanium sub-structures with acrylic wrap around.  Not only is this restoration cost-effective, it is easier and creates a more manageable restoration as compared to most any other option.  Easy to clean, easy to repair, and even easy to re-process should the patient decide to change their look or have more work done in the future, the NobelProcera Milled bar is the choice for the restoration for a healthy long-term solution to the full-arch implant case.

Russellville Dental Lab is proud of the influence that we have had in the continuing development of this process. The staff here have helped to train surgeons, clinicians, and technicians all over the United States and as far away as Great Britain on effective and efficient treatment of these surgical methods.  We’ve developed the 4 Stage Process for restorations, reduced chair time by grouping tasks on patient visits, and worked hard to help keep the surgical time to a minimum.

From the restoring clinicians perspective, All-On-4 provides several unique features:

• The patient almost always has a temporary prosthesis for reference, and frequently patients want the final to be “just like” the temporary, making the job of communicating esthetic requirements to the laboratory easier
• A detailed 4-Stage or simplified 1-Stage method for creating the final prosthesis, thereby reducing chairside time for a complex case
• A higher number of fee-for-service patients who have their expectations exceeded.