Full dentures are a classic therapeutic solution for total teeth loss in the upper and lower jaw. A frequent complaint of patients who wear a complete set of dentures is their movement, especially during more active moments – like eating, laughing and/or speaking. Due to the further loss of bone, over time, the prosthesis forms a weaker support for the cradle and its instability becomes even more pronounced. For this reason, the role of implants in total teeth loss therapy has become increasingly significant. By supporting the prosthesis using a small number of implants (2 implants), its mobility can be reduced, however, such so-called ‘cover prostheses’, just like the classic ones, are not permanently fixed to the implants, but can be removed from the oral cavity, and their surface is equal to, or slightly smaller than, classic ones.
For these reasons, fixed prosthetic works (bridges) are very desirable, which have to be supported by a large number of implants, but they also enable the patient to feel "complete" and enjoy the sense of having their own teeth.
All-on-4® and All-on-6 are implant therapeutic concepts that allow patients without any teeth to leave the practice on the day of the procedure with aesthetic and fully functional fixed prosthetic work, and as the name suggests, it can be supported by 4 or 6 implants.
The All-on-4® Therapeutic Implantology Protocol features several advantages over the classic one. The time of therapy and the number of visits to the dental practice are significantly reduced – implants in the bone are immediately loaded with the prosthetic work after surgery. The entire surgical procedure is therefore reduced to a single visit, during which the patient receives a temporary replacement within 24-48 hours. After a period of 3 to 6 months, during which time the implant merges with the surrounding bone, a permanent prosthetic work is made that is attached securely to the implants. Aesthetics and function are consequently ensured from the outset of therapy.
Probably the biggest advantage of this procedure is that it allows the therapy to also be undertaken on people with higher bone loss due to long-term teeth loss, especially in the posterior regions of the jaw. In such patients, in order to ensure sufficient space for implant placement according to the classical protocol, it is necessary to perform bone augmentation procedures first. Avoiding this phase of therapy drastically reduces not only its duration, but also its cost. Implants are installed according to the All-on-4 protocol in the front part of the upper and lower jaw, where bone quality is better. The posterior implants are placed at an angle in the bone, which increases the contact surface between the implant and the bone and thus ensures greater stability, and also avoids anatomical structures that would preclude classical implantation (mental nerve exit in the lower jaw or lower bottom of the maxillary sinus in the upper jaw).
In some cases, when an increase in the number of bridge elements (teeth, and therefore chewing surface) are required, without compromising the stability of the implant due to excessive forces, it is possible to install two additional implants in the posterior regions of the jaw. Since there is usually a greater lack of bone in these areas, and if it is impossible to install implants in a vertical direction, these additional implants are also inserted into the bone at an angle. Nevertheless, the most recent data* suggest that the reliability of implants have proved to be equally successful, based on a five-year review of fixed works supported by 4 (All-on-4 protocol) and 6 (All-on-6 protocol) implants.
All-on-4® is a registered trademark of the Swedish company Nobel Biocare, which has scientifically proved the success of this therapeutic concept through many years of clinical monitoring. In the Stomatologija i estetika private dental practice, All-on-4® therapy is carried out using the Nobel Biocare implant system and we aim to provide our patients with an immediate aesthetic solution and provide long-term satisfaction using the best products available with minimal invasive treatment.
* http://www.ncbi.nlm.nih.gov/pubmed/26446912
Tallarico M, Meloni SM, Canullo L, Caneva M, Polizzi G. Five-Year Results of a Randomised Controlled Trial, Comparing Patients Rehabilitated with Immediately Loaded Maxillary Cross-Arch Fixed Dental Prosthesis Supported by Four or Six Implants Placed Using Guided Surgery. Clin Implant Dent Relat Res. Oct 7, 2015 doi: 10.1111/cid.12380. [Epub ahead of print]
