THE All on 4
There is now some good news for patients with diseased or damaged teeth, or those who are already missing all their teeth in one or both arches and are suffering with dentures. Until recently those seeking help with implants would have endure long, difficult and complicated surgeries requiring bone grafting and lengthy recovery periods often with uncomfortable removable dentures and sometimes nothing could be worn for extended periods of time to prevent healing complications. Most cases needed multiple implants to have fixed dental work in their mouth.
The “All on 4” ™ clinical solution, or “Teeth in a Day”™ was developed by Dr. Paulo Malo’ of Lisbon, Portugal in collaboration with Nobel Biocare the world's leading Dental Implant Company. He started to compile his clinical results in 1995 and since then his clinic has performed the procedure on thousands of patients with a success rate of 97%, equal to or better than the results of other large studies of implant supported fixed hybrid bridges. In 2005 he reported the 10 year results and attracted the interest of American surgeons and restorative dentists.
The solution was developed to maximize the use of a patients available jaw bone and to allow for “Immediate Function”™. Using only 4 implants in each jaw, the solution takes advantage of tilting the back implants towards the back of the mouth, avoiding the sinus and lower jaw nerve, to provide support beneath the bridge, even with inadequate amounts of bone present in the back of the jaws.
This new technique is base on the placement of implants using the newest and most advanced x-ray imaging, the office based cone beam computerized radiation or cost it gives the detail of your bone that the surgeon/restorative dentist team needs to plan your surgery. The “All on 4”™ is accomplished with the team work of your oral surgeon and restorative dentist. This usually takes about 3 to 4 weeks before surgery.
The surgeon visualizes the front wall of the sinus by making a small window in the side wall of the sinus.
Knowing then where the bone is and also with information from the CT scan the surgeon makes a path for the insertion of an implant. It is angled to avoid the sinus and to keep the implant in solid bone.
The Malo’ guide is also used by the surgeon in keeping this angle.
Two more implants are placed in the incisor area but are straight up and down.
The surgeon temporarily places the Malo’ guide to help him in placing the implants in the correct position for the support of the fixed bridge.
The bridge connections (abutments) are placed by the surgeon aided by a temporary handle to assist in handling these small components and also to visualize the direction of the abutment, which has a built in correction of 30 degrees to straighten out the direction for the restorative dentist. These 30 degree abutment is what makes this technique possible.
The front implants are placed and then all the abutment are placed and tightened to a carefully prescribed torque value with a small torque wrench.
The gums are sutured and torque confirmed. the restorative doctor can then begin the restorative treatment.
An impression is then made of the positions of the implants so a model can be made to assist the laboratory in making your bridge out of the starting denture.
Titanium copings are then placed on the abutments and several are picked up in the denture with acrylic while the restorative doctor is assuring that you are in your correct vertical position and bite.
In the laboratory the technician gradually adds more acrylic to the underside of the denture and carefully trims it and smoothes the surface to convert in to a cleansable fixed bridge. Since there is no more surgery to do you are allowed to wake up and while this lengthy process is progressing you can visit your family in our recovery room which has satellite TB and wireless internet.
The dental lab technician checks the fit and finish of your new bridge and provides it to your restorative dentist to place in your mouth. They now make the final prosthetic adjustments and torque the small retaining screws to their final prescribed tightness.
The bridge is held in place by the screws in each of the four abutments. The holes are filled with tooth colored plastic material and a post op panoramic x–ray is taken. Diet and hygiene instructions are reviewed and you are discharged to home.
The procedure can be done in one day and has been called “Teeth in a Day”™. It can also be inserted in one to two days and that is the decision of the restorative doctor.
Mirrored Images of Final Prosthetics
The basic bridge has a substructure (framework) made of titanium. The premium bridge is made of a strong tooth colored metal called zirconium. The decision on material choices and when to advance to a final prosthesis is made by you and your restorative doctor.
In the mouth there is a “transition” line of where your natural gums meet the prosthetic base. It is designed for oral hygiene access but still close enough to your gums to provide a seal to prevent speech problems.
The prosthesis in the mouth are quite beautiful, strong and reliable. Being screw retained, if minor problems occur, like a chipped tooth or porcelain, the bridge can be easily removed, repaired, and replaced back in your mouth in a short period of time.