All-on-4: Difference between revisions

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[[File:3D All-on-4 technique.ogv|thumb|right|250px|Technique depicted in 3D video]]
{{Short description|Dental implant technique}}
The term '''All-on-4''' refers to "all" teeth being supported "on four" dental implants, a surgical and technique [[prosthodontics]] procedure<ref>{{cite journal|vauthors=Patzelt SB, Bahat O, Reynolds MA, Strub JR |title=The All-on-Four Treatment Concept: A Systematic Review| date=April 2013|pmid=23560986|doi=10.1111/cid.12068|journal=Clin Implant Dent Relat Res|volume=16|pages=836–855}}</ref><ref>{{cite journal|vauthors =Zhao X, DI P, Lin Y, Li JH, Qiu LX, Luo J, Cui HY |title=Implanting the edentulous jaws with "All-on-4" immediate reconstruction: a preliminary clinical observation| date=October 2014|pmid=25331394|volume=46|journal=Beijing Da Xue Xue Bao|pages=720–6}}</ref> for total rehabilitation of the [[edentulous]] patient or for patients with badly broken down teeth, decayed teeth or compromised teeth due to gum disease. It consists of the rehabilitation of either edentulous or dentate [[maxilla]] and/or [[mandible]] with fixed [[prosthesis]] by placing four [[Dental implant|implants]] in the anterior maxilla, where bone density is higher. The four implants support a fixed prosthesis with 10 to 14 teeth and it is placed immediately, typically within 24 hours of surgery.


Implant manufacturer [[Nobel Biocare]] was among the first to identify the evolution of the All-on-4 technique as a potential valid and cost-effective alternative to conventional implant techniques, and funded studies by [[Portuguese people|Portuguese]] dentist [[Paulo Maló]]<ref>{{cite journal |doi=10.1111/j.1708-8208.2003.tb00010.x |title='All-on-Four' Immediate-Function Concept with Brånemark System Implants for Completely Edentulous Mandibles: A Retrospective Clinical Study |year=2003 |last1=Maló |first1=Paulo |last2=Rangert |first2=Bo |last3=Nobre |first3=Miguel |journal=Clinical Implant Dentistry and Related Research |volume=5 |pages=2–9 |pmid=12691645}}</ref>  to determine the efficacy of this approach. During this time this technique was also used by various other clinicians around the world.
The '''All-on-4''' is a dental implant technique that provides a full set of teeth using only four implants to support a fixed prosthesis. This method is often used for patients who are edentulous (without teeth) or have severely compromised teeth that require extraction. The All-on-4 technique is known for its efficiency and effectiveness in restoring oral function and aesthetics.


All-on-4 is not an invention, but rather a treatment technique that has evolved over time and has the following features:
==Overview==
* four dental implants to support a full fixed bridge (documented since 1977<ref name=":0">{{Cite book|title=Osseointegrated Implants in the Treatment of the Edentulous Jaw|last=Branemark|first=Per-Ingvar|publisher=Almquivist & Weksell International|year=1977|isbn=91-22-00128-X|location=Sweden|pages=79, 81, 83}}</ref>)
The All-on-4 technique was developed to maximize the use of available bone in the jaw while minimizing the need for bone grafting. This is achieved by strategically placing four dental implants in the anterior maxilla or mandible, where bone density is typically higher. The posterior implants are often tilted at an angle to increase support and avoid anatomical structures such as the maxillary sinus or the inferior alveolar nerve.
* the use of angulated implants in the back to overcome bony deficiencies or anatomical structures (documented since 1990<ref>{{Cite journal|last=Kallus|first=T|date=Spring 1990|title=Clinical evaluation of angulated abutments for the Brånemark system: a pilot study.|journal=Int J Oral Maxillofac Implants|doi=|pmid=2202668|volume=5|pages=39–45}}</ref>)
* immediate loading (documented since 1990<ref>{{Cite journal|last=Lefkove|first=MD|date=1990|title=Immediate loading of cylinder implants with overdentures in the mandibular symphysis: the titanium plasma-sprayed screw technique.|journal=J Oral Implantol|doi=|pmid=2098572|volume=16|pages=265–71}}</ref>)


The concept itself of the total rehabilitation of a full set of teeth supported by as few as four fixtures was not a new one. Professor P-I Branemark,<ref name=":0"/> who discovered [[osseointegration]], published numerous articles in the 1970s with successful rehabilitation of a full arch supported by this number of fixtures. However, it was the angulation of the back implants that led to today's All-on-4, and has been trialed by numerous clinicians simultaneously in the United States, Sweden, Portugal, and South America in the 1990s. The technique evolved when in an attempt to avoid certain anatomical limitations typically seen in the back of the upper and lower jaws have, clinicians successfully avoided bone-deficient areas with the use of angulated implants. Anatomical limitations are more prevalent in patients with full dentures, and once the back implants are placed at an angle there is often only enough room left for two more implants in the front. This has led to the use of only four fixtures to support a full set of teeth.
==Procedure==
The All-on-4 procedure involves several steps:


<gallery>
===Consultation and Planning===
File:Nobel Biocare All-on-4 solution image 1.jpg|This image shows how Nobel Biocare's All-on-4 solution works.
The process begins with a comprehensive evaluation, including [[dental imaging]] such as [[CT scans]] or [[panoramic radiographs]], to assess bone quality and quantity. A treatment plan is developed based on the patient's specific needs.
</gallery>


==References==
===Surgical Phase===
{{reflist}}
During the surgical phase, any remaining teeth are extracted, and the implants are placed. The two anterior implants are placed vertically, while the two posterior implants are angled to provide optimal support. This angulation helps to distribute the forces evenly across the prosthesis.


[[Category:Dentistry]]
===Prosthetic Phase===
[[Category:Restorative dentistry]]
After the implants are placed, a temporary prosthesis is attached, allowing the patient to leave the office with a functional set of teeth. After a healing period, during which the implants integrate with the bone, a final prosthesis is fabricated and attached.
[[Category:Oral surgery]]
 
[[Category:Articles containing video clips]]
==Advantages==
{{dictionary-stub1}}
The All-on-4 technique offers several advantages:
* '''Reduced Treatment Time''': The procedure can often be completed in a single day, reducing the overall treatment time compared to traditional methods.
* '''Cost-Effective''': By using only four implants, the cost is generally lower than other full-arch restoration methods.
* '''Avoidance of Bone Grafting''': The strategic placement of implants often eliminates the need for bone grafting, which can be a lengthy and costly process.
* '''Immediate Function''': Patients can receive a temporary prosthesis on the same day as the surgery, allowing for immediate function and aesthetics.
 
==Considerations==
While the All-on-4 technique is highly effective, it may not be suitable for all patients. Factors such as bone density, overall health, and specific anatomical considerations must be evaluated. Patients with severe bone loss may require additional procedures to ensure the success of the implants.
 
==Related pages==
* [[Dental implant]]
* [[Prosthodontics]]
* [[Oral and maxillofacial surgery]]
* [[Edentulism]]
 
[[Category:Dental procedures]]
[[Category:Implantology]]

Latest revision as of 19:25, 22 March 2025

Dental implant technique


The All-on-4 is a dental implant technique that provides a full set of teeth using only four implants to support a fixed prosthesis. This method is often used for patients who are edentulous (without teeth) or have severely compromised teeth that require extraction. The All-on-4 technique is known for its efficiency and effectiveness in restoring oral function and aesthetics.

Overview[edit]

The All-on-4 technique was developed to maximize the use of available bone in the jaw while minimizing the need for bone grafting. This is achieved by strategically placing four dental implants in the anterior maxilla or mandible, where bone density is typically higher. The posterior implants are often tilted at an angle to increase support and avoid anatomical structures such as the maxillary sinus or the inferior alveolar nerve.

Procedure[edit]

The All-on-4 procedure involves several steps:

Consultation and Planning[edit]

The process begins with a comprehensive evaluation, including dental imaging such as CT scans or panoramic radiographs, to assess bone quality and quantity. A treatment plan is developed based on the patient's specific needs.

Surgical Phase[edit]

During the surgical phase, any remaining teeth are extracted, and the implants are placed. The two anterior implants are placed vertically, while the two posterior implants are angled to provide optimal support. This angulation helps to distribute the forces evenly across the prosthesis.

Prosthetic Phase[edit]

After the implants are placed, a temporary prosthesis is attached, allowing the patient to leave the office with a functional set of teeth. After a healing period, during which the implants integrate with the bone, a final prosthesis is fabricated and attached.

Advantages[edit]

The All-on-4 technique offers several advantages:

  • Reduced Treatment Time: The procedure can often be completed in a single day, reducing the overall treatment time compared to traditional methods.
  • Cost-Effective: By using only four implants, the cost is generally lower than other full-arch restoration methods.
  • Avoidance of Bone Grafting: The strategic placement of implants often eliminates the need for bone grafting, which can be a lengthy and costly process.
  • Immediate Function: Patients can receive a temporary prosthesis on the same day as the surgery, allowing for immediate function and aesthetics.

Considerations[edit]

While the All-on-4 technique is highly effective, it may not be suitable for all patients. Factors such as bone density, overall health, and specific anatomical considerations must be evaluated. Patients with severe bone loss may require additional procedures to ensure the success of the implants.

Related pages[edit]