All-On-4® Hybrid Treatment Options

One of the most common options for treating an All On 4® case is a hybrid prosthesis. But all “hybrids” are not created equal. We are a long way from the days of the only option being a cast metal substructure with traditional acrylic and denture teeth.

To begin, allow me to define what a hybrid is, as there are various vague interpretations out there. It appears that the term was coined because this prosthesis combines denture technology with screw-retained implant restorations, resulting in a hybrid denture, also known as a fixed/removable. The objective was to offer patients a non-removable alternative that could still be removed by the clinician for regular cleaning, tightening, and screw replacement.

In 2023, hybrid dentures offer a range of material options such as traditional metal with acrylic or metal-free alternatives like zirconia. These dentures are designed to mimic the appearance and functionality of natural teeth.

At Burbank Dental Lab, you can choose from four categories of implant hybrid restorations for screw-retained full arch “denture” prosthesis. Let me give you a brief overview of each category and compare and contrast them.

4 Types of Implant Hybrid Restorations

1. Traditional Acrylic with Titanium Substructure

This restoration is fabricated using a titanium frame that is designed to merge with the implant interface and has a retentive design that accommodates the adherence of acrylic and denture teeth.

Features & Benefits

• Has resiliency that reduces impact forces so that it is not transferred to the implant.
• Easily repaired should you sustain trauma, which is a great advantage.
• It does stain over a period of time, but this can be readily cleaned and polished.
• This prosthetic denture is made of cured acrylic base; teeth can be dislodged; however, they are easily repaired.
• Acrylic is generally cheaper and lighter but won’t last as long as zirconia.
• Acrylic teeth have the longest track record.
• May wear and will chip, but they are easily repaired in a few days.
• Wears faster than natural teeth but will not wear opposing natural teeth.

2. SmartComposite Hybrid Prosthesis

A unique approach within the fixed hybrid category of restorations, SmartComposite is a combination of milled CO/CR and Milled Monolithic Composite.

Features & Benefits

• Strong, rigid metal bonded to resilient hybrid composite.
• Highly polishable, it can be repaired in the mouth.
• Less likely to chip compared to acrylic options.
• Lightweight compared to Zirconia.
• Very durable but may not be quite as durable as full zirconia.
• Kind to opposing teeth; wears at about the same rate as natural teeth.

3. ZIRMAX M Hybrid (Monolithic Zirconia Screw Retained Full Arch Prosthesis)

The ZIRMAX M Hybrid is one of the most esthetic and durable restorations for the edentulous patient seeking an implant-retained solution. ZIRMAX M Hybrid Restorations exhibits a flexural strength of up to 1200 MPa, allowing you to deliver a restoration that looks natural and that will endure even challenging occlusal loads.

Features & Benefits

• This is the option with the greatest combination of strength and cosmetics.
• Most patients feel this is the option that is the closest to the feel of their natural teeth.
• It has been around for approximately 10 years.
• As far as durability, zirconia will tend to be the most durable option and will be the least likely to chip.

4. Porcelain Fused to Metal Hybrid Prosthesis

Features & Benefits

• Requires the least vertical of any other hybrid option.
• This is the most esthetic option.
• It is more likely to chip than Monolithic Zirconia but has decades of acceptable longevity.
• Typically the most expensive option.
• Has the most versatility of treatment solutions.

With these four hybrid options, there is something for virtually every All On 4® case requirement. The implant department at Burbank Dental Lab can assist you in determining which type of hybrid will work best for your case.