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Full-Arch Implant-Supported Cases: The Beauty of All On 4
Written by Andrew Sedler
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Google “All On 4,” and over 25 billion results appear. This treatment option is a fast-growing area of dentistry. The concept of All On 4, also known as full-arch implant-supported bridges, is a highly desirable alternative to conventional removable dentures driven by patient demand.
All On 4
Often patients come into the dental practice requesting this treatment. There are many benefits to treating patients with All On 4 and giving them the best possible outcomes and experience is critical to overall patient satisfaction.
Specific criteria should be implemented when attempting these types of cases, especially when implementing a digital workflow.
Several factors must be considered when deciding on this treatment option. Each patient presents unique considerations that should be evaluated individually when deciding on the best treatment plan. These cases are usually supported with 4 to 6 implants and a framework fabricated with either monolithic zirconia, a cobalt-chromium frame with stacked porcelain, a titanium frame with acrylic, or some other restorative option.
With their versatility, these fixed prostheses offer several benefits over conventional dentures, including:
The success rate of these types of prostheses is well documented.
It can be a cost-effective treatment option.
Bone grafts are usually not required.
Biomechanics are greatly improved.
The complexity of surgery is reduced.
Function is immediate.
Easily cleaned by the patient.
With so many benefits, it is easy to see why this is such a highly sought-after option.
Higher Success Rates Mean Proper Patient Evaluation
To increase the success rate, though, it is essential to properly evaluate whether a patient is well suited for this type of treatment. For example, patients with medical issues, those who take various medications, or those who smoke have a higher risk of experiencing a failure at the implant level.
It is critical to assess these issues and take the proper X-rays and cone-beam tomography scans when matching a patient to this treatment option. Other issues that need to be evaluated are:
Will the patient follow the more detailed oral hygiene protocols needed to make these cases successful? This type of case will require more frequent dental visits and strict at-home oral care.
Parafunction issues such as bruxism and clenching should be considered when making the final treatment plan.
Proprioception factors should be discussed with the patient. Periodontal mechanoreceptors help protect teeth by registering the forces placed on natural teeth. Implants do not have these receptors, and because of this, excessive biting forces on the occlusal contacts may occur, possibly resulting in fractures or bone issues.
These bridges can be bulky and prove to be difficult to get used to. This can affect the speech patterns of patients and prove to be challenging when adapting into the mouth.
These issues should be discussed with the patient before implant placement to ensure the patient is aware of not only the many benefits but also of those issues that might affect the final restorative outcome and their overall satisfaction.
All On 4 Digital Workflow
Using a fully digital workflow for full-arch implant-supported restorations offers many benefits. Patient acceptance is enhanced, and the overall process is more efficient, predictive, and comfortable.
To achieve these benefits, the clinician must understand the overall All On 4 dental implant process and be familiar with the digital workflows. Therefore, Burbank Dental Lab recommends that doctors implement digital processes to complete several cases using conventional impression methods. Also, the clinician should be familiar with using an intraoral scanner.
With the proper experience, a digital workflow will be as follows:
1. Evaluate the patient’s existing denture
Approve form and function
Evaluate the vertical dimension of occlusion
2. Pre-surgery
Scan the denture
Scan the soft tissue past the rugae
Scan the denture while in the mouth down to the vestibule
Measure the height of the scan bodies and use those closest in height.
The palatal tissue should be scanned (this scan will be superimposed with the scan body data).
4. Temporaries
The scans will be used to create a provisional that can be inserted within a day or two of surgery.
If requested, the PMMA will be fabricated using titanium bases.
The design of the PMMA will be a highwater design to combat inflammation.
A printed model can be used along with a verification jig.
5. Post Osseointegration
Use a verification jig to double-check that the models and scans are accurate.
Send jig to Burbank Dental Lab
Scan the tissue using three scan bodies
Create final restorations
As with many dental procedures, there are several different approaches a clinician can take when deciding on a specific workflow of a particular case. The digital protocols offer the highest level of fabrication processes. Understanding the overall pros and cons of these cases is extremely important.
Also, knowing which workflow would work best is important. When working on these large complex cases, Burbank Dental Lab should become involved as early as possible to help with proper treatment planning. The doctor and lab relationship is essential during an All On 4 case to ensure complete patient satisfaction.
A large case like this deserves the best, and that is exactly what we offer here at Burbank Dental Lab. If you are interested in working with Burbank Dental Lab on your next All On 4 cases, call or chat with us today.
Zir-MAX.M, and Zir-MAX.Me are high strength monolithic zirconias that exceed your expectations for zirconia restorations, ideal for use in full and single crowns and bridges.
Composite restorations provide a viable, option for conservative “biomimetic” metal-free restorations. Burbank Dental Lab technicians are trained to provide ideal marginal fit, full polymerization and lifelike esthetics.
DuraTemps are laboratory fabricated provisional restorations that are much more durable and esthetic than traditional chair-side fabricated provisionals, even rivaling the finished restorations.
DURATEMP PMMA, a lab fabricated provisional restorations that are milled from PMMA (Polymethylmetacrylate). Our PMMA provisionals are CAD/CAM generated and can be created from either conventional impression or a digital IOS workflow. These provisionals are recommended for long term provisional needs such as implant or surgical cases.
Burbank Dental Lab's Smart1 Implant Bars & overdentures are designed using our decades of experience and fabricated with the world's most advanced technology, resulting in ease of delivery, and the most durable, comfortable denture available.
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Our New State-Of-The-Art 3d Printers
Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.
Fabrication of the future is here!
Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.
Our New State-Of-The-Art 3d Printers
Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.
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