All On 4
All On 4: Full-Arch Implant-Supported Bridges

Full-Arch Implant Supported Cases:

The Beauty of All On 4

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

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.

There are specific criteria that should be implemented when attempting these types of cases. This is especially true when implementing a digital workflow.

All On 4 - Digital Workflow

When deciding on this treatment option, there are several factors to consider. Each patient presents with their own unique considerations and 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 prosthesis 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, or who take various medications, or those that 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 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 patient's existing denture
a. Approve form and function
b. Evaluate the vertical dimension of occlusion

Papillameter - Ivoclar Digital Denture

2. Pre-Surgery
a. Scan the denture
b. Scan soft tissue past the rugae
c. Scan the denture while in the mouth down to the vestibule
d. Send the scanned data to Burbank Dental Lab

Approved scanned prototype

3. Post Surgery
a. Place multi-unit abutments (MUA)
b. Screw scan bodies into the MUAs
c. Measure the height of the scan bodies and use those closest in height.
d. The palatal tissue should be scanned (this scan will be superimposed with the scan body data).

4. Temporaries
a.The scans will be used to create a provisional that can be inserted within a day or two of surgery.
b. If requested, the PMMA will be fabricated using titanium bases.
c. The design of the PMMA will be a highwater design to combat inflammation.
c. A printed model can be used along with a verification jig.

Printed model with a verification

5. Post Osseointegration
a. Use a verification jig to double-check that the models and scans are accurate.
b. Send jig to Burbank Dental Lab
c. Scan the tissue using three scan bodies
d. 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.

All On "X" Success Guide Coming Soon

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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.