Improving Case Success: The All On 4 Workflow

mm Written by Andrew Sedler

The All On 4 treatment is one of the quickest growing areas of dentistry. All On 4 bridges, also known as full-arch implant-supported bridges, are becoming an increasingly popular alternative to conventional removable dentures. Patients often request this treatment at the dental practice.

The All On 4 Workflow - Burbank Dental Lab - Los Angeles - Burbank, CA

With All on 4, patients receive many benefits, and overall patient satisfaction is dependent on providing them with the best possible outcomes and experience. When performing these types of cases, specific criteria should be followed. In particular, digital workflows have a specific sequencing that should be followed.

Consideration for All On 4

Several factors need to be considered when choosing this treatment option. To determine the best treatment plan, each patient must be evaluated individually based on their specific circumstances. Most of these cases are supported by four or more implants and a framework made of either monolithic zirconia, a cobalt-chrome frame with stacked porcelain, a titanium frame with acrylic, or some other option. The versatility of fixed prosthetics offers several advantages over traditional dentures, including:

  • Prostheses of this type are well documented for their success. 
  • Cost-effectiveness makes it a viable treatment option. 
  • Bone grafts are usually not needed. 
  • Improved biomechanics. 
  • Surgical complexity is reduced. 
  • Instantaneous functionality. 
  • Cleaning is easy for patients.
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Optimal Case Selection

This option is so popular because it offers so many benefits. To increase the rate of success, a patient must be properly evaluated to determine if this type of treatment is right for them. The chances of failure at the implant level are higher for patients who suffer from medical issues, take various medications, or smoke. Assessing these issues and taking cone-beam tomography and x-rays is key to finding the best treatment plan for a patient.

A patient should also be evaluated for the following:

  • Can the patient follow the more detailed oral hygiene protocols that are needed to make these cases successful? For these types of cases, more frequent dental appointments and strict oral hygiene instructions will be necessary at home.  
  • Making a final treatment plan should consider bruxism and clenching issues. 
  • It is important to discuss proprioception factors with the patient. As a result of registering forces placed on natural teeth, periodontal mechanoreceptors protect teeth. Because implants do not have these receptors, excessive biting forces may be applied to the occlusal contacts. These forces can cause fractures or bone damage.  
  • Bridges of this type can be bulky and difficult to use. This can affect patient speech patterns, and adaptation to it in the mouth can be challenging.

In addition to the many benefits of implants, it is imperative to discuss with the patient the issues that might affect the final restorative outcome and the patient’s overall satisfaction before the implant is placed.

Digital Workflow All On 4

Many benefits are associated with using a full-arch implant-supported restoration workflow that is entirely digital. The overall process is more efficient, predictive, and comfortable, and patient acceptance is improved. To reap these benefits, the clinician must understand the All On 4 process and the digital workflows.

Burbank Dental Lab recommends that dental practitioners interested in implementing digital procedures first use conventional impression methods to complete several cases. Furthermore, the clinician must be familiar with using an intraoral scanning system.

This will result in the following digital workflow:

  1. Analyze the existing dentures of the patient 
  2. Form and function must be approved
  3. Calculate the vertical dimension of occlusion (Figure 2)
  4. Pre-Operative
  5. Take a scan of the denture
  6. Scan soft tissue past the rugae
  7. While in the mouth, scan the denture down to the vestibule
  8. Data must be sent to Burbank Dental Lab
  9. Surgical Post-Op
  10. Insert multi-unit abutments (MUA)
  11. Screw the scan bodies into the MUAs
  12. The height of the scan bodies should be measured. Select the scan bodies that are closest in size. 
  13. Scan the palatal tissue (this scan will be superimposed with data from the scan body). (Figure 3)
  14. Temporaries
  15. A provisional will be created based on the scans within a day or two of surgery.
  16. PMMA can be fabricated using titanium bases if requested.
  17. To combat inflammation, the PMMA will have a high water design. 
  18. A printed model can be used in conjunction with a verification jig. (Figure 4)
  19. After Osseointegration
  20. Verify the accuracy of the models and scans using a verification jig. 
  21. Send the jig to Burbank Dental Lab
  22. Using the scan bodies, scan the tissue
  23. Finalize the restorations (Figure 5)
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The Final Prosthesis

There are a few options to choose from when considering the final prosthesis. Considering which restorative option to implement should be considered during the treatment planning phase and can include a consultation with a Burbank Dental Lab implant team member.

Following are the hybrid options available at Burbank Dental Lab:

  • ZIRMAX M Hybrid – This is a monolithic zirconia prosthesis for a screw-retained restoration. This is a highly esthetic option that is extremely durable. These restorations offer a flexural strength of up to 1200 MPa.  
  • SmartComposite Hybrid – This is a combination of both milled CO/CR and milled composite.  
  • Traditional Acrylic – This prosthesis is fabricated with a titanium frame and acrylic denture teeth.

There are several different ways to decide on a specific workflow for a particular dental procedure, just as there are for many other medical procedures. With digital protocols, high-quality fabrication can be achieved. However, you must understand the pros and cons of each case. Additionally, you must know the best workflow to use.

Burbank Dental Lab should be consulted as early as possible in these high-complexity cases to help plan the appropriate treatment. An All On 4 case requires a strong doctor-lab relationship to ensure the patient’s complete satisfaction.

Burbank Dental Lab offers the highest quality care for cases like this, and we are proud to offer it. Burbank Dental Lab offers our success guide for free when you call us to learn more about All-On-4 cases.

All On X Success Guide

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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.