All-on-4 implants system longevity and durability osseonews inspirational quotes for phd students

There have been numerous advertisements promoting treatment plans based on the all-on-4 implant systems. When I first started restoring implants, the strategy was for the implants to be placed perpendicular to the plane of occlusion. This was supposed to result in more favorable transmission of forces to the implant and surrounding bone. This was also supposed to transmit the occlusal and lateral forces to the implant restorative system so that there would be less unfavorable force on the abutment and abutment screw and was supposed to result in decreased incidence of abutment or screw fracture or abutment screw loosening. With the all-on-4 design, the terminal abutments are tilted at a 30 degree angle from mesial to distal, thus extending the length of the metal framework that can be supported.

So have the laws of physics change or do we just know more about implant restorations now. I have seen a ton of articles in the peer reviewed literature supporting the use of all-on-4 design. But what do you experienced practitioners who have used the system say about its longevity and durability?

I have performed 238 “all on 4” procedures to date. This is all within the last 3.5 years (spring 2006). I was at first extremely skeptical of the procedure, before I listened and learned about the science. Inspirational education quotes for teachers the procedure has well documented success over 10 years. Bo rangert, a PHD in mechanical engineering, helped develop the technique. Dr. Bo rangert also wrote the book on why implants fail. “risk factors in implant dentistry: simplified clinical analysis for predictable treatment, second edition”

I trust his understanding of physics much more than some of the so called experts who base what they know on opinion rather than science. I have great success and offer this as a lower cost technique for those who desire immediate teeth (90% of the time I can immediately load these cases) without grafting and I have a much more esthetic result.

I am glad I finally looked into the science of the technique. Granted, their is a paradigm sift that must occur. I am glad I stopped listening to the opinions of some speakers and I can know offer a great low cost treatment option to many of my patients.

I will try and answer a few questions since my last post. The “all on 4” is not porcelain fused to metal with 14 teeth on 4 implants. It is a PIB framework with 4 to 6 implants and denture teeth to the first molars only. (a total of 12 teeth)

Not to be critical, but most people just do not understand the concept and they believe it cannot work. I understand this, because I had the same opinion before I went to a two day course to understand the principles. I have over a 99% success for 238 cases after the final prosthesis has been placed. I have only lost 3 implants after the final prosthesis. The patients did fine on 3 implants until I could replace the lost implant. I then luted this implant back into the PIB denture prosthesis, saving the patient from incurring anymore cost. Something you cannot do with porcelain fused to metal crown and bridge.

I ask a similar question. Best inspirational quotes for facebook status what do you do with any full arch prosthesis when you lose the distal most implant. You replace the implant and redo the porcelain fused to metal. If it is a traditional “all on 4” PIB with denture teeth attached, you do not need to replace the prosthesis, but lute this back into the framework.

There is a reason the clear choice invested millions of dollars to establish 17 full service dental centers around major cities in the US. Believe me, it is not because the “all on 4” does not work. It is because it does work and works very well.

I know it is hard to change. Branemark is a great example. He stated the machined implant was the only surface to use. Until nobel bought sterios and the roughened surface implant became the only surface to use. It is amazing how quickly opinions can change.

Calif – no anger towards anyone who disagrees and I’m sorry if that’s how it’s come across. I merely get frustrated when people who should know better, make silly statements as if fact – frankly, I was rather bemused by carl’s suggestion of a 20% failure rate for implants (those pesky decimal points really are a nuisance!)

Absolutely, you utilise cantilevers. In my practice, we use a milled titanium beam for the bridge. VERY rigid and light and the fit is immaculate. Does anyone have a concern about cantilevering back a unit off something as strong and rigid as this?

If a patient chooses to have porcelain then the “gum” is made of composite and the titanium beam is milled with individual “cores” for each teeth. It’s expensive (though way less than 8 implants!) to make but if a “tooth” gets chipped you just replace the one tooth.

Is all-on-4 the only option for a full-arch? Of course not. I’ve restored full-arches with 8 implants (four 3-unit bridges), and with 6 implants (both as a single full-arch bridge and in smaller units) and the usual way I restore them now is with an all-on-4 that I load with a temporary bridge the following day.

PIB is PROCERA IMPLANT BRIDGE or, more simply, a titanium substructure custom designed based on the position of the implants placed during a all-on-4(5-6) procedure. It is done typically 4-6 months after surgery and after integration has been achieved. It allows for the implants to be splinted together, the 5-10 year studies have success rates at 99-100%. Even if a single implant is lost due to whatever circumstance, the “bridge” prevails and can still be used for a long period of time with no major effect on the already integrated implants.

The temporary bridge is constructed from an immediate denture and consists of only acrylic and temporary titanium copings. There is no more than one tooth cantilever on a provisional. You would never have an implant in, say, #12, and then cantilevered to #15. It doesn’t (shouldn’t) happen. It is during this period (the first 4-6 months) that you may “lute” a new implant back in to the existing prosthesis. You do not do typically ever do this with the final PIB.

An inherent problem with all-on-4 is that it represents the minimal mechanical solution for the edentulous arch. For example, a bruxer with natural opposing dentition may have a hard time not breaking teeth or implants, or experience accelerated bone loss on the distally angled implants. The entire prosthesis is being retained by 4 screws, which will certainly experience fatigue and distortion over time. Inspirational teacher quotes for teachers A relatively large amount of prosthetic space is required to fit the teeth, the pink, and the frame between the edentulous arch and the opposing dentition. Patients with symptomatic mandibular flexure will not know that this option doesn’t work until it is attempted. Denture teeth will not adequately resist wear beyond a decade, then it is remaking the entire prosthesis again.

My greatest reluctance to put my name behind the all-on-4 concept is that in patients with minimal bone loss or who are losing their teeth, it may require an unacceptable removal of bone in order to create the necessary prosthetic space for the prosthesis. Thus, we would be making our patients fit our prosthetic solution. Also, mechanically and statistically (regarding potential failures in key locations), if a hybrid type of prosthesis is chosen, it is better for everyone to put just one more fixture in, making it an all-on-5.

Finally, nobel has pulled the wool over our eyes in the past by rushing products to market, to the chagrin of dr. Branemark, including the earliest version of the all-on-4. I believe this is what dr. Misch was referring to regarding the 20% failure rate, when nobel used to advocate placing the final all-on-4 prosthesis at the time of surgery, using a crazy adjustable abutment that only led to an unacceptably high failure rate. They scrapped that for making the final prosthesis only after osseointegration could be verified.

In regards to saving patients money, we provide an all-on-5 type of solution for approximately $17,000 including iv sedation, all temps and final restorations and minor grafting. We charge only $25,000 per arch for 8 or more implants, porcelain crowns, and a vacuum cast noble framework that has no pink, but retains the benefits of a single frame and individual teeth (we are the only ones in the country offering this). The local clearchoice gives quotes ranging from $25,000-$35,000 per arch for the all-on-4 depending on their current demand.

In summary, while all-on-4 can work for many patients, it is rarely the optimal solution for prosthetic longevity, clinician’s and patient’s ease of repair, and never optimal for patients who are gummy or who would otherwise need a significant alveoloplasty in order to have the all-on-4 prosthesis.