All-on-4

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Technique depicted in 3D video
This image shows how Nobel Biocare's All-on-4 solution works

The term All-on-4, also known as All‐on‐Four

gum disease. It consists of the rehabilitation of either edentulous or dentate maxilla and / or mandible with fixed prosthesis by placing four implants in the anterior maxilla
, where bone density is higher. The four implants support a fixed prosthesis with 10 to 14 teeth, and it is placed immediately, typically within 24 hours of surgery.

The All-On-Bar solution, with the latest technology, computer aid design/Mill (cad/cam) the all-on-4 has evolved including the All-on-bar concept, which is adding a milled titanium bar structure to the dental implants which helps keep them working together. Protecting the implants from failures even after the hybrid bridge is broken. this concept helps the clinician provide a better long-lasting solution, instead of a conversion-denture which is a chair side repair and modified denture. The All-On-Bar reduces the appointments, eliminating the Denture Conversion Temporary by replacing it with a long lasting hybrid, some patients keep this option as their final due to a lower budget or because the space is limited for other final solutions.

Pmma or Denture teeth over the titanium bar wears out over time and need replacement, this is a controversial topic since the Pmma has the advantage of been shock absorbent. This helps the implants receive less stress during mastication forces but keeping a solid structure on the inside.many processionals think this is a better solution, keeping in mind that the bridge can be switched to a new one a few years after.

Implant manufacturer Nobel Biocare AB of Gothenburg, Sweden, was among the first to identify the evolution of the All-on-4 technique as a potential valid and cost-effective alternative to conventional implant techniques,[5] and funded studies by Portuguese dentist Paulo Maló[1] to determine the efficacy of this approach.[6][7] During this time, this technique was also used by various other clinicians around the world.

All-on-4 is not an invention, but rather a treatment technique that has evolved over time, and has the following features:

The All-on-4 treatment concept is a

bone grafting. The All-on-4 technique takes advantage of the dense bone that remains in the front part of the jaws, and by placing the two posterior implants on an angle to avoid the sinus cavities in the upper jaw and the nerve canal in the lower jaw. The cost of the All on 4 procedure varies based on the final prosthetic material. Acrylic resin teeth over titanium bar is substantially cheaper resulting in a total cost of around $30K per arch/jaw in the United States. Premium prosthetic materials like Zirconia can result in a total treatment cost between $36K to $40k per arch/jaw in the United States. For the implementation to be successful a careful analysis of the bone structure needs to be made. The most ideal way to evaluate the bone is by a cone beam computed tomography (CBCT) scan. The All-on-4 protocol is for at least four implants to be placed in a jaw. The back implants are typically angled approximately 30 to 45 degrees from the occlusion (biting plane). The implant is placed in front of the maxillary sinus in the upper jaw (maxilla), and in front of the mental nerve in the lower jaw (mandible). The head of the implant emerges in approximately the second premolar position. This will allow a molar tooth to be cantilevered posterior, resulting in a denture or bridge with approximately twelve teeth.[2][11]

References

  1. ^
    PMID 12691645
    .
  2. ^ a b "השתלות שיניים בשיטת אול און פור / אול און 4 – פה מושלם ביום אחד" [All-in-four / All-on-4 dental implants - perfect mouth in one day]. www.MaloClinic.co.il (in Hebrew). Malo Clinic. Retrieved 19 February 2021.
  3. PMID 23560986
    .
  4. PMID 25331394
    .
  5. ^ "All-on-4® treatment concept". www.NobelBiocare.com. Nobel Biocare Services AG. Retrieved 19 February 2021.
  6. S2CID 85565798
    .
  7. ^ History and evolution of the All-on-4® treatment concept | Nobel Biocare. Paulo Malo on the evolution and history of the All-on-4® treatment concept, from Nobel Biocare's speaker forum at EAO 2013. Why did it take so long?. www.YouTube.com. Nobel Biocare. 8 November 2013. Retrieved 19 February 2021.
  8. OL 18985290M
    .
  9. PMID 2202668
    .
  10. PMID 2098572
    .
  11. ^ "Everything about All On 4 Dental Implants".
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