All On Five Dental Implants - Amit Punj, DMD, MCR, FACP, Sameh K. El-Ebrashi, BDS, MS, FACP, and Jeffrey M. Burstein, DDS, MD
Dental implant care has revolutionized the field of surgery. Traditional implant loading protocols called for four to six months of burial of the implants before reimplantation with a prosthesis.1 The first reports of immediate loading on the day of surgery came in the early 1990s, but these were done with axially placed implants. .2 The all-on-four concept was popularized by Malo et al.3 about 20 years ago.3 The essence of this concept is to tilt the distal implants to avoid important structures and separate the temporary prosthesis after loading, thus providing different arch stability in the first prosthesis. healing period. .3 In the early years, this new concept was dubious because there was insufficient data to support the idea of curved implants and immediate loading, or the effect on survival and success of implants and prostheses.
All On Five Dental Implants
The all-for-four concept is a pretreatment option for atrophic jaws, with acrylic fractures being the most common prosthetic problems and peri-implantitis being the most common biological problems. Prosthetic success rates with monolithic zirconia formation are promising and with a lower likelihood of prosthetic complications.
All On 4 Dental Implants Toronto
Although highly successful, this treatment concept is not a panacea for all edentulous patients (or recently edentulous patients) as complications can occur.
The advantages and disadvantages of the all-four concept are listed in Table 1. Because of the surgical, prosthetic and technical aspects of this treatment, effective communication and a high degree of knowledge and experience are required. correct diagnosis; case selection and treatment plan.
For a sensitive patient, the doctor should evaluate whether this treatment is a suitable choice. The first step is to evaluate the patient's medical history to see if he is a good surgical candidate for transplant treatment. Curtis et al 15 recently published an evaluation of risk factors for dental implantology, which showed that the more medically compromised the patient, the greater the chance of implant failure. Risk factors such as smoking, uncontrolled diabetes, and certain medications can inhibit osseointegration, leading to early failure or increased late failure. As part of the treatment planning process, clinicians should perform an oral, nonverbal, and radiographic examination, including computed tomography (CBCT).
During additional evaluations, providers should look for temporomandibular disorders and range of motion, as these conditions may adversely affect treatment outcomes. General facial esthetics, skeletal relationships, vertical occlusal orientation, and any facial symmetry should be considered. An intraoral examination should assess the oral mucosa, arch shape, tooth position (periodontal tissue if present), oral hygiene, and current occlusion. beauty and prevention, and if necessary, updated or repaired. CBCT imaging reveals information about bone density, bone volume, anatomical structures, and intravascular pathology. Specific implant planning software can be used to plan the positions of the implants. Radiographic and surgical guides can be made as replicas of prostheses with cut-out windows to visualize bone reduction and coagulation status, or more commonly using computer-aided design/computer-aided manufacturing (CAD/CAM) software.
A Complete Guide For Eating After Dental Implants: What Can You Eat And What Should You Avoid
Anatomic structures - maxillary sinus and anterior-posterior extension of the mental foramen or nerves can affect the anterior-posterior (A-P) spread, or in other words, the length of the cantilever. The recommended cantilever length is approximately 15 to 20 mm, or 1.5 times the distance between the center of the most anterior implant and the distal edge of the posterior implant platform. A hybrid alloy prosthesis has been widely used. The risk of having a long cantilever is loosening, breaking the screw, or breaking the prosthesis screw at the most distal implant. Fixed dentures used for implants are designed to have a total of 12 teeth, usually two premolars and one molar, or three molars (with one to two cantilevers) if the implant space is less than ideal. Patients should be fully aware that second molars should not be in dentures (temporary or permanent).
Vertical Bone Measurement - The protocol for the four-person method requires alveolectomy, the surgical removal of part or all of the alveolar bone for three main reasons:
The upper and lower limits of bone reduction are the occlusal plane and anatomical structures. The vertical size of the plugin can be adjusted within aesthetic and functional parameters. Altering anatomical structures is more difficult because it increases the cost and morbidity of the treatment. During the planning stages of implantology, the treatment plan should be modified if the physician encounters bone reduction complications and recommendations that may affect the results.
The horizontal measurement of the bone is a pattern of alveolar bone resorption in the upper and thinner bone, and lower and outward in the mandible. Because the four-by-four concept reduces or prevents bony union, the implants may be misaligned in the superior anterior and mandibular orientation. This may result in additional palatal/lingual mass of the prosthesis affecting speech; In addition, the palatal implant position may also result in a large anterior cantilever, which may be more susceptible to mechanical and hygienic problems.19
Treatment Options For The Edentulous Patient (including All On 4)
Prosthetic Materials — Implant-supported complete dentures are available in a variety of configurations and materials, particularly combinations of acrylic resins, high-performance polymers, metal alloys, and ceramics. Full knowledge of material properties and dimensions is required for adequate strength to plan appropriate cantilever length and vertical beam reduction.20
The following case report describes the application of these treatment planning concepts using a four-by-four approach, providing a brief summary of the treatment protocol. A detailed explanation of this procedure is beyond the scope of this article. A recent review article describes these concepts in more detail.
Examination and Treatment Plans - A 42-year-old man presented with a chief complaint of inability to chew his food and missing posterior and mandibular anterior teeth. His medical history was unremarkable. He has not received dental care for 10 years. On further examination, the jaw joints and range of motion were within normal limits. Tests for oral cancer were negative. Examination of the maxilla revealed the absence of posterior teeth except tooth #15. Tooth #5 was fractured and the palatal surfaces of the anterior incisors showed signs of tooth surface loss (Figure 1 and Figure 2). In the mandibular arch, tooth #24 is fused with teeth #23 and #25. Around #24, there were moderate to heavy calculations. The mandibular incisors were missing (Figure 1 and Figure 3). A complete intraoral radiograph was obtained, including a panoramic radiograph (Figure 4). X-ray examination revealed radiolucency relative to #24, mild to moderate bone loss.
Periodontal examination revealed mild generalized gingivitis due to periodontal abscess and plaque related to No. 24. On occlusal examination, there was a deep anterior bite, 6 mm of vertical overlap, and loss of posterior support. Facial arch transfers, midline relationship recording, and maxillary and mandibular alginate impressions were performed on a semi-adjustable device for imaging and wax-up testing. After a thorough discussion of the diagnosis and treatment options with the patient, he decided to have a complete mandibular fixed prosthesis on four dental implants, and four dental implants in the upper left and right posterior region for a permanent restoration.
Comparing Snap On Dentures Vs. All On 4 Implants
A CBCT image was obtained and implant positions were planned using implant planning software with input from the oral surgeon (Figure 5). Accurate impressions and records of the maxillomandibular relationship were obtained in the dental laboratory for the fabrication of temporary maxillary and mandibular prostheses. For each arch, two surgical approaches were made using a copy of the denture outline.
Surgery and Immediate Temporary Denture Loading - On the day of surgery, the patient was sedated and all mandibular teeth #5 and #15 were extracted. A full-thickness plate was elevated in the mandibular arch to expose the alveolar process and mental envelopes of the cranial nerves. An alveolectomy was performed to remove and align the bone, using the surgical guide as a reference, and creating a platform for the implants (Figure 6). Four endosteal implants were placed in the mandible, the two anterior two directed straight, and the two posterior implants angled 30 degrees to avoid mental foramina on each side (Figure 7). Another surgical approach was used to help place the implants at sites #3, 5, 13, and 14. A removable acrylic overdenture was used as a temporary method in the upper arch.
In the mandibular arch, direct multiunit connections were placed on the anterior implants, and 30-degree multiunit connections were placed on the distal implants. The multi-unit connecting rods are drilled according to the manufacturer's recommendations and curing caps are applied to the fasteners. Polyvinylsiloxane occlusal registration material was projected onto the intaglio surface of the complete mandibular prosthesis to index attachment position. Using this information, the full denture was modified to become a permanent temporary prosthesis.
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