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All on 4 Procedure
The “All-on-4”
Procedure is a simple surgical technique, developed by a
Portuguese doctor along with Nobel Biocare. It commenced in
the beginning of the 1990´s, in order to rehabilitate the
edentulous maxilla and mandible with fixed prostheses.
In this technique, 4
implants are placed in the anterior region of the jaw, which
has the highest bone density and thus also represents the
highest success rate. This allows the fitting of a fixed
prosthesis with 12 to 14 teeth immediately on the day of
surgery.
Through this technique,
the rehabilitation of aesthetics and dental function can be
achieved. Furthermore, the use of fewer implants simplifies
and speeds up the surgical and prosthetic procedures.
Hygienic maintenance is also favored, thus increasing the
longevity of the rehabilitation.
Description
The “All-on-4” technique
allows a full arch bridge to be place on four implants in
the anterior region of the jaw. Two of these are off-centre
at an angle of 30 to 45 degrees, thus allowing the maximum
bone support.
The “All-on-4” technique
allows doctors to place implants in patients with poor bone
levels, who would normally require a bone graft prior to
implant placement. The use of the “All-on-4” technique makes
it possible for a dentist to achieve the complete
reconstruction of a patient’s mouth, by fitting a dental
prosthesis attached onto four points on implants.
During the procedure, a
gum flap is raised and a small hole is drilled into the
jaw-bone. This hole has exactly same length and width as
needed to place the implant. The implant’s orientation must
be very precise and it should be already determined before
the surgery starts.
This procedure permits
the patient to achieve the immediate functioning of the
mandible and the maxilla and it will be done in two phases:
1st Phase
Surgical--In this phase,
the patient will undergo surgery where the remaining teeth
are removed, bone is contoured, and 4 implants are placed in
positions predetermined during the treatment planning. Then,
an interim full acrylic prosthesis is placed and fixed to
these implants in the maxilla and mandible. This temporary
full acrylic prosthesis has a life expectancy of between 6
months to 1 year.
2nd Phase
Prosthesis--This 2nd
phase usually takes place 4 to 6 months after the 1st phase
is finished. The goal is to install the final prosthesis,
which can be made of ceramic or acrylic with titanium
infrastructure, which is fabricated by the lab to be fixed
by your dentist. It is the choice of the patient to decide
whether to install the final prosthesis in ceramic or
acrylic.
Risks, complications and side effects
The “All-on-4” surgical
technique has the usual risks associated with any kind of
oral surgery or other implant procedures. To prevent
infections, the patient must always takes proper medication,
including antibiotics and anti-inflammatory drugs. This
medication is selected according to the patient’s general
health condition and allergies.
Side effects associated
with this procedure include bruising and swelling--which
disappear after 5 to 10 days depending on the patient’s
health condition and the type of surgery technique:
“All-on-4”, “All-on-4 Hybrid”, “All-on-4 Zygoma”.
Patients receiving
anti-clotting medication will tend to have a longer recovery
time. Temporary numbness may also occur in some cases. The
Esthetique Dentistry specialist gives every patient appropriate medication,
as well as an oral hygiene and a maintenance protocol before
the surgery.
Below are the basic protocols to be followed. These protocols are adapted whenever necessary. By following these protocols, it reduces post-surgical discomfort and it helps to improve wound healing.
Post-operative care, Convalescence
The post-operative
experience of an “All-on-4” surgery does not compromise
“normal” life. However, some precautions are recommended,
such as: apply ice on the post-operative area and eat soft
and cold food during the first 48 hours after surgery.
It is also recommended
to avoid exposure to sunlight and to adjust the sleeping
position so that the patient’s head is kept higher than the
body. The post-operative medication protocol must be
followed because this has been planned to ensure a quicker
healing process and a better control of pain and bruising.
Recovery time
Depending on the
patient’s general health condition, recovery time for an
“All-on-4” surgery varies from 5 to 10 days. From a systemic
point of view, one day is usually all that is necessary for
surgery recovery.
Aesthetically, because bruising and swelling may appear, the full recovery period ranges can be a little more prolonged - going from 5 up to 10 days. Usually, the patient is aesthetically recovered by the time that the stitches are removed during an appointment, 10 to 15 days after surgery.