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What are All-on-4 Dental Implants in Implant Dentistry? | i-Fix Implants
September 20, 2021
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Developments in dental implantology have facilitated a departure from the early paradigms set by Branemark and his co-workers’ pioneering work. The operational success rate of dental implants is primarily influenced by the mechanical environment in which they function as a separate entity. The size of implants, their design, and their placement are all determined by the patient’s systemic state, the availability of bone, the type of bone, and, finally, the dentist’s treatment plan. While early recovery of 6 months in the upper jaw and 3 months in the mandible was once indicated, advances in biology and technological advancements have allowed for instantaneous implant loading in some clinical conditions.

Because of insufficient availability of residual alveolar bone and nerve proximation, implant-supported fixed prostheses are not viable in some totally edentulous patients. To overcome the problem in these impaired cases, nerve transposition and grafting are required. The All on 4 teeth implant could provide an alternative to the above-mentioned dilemma.

The All on 4 Dental Implants Concept:

Paulo Malo and his co-workers came up with the concept of “All on four” in 2003. Here two implants are inserted vertically in the anterior region and two implants are placed at a 45-degree angle in the posterior edentulous region. The All on 4 Dental Implant is one treatment process that invigorates us for its usage in entirely edentulous patients, leaving behind the normal management option of conventional dentures with successful results in the short to mid-term, long term, period. Also, this method involves tilting the distal most implants on the edentulous arches which allow us to place longer dimension implants, resulting in acceptable support for the prosthesis with a shorter cantilever arm, which improves the inter-implant distance and implant anchorage in the bone.

Practical Considerations for All on 4 Dental Implants:

  • The most important consideration in all four procedures is to attain initial or fundamental stability of at least 35Ncm and up to 45Ncm.
  • In the upper jaw, at least of 10mm of bone height should be accessible from canine to canine, whereas in lower jaw it should be 8mm
  • The implant insertion site should have a minimum of 5mm of bone breadth.
  • If the angulation of the implants put is greater than 30 degrees, one should think of splinting of tilted implants
  • The access hole for the distal screw should be situated on the occlusal face of the first molar, second premolar, and on the first premolar in the case of slanted implants put in the posterior edentulous region.

The Surgical Procedure Involved in All on 4 Dental Implants:

In the surgical placement of All on 4 Dental Implants, the maxillary posterior edentulous region is loaded or inserted with two distal implants which are slanted anteriorly to the maxillary sinus. On the other side, implants were implanted anterior to the mental foramen region in the mandibular arch. The angle of insertion for these implants should be between 30 and 45 degrees. The All on 4 teeth implant surgical guide ensures that the implant is placed correctly in terms of emergence, location, and angulation. The guide is inserted into a 2mm osteotomy produced in the maxilla or mandible’s central position, and the titanium band is moulded to follow the opposite arch’s arc. In mandibular situations, the guide also helps abduct the tongue. The guide’s vertical lines serve as guidance for drilling at the proper angulation, which should not exceed 45o degrees.

When compared to vertical implants supporting FFP with longer cantilevers, Bevilacqua et al. found that tilting the distal implant by 300 degrees in a Full fixed prosthesis, reduced stress levels by 52 percent and 47.6 percent in compact and cancellous bone, respectively. With cross-arch splinting and angled abutments on two tilted implants placed in a curved arch, the stresses around the distal implants may be reduced.

Steps involved in All on 4 Dental Implants

  1. Surgical phase: After the case is evaluated for the eligibility of All in 4 dental implants, the guide template is used to locate the position for placement which is around the maxillary antrum in the maxilla and mental foramen in the mandible
  2. Antero-posterior spread: Rangert et al advocated a 10 mm antero-posterior prosthesis spread (the separation between the most front and most rear implant) for a cantilever length of 20mm, or 2 times antero-posterior spread. In the case of a mandibular implant-supported fixed prosthesis, the antero-posterior length of the cantilever should be 1.5 times the antero- posterior spread, according to English.
  3. Prosthetic phase: Here an open tray impression is made with resin and wire for improving the accuracy. Following verification of integration, the final impression is splinted with metal and resin. Next, using CAD/CAM technology, all ceramic Zirconia bridge is manufactured. Alternatively, a titanium framework is milled is developed. This is followed by the application of luting cement under the zirconia framework. The final step includes cementation and placement of implant supported zirconia formwork.

Benefits of the All on 4 Dental Implants:

  • Avoidance of neurovascular anatomical structure due to angulation of posterior implants
  • Longer implants anchored in superior grade bone are possible with angled posterior implants
  • Cantilever in posterior segment reduces
  • In the majority of instances, bone grafts in the edentulous maxilla and mandible are eliminated
  • Superior success rate
  • Implants that are well distributed and spaced, have good biomechanics, are easier to maintain, and have immediate function and appearance
  • The final restoration can be either permanent (Fixed) or detachable (removable)
  • Cost-effective due to fewer implants and the absence of grafting in the majority of cases.

Limitations of All on 4 Dental Implants:

  • Hands-free Implant placement is fully prosthetically driven, therefore arbitrary surgical placement is not usually possible
  • The cantilever length in the prosthesis cannot be increased beyond a certain point.
  • It is extremely technique-dependent and necessitates extensive pre-surgical preparation, including CAD/CAM and surgical splints.

Overall, scientific literature has shown that assimilative survival rate of All on 4 teeth implant ranges between 90%-100%. Owing to freedom of placing a n angled implant by tilting it, the implants can be inserted into compact and dense bone structures which are well spread antero-posteriorly providing an effective base for prosthesis. Also, by plummeting the number of implants to four, each can be place without encroaching with adjacent implants.

For more information on dental implants, contact Kamal MedTech:

Kamal Medtech has been a well-established dental implant manufactures in India since last many years. Under its flagship of Kamal MedTech, i-fix Indian dental implant has gained the immense trust of dental clinicians and implantologists pan India.  Due to our pledge to producing innovative, effective, and high-quality Indian dental implants, I fix Indian dental implants has been regarded as one of the best dental implant brands by leading and eminent clinicians. If you wish to know more about All on 4 teeth implant then please contact us.

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