Steven Pigliacelli, CDT, MDT, and Dr. Leonard Marotta are two of the three principles of Marotta Dental Studio. An erudite dental technician and engineer, Marotta earned his PhD in Biomedical Engineering from Leeds Metropolitan University in the UK. Pigliacelli has more than 30 years’ experience at Marotta Dental Studio as a dental implant specialist and holds a Master of Dental Technology from NYU.
How did you get started with All-on-4® treatment concept cases?
Steven Pigliacelli: We have been making hybrid cases for over 30 years and receiving milled titanium Procera frames from Nobel Biocare since the early 90s. We were the beta lab for the original Procera implant bridge, which was called the All-in-one Bridge. So for us to make the transition to a milled titanium hybrid solution on four implants was an easy and natural one.
Lenny Marotta: Back in the 1990s, I started doing All-on-4® cases with Nobel Biocare as a continuation of our studies with Drs. Steve Parel and Steve Lewis, and we’ve done the All-on-4® treatment concept ever since.
What do you see as the key benefits of handling All-on-4® treatment concept cases for a lab?
Pigliacelli: For the lab and doctor, a key benefit is having a standard denture and implant protocol. We have a detailed protocol at the lab that has served us well for many years. Every step is discussed with the doctor, supported by instructional memos and chairside consultation, if needed. This ensures that there are no complications, and everything goes smoothly.
You have been working with NobelProcera titanium frameworks for a long time. What are the main advantages of titanium, particularly for substructures for the All-on-4® treatment concept?
Marotta: The NobelProcera Titanium frames always come back with a precise and accurate fit. This is particularly important for All-on-4® cases, since no adjustment is needed and no undue stress is put on the implants.
Pigliacelli: A milled titanium frame avoids distortion issues in the interface that happen during a casting process. Once the gold cylinder is placed in an oven, it distorts, then when the alloy melds to it, it distorts again.
Soldering, when necessary, is another source of distortion and a possible source of breakage and porosity. Because the milled titanium frame is a solid one-piece milled bridge, the need for solder connections is completely eliminated.