Challenges and evolution of restoring fully edentulous and failing dentition patients

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Dr. Ferro’s presentation “All-on-4® treatment concept: Challenges and evolution of restoring fully edentulous and failing dentition patients is now available to watch on-demand.

“Why are we here?”

“Why are we here?” That was the simple yet profound question posed to attendees to open the presentation. The answer, she explained, lies in the patients like Isabel, Manuel, and Maria who seek the help of clinicians for dental issues affecting their quality of life.  

Dr. Ferro emphasized the life-changing impact the All-on-4 treatment concept has in the lives of patients, citing the remarkable case of Regina. In her early forties, Regina became edentulous (save for a few roots in the mandible) after a motor vehicle accident. With the help of Dr. Ferro and the All-on-4® treatment concept, she was able to regain confidence and a renewed sense of purpose. 16 years later, Regina is still very happy with the results.

The origins and evolution of the All-on-4 treatment concept

The evolution of the All-on-4 treatment concept has been marked by continuous innovation, with advancements such as zygomatic implants and the NobelSpeedy® implant, designed to offer stability even in soft bone. Dr. Ferro highlighted the importance of proper implant selection and placement, guided by classifications that consider bone quality and quantity.

The "secret weapon" of the All-on-4 treatment concept

What does Dr. Ferro consider to be the All-on-4® treatment concept’s “secret weapon?” In her words, "For me, the multi-unit abutments, I think, are one of the biggest secrets of the All-on-4." She said that the abutment is crucial because everything that is done after implant placement is at the abutment level. 

Dr. Ferro also discussed the remarkable results achieved with TiUltra™ implants and Xeal™ abutments, which have demonstrated high survival rates and minimal bone loss.

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Involving the patient in maintenance

Dr. Ferro emphasized the importance of patient involvement in the long-term success of the All-on-4 treatment concept. Patients need to understand how to maintain their prosthesis and peri-implant tissues.

Getting started with All-on-4 dental implants

For clinicians looking to get started with the All-on-4 dental implants, Dr. Ferro advises beginning with cases in the mandible, where bone is typically denser. She also recommends seeking hands-on training, mentorship, and gradually progressing from single-unit implants to full-arch rehabilitation.

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Avoiding and managing All-on-4 complications

In managing complications, Dr. Ferro highlighted the need for careful planning and being based on individual cases. She shared strategies for achieving primary stability and avoiding issues during implant placement.

When asked how she manages complications, Dr. Ferro mentioned some of the ways she avoids them. If she is unable to achieve primary stability, she investigates areas such as:

– Is it possible to drill a little bit more and approach it with a cortical implant? 
– Is it possible to get bicortical anchorage? 
– If the bone appears to be good, could a wider implant be used? 

Dr. Ferro recommends always under-preparing the implant site if you are unsure of whether the bone is soft, saying "If your implant gets stuck with a long way still to go – stuck already with 30 Ncm – you reverse it, take it out and you drill a little bit more." She also cautioned against assuming that the bone is hard – “it may just be that the drilling isn’t cutting.”

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