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Just four implants, but countless benefits

by: Michael Stuart

All-on-4® treatment concept − The scientifically proven solution for edentulous and soon-to-be-edentulous patients.

Working with just four abutments to restore a full jaw, accurate implant placement in essential. NobelClinician and NobelGuide provide predictably precise digital planning and guided surgery templates.

Professor Per-Ingvar Brånemark put it this way: “No one should die with their teeth sitting in a glass of water.” This simple statement by the pioneer of osseointegration serves as the inspiration for Nobel Biocare’s mission, “Designing for Life.”

Unfortunately however, edentulism remains a very real problem for millions of people around the world. The World Health Organization (WHO) even goes so far as to classify it as a physical impairment; and it is on the increase. 

Although WHO reports have identified an overall improvement in oral health globally, as more people live to reach old-age, the number of people suffering from edentulism continues to rise. 

This represents an incredible chance for dental professionals to make a constructive contribution.

Per-Ingvar Brånemark started a revolution by treating edentulous patients first, and it is still in edentulous cases where clinicians can have the biggest impact on patient quality of life today. This is why Nobel Biocare is so eager to help dental professionals treat more patients better with the scientifically proven All-on-4® treatment concept.

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Fewer implants, better results

The All-on-4® treatment concept was developed to provide edentulous and soon-to-be-edentulous patients with an efficient and effective restoration that uses only four implants to support immediately loaded, fixed full-arch prostheses. By tilting the two posterior implants, longer implants can be used in reduced bone volume, increasing bone-to-implant contact and reducing the need for vertical bone augmentation. As tilted posterior implants can be anchored in better quality anterior bone, cantilevers are reduced, improving support for the prostheses. Tilting also reduces the need for bone augmentation. 

It’s an approach that is less invasive and cost-intensive for the patient than conventional implant restoration (based on more implants), more efficient for the clinician and, most importantly, is clinically validated to work.

Supported by almost 15 years of clinical success, the All-on-4® treatment concept offers a reliable solution for patients looking to escape the discomfort that so often comes from wearing a removable denture. 

As Dr. Paulo Malo points out, “Dozens of clinical studies have uncontestedly documented the safety and efficacy—and remarkably high success rates—of the All-on-4® treatment concept.”

Suitable for many different patient groups

Every patient is different, but thanks to Nobel Biocare’s extensive range of products and solutions, the All-on-4® treatment concept is suitable for use in a wide range of cases. 

The Multi-unit Abutments required are available for all Nobel Biocare implant systems. Thanks to the high primary stability that can be obtained  by implant innovations such as NobelSpeedy and NobelActive, Immediate Function can be achieved even in patients exhibiting severe bone resorption. In cases with severely atrophic maxillae, the concept usually can be adapted to incorporate zygomatic implants. This revolutionary treatment concept also offers flexibility when it comes to prosthetics. Given that they leave the surgery with fixed provisional prostheses, patients taking advantage of the All-on-4® treatment concept benefit from the renewed confidence offered by an implant-supported restoration straight away. 

Related article: Multi-unit Abutment – Key to the All-on-4® treatment concept

When using a conscientious system approach, options for the final restorative solution include fixed prostheses, such as the conventionally veneered NobelProcera Implant Bridge Zirconia or Titanium with acrylic, composite or ceramic veneering, as well as individual NobelProcera Crowns cemented to the NobelProcera Implant Bridge framework. Our implant bar solutions also offer a wide range of options from fixed implant bars, such as the hybrid bar, to fixed removable solutions.

Predictable placement with NobelGuide

When restoring a full arch using just four implants, accurate placement is essential. Guided surgery using NobelGuide is therefore optimized for All-on-4® treatment concept cases. 

Diagnostics and treatment planning are supported by the NobelClinician Software. Using (CB)CT diagnostic imaging of the patient and a radiographic guide, NobelClinician facilitates safe, accurate implant placement. 

By using the radiological data set with 3D models of bone and the radiographic guide in combination, the clinician can assess the quantity and quality of the bone available. Vital anatomical structures such as the alveolar nerve and the maxillary sinus can also be marked so that prosthetic-driven planning can be conducted with no unknown limitations. 

The split-screen view in the software allows the user to control and customize the angulation of the dental reslice planes—ensuring that the tilted posterior implants, which are fundamental to the All-on-4® treatment concept, are optimally positioned. After completing precise planning in NobelClinician, ordering a ready-to-use surgical template and all the components required for the surgery is just a few clicks away. 

The NobelGuide surgical template enables guided implant site preparation, as well as accurate implant insertion, minimizing pain and swelling for the patient. 

The surgical template can also be used to begin developing fixed temporary prostheses prior to surgery. It enables the creation of a stone model with implant replicas in advance. 

This means the dental technician can also produce the abutment placement jig and the fixed provisional prostheses ahead of time. All that remains is for the clinician to mount the final prosthesis and do adaptations, if applicable.

The patient leaves the practice with a brand new set of teeth, and many other benefits besides.

Restoring more than a smile

The All-on-4® treatment concept is becoming a popular choice for patients and it’s easy to see why. Reduced cost and less trauma compared to bone augmentation, Immediate Function and excellent esthetic results are all clear benefits, as is the prospect of a solution that feels like natural teeth.

Restored chewing ability, clear speech, and high esthetics and comfort—the list of attributes that can help drive patient acceptance goes on and on. Above all, the combination of these benefits leads to a life-improving result: the return of a patient’s self confidence

Dramatic demographic shift

In 2012, those aged 60 years or older accounted for eleven percent of the world’s population—approximately 810 million people. During the next four decades, this older population is projected to increase very quickly. By 2050, its size will reach over two billion. 

While these demographics represent a formidable challenge for dental professionals, thanks to the All-on-4® treatment concept, they also provide an incredible opportunity for the well-prepared.

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