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"All-On-4" Dental Implant Restorations (Teeth in a Day) in Boston, Newton, and Framingham - What About You?

My partner, Giovanni Castellucci, and I have been placing dental implants in our periodontal practice for over 20 years. In the early days, the Branemark"hybrid" prosthesis was the standard of care for restoration of fully edentulous patients with five or six implant fixtures. We followed the traditional two-stage protocol and our patients enjoyed tremendously successful outcomes which have improved their quality of life. However, as time progressed, the hybrid prosthesis became less popular as more conventional PFM fixed restorations were fabricated on custom abutments.

In recent years, we have seen a resurgence of the use of the hybrid prosthesis with the "All-On-4" Immediate Dental Implant (Teeth in a Day) protocol. Now, we successfully restore fully edentulous arches on four implant fixtures on the same day that the hopeless teeth are removed, oftentimes without the need for bone grafts. Our patients are thrilled with the results, and the functional and  esthetic benefits are instant.

Yet, when speaking with many of our restorative colleagues in Boston, Newton, Framingham, and  the Metrowest communities, I occasionally hear them say "my practice doesn't have edentulous patients", or "we don't make dentures". This would imply that the demographic profile of these practices does not include a major component of the general population. Yet, we know that millions (if not billions) of dollars are spent annually on denture adhesives, and that the national dental clinics that focus on denture fabrication are thriving.

In our practice, we see "All-On-4" patients from all communities, even the most affluent. After all, dental and periodontal diseases do not discern one community from another. With this in mind, we urge all clinicians to "open their eyes" to the benefits of immediate dental implant restorations as another tool to help enhance the lives of our patients.

Have any of you had similar experiences? Please share them with the community.

Cary Feuerman, DMD
www.periodontal.com

photo credit:

Tags: All-On-4, Boston, Framingham, Metrowest, Newton, associates, dental, implant, periodontal, teeth-in-day

Views: 546

Replies to This Discussion

% of integration?

sir, 

    whats success rate to all on 4 hybrid prosthesis?

    what should be minimum diameter and length of implants for this type of case?

    can we give PFM bridge over this?  if yes, what will be impact of MMF?

There have been many publications regarding the All-on-4. Below are listed some of those articles including its clinical success over the years, authors, titles, and publications.

  • 1. Maló P, Rangert B, de Araújo, Nobre M. "All-on-Four" immediate-function concept with Brånemark System® implants for completely edentulous mandibles: A retrospective clinical study. Clin Implant Dent Relat Res 2003; 5 (Suppl 1): 2-9.
  • 2. Maló P, Rangert B, de Araújo, Nobre M. All-on-4 immediate-function concept with Brånemark System® implants for completely edentulous maxillae: A 1-year retrospective clinical study. Clin Implant Dent Relat Res 2005; 7 (Suppl 1): 88-94.
  • 3. Maló P, de Araújo, Nobre M, Petersson U, Wigren S. A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: Case series. Clin Implant Dent Relat Res 2006; 8:223-232
  • 4. Maló P, de Araújo, Nobre M, Lopes A. The use of computer-guided flapless implant surgery and 4 implants placed in immediate function to support a fixed denture: Preliminary results after a mean follow-up period of 13 months. J Prosthet Dent 2007; 97 (suppl): 26-34.
  • 5. Davo Rodriguez, Malevez C and Rojas J. Immediate FunctionT in atrophic upper jaw using Zygoma implants. J Prosthet Dent 2007; 97 (suppl): 44-51.
  • 6. Tulasne J F. Osseointegrated fixtures in the pterygoid region. in: Advanced osseointegration surgery. Applications in the maxillofacial region. Worthington P; Brånemark PI.- Chicago, USA: Quintessence Publ. Co, Inc. 1992.- p. 182-188.
  • 7. Graves SL. The pterygoid plate implant: a solution for restoring the posterior maxilla. Int J Periodontics Restorative Dent, 1994; 4: 512-523.
  • 8. Parel S, Brånemark PI, Ohrnell LO, Svensson B. Remote implant anchorage for the rehabilitation of maxillary defects. J Prosthet Dent 2001; 86: 377-381.
  • 9. Vrielinck L, Politis C, Schepers S, Pauwels M, Naert I. Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow-up study. Int. J Oral Maxillofac Surg 2003; 32:7-14.
  • 10. Hirsch J-M, Henry P, Andreasson L et al. A clinical Evaluation of the Zygoma Fixture. One-year follow-up at 16 clinics. J Oral Maxillofac Surg 2004; 9 (Suppl): 22-29.
  • 11. Krekmanov L, Kahn M, Rangert B, Lindström H. Tilting of posterior mandibular and maxillary implants of improved prosthesis support. Int J Oral Maxillofac Implants 2000; 15: 405-414.
  • 12. Aparicio C, Perales P, Rangert B. Tilted implants as an alternative to maxillary sinus grafting: A clincal, radiologic, and periotest study. Clin Implant Dent Relat Res 2001; 3: 39-49.
  • 13. Fortin Y, Sullivan R, Rangert B. The Marius implant bridge: surgical and prosthetic rehabilitation for the completely edentulous upper jaw with moderate to severe resorption: A 5-year retrospective clinical study. Clin Implant Dent Relat Res 2002; 4: 69-77.
  • 14. Aparicio C, Arevalo X, Ouzzani W, Granados C. A retrospective clinical and radiographic evaluation of tilted implants used in the treatment of severely resorbed edentulous maxilla. Appl Osseointegrat Res 2003; 1: 17-21.
  • 15. Calandriello R, Tomatis M, Rangert N, Gottlow J. Immediate FunctionT of tilted implants in the atrophic posterior maxilla. Clin Oral Impl Res 2004; 15: 1xxi
  • 16. Calandriello R, Tomatis M. Simplified Treatment of the Atrophic Posterior Maxilla via Immediate/ Early Function and Tilted Implants: A Prospective 1-Year Clinical Study. Clin Implant Dent Relat Res. 2005; 7 Suppl 1:S1-126
  • 17. Block, Michael S, Haggerty, Christopher J, Fisher G. Rawleigh Nongrafting Implant Options for Restoration of the Edentulous Maxilla. J Oral Maxillofac Surg 2009; 4: 872-881

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