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

My partner, Giovanni Castellucci, and I have been placing dental implants in our periodontal practice for over 27 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.

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. And, let us not forget that many people with hopeless teeth due to severe gum disease or decay oftentimes avoid treatment because of fear of having to wear a complete removable denture. The "All-On-4" treatment is the perfect solution for these patients as they can have their natural teeth replaced by non-removable, fixed implant-supported teeth on the same day in one dental appointment.

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
PERIODONTAL ASSOCIATES
photo credit:

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Comment by Meera Dental Hospital on September 6, 2014 at 3:50am

Dental implant is a surgical process for losing teeth. It is biologic process called osseointegration where materials such as titanium form an intimate bond to bone. Dental implant improves appearance, speech and oral health. Thanks for sharing useful information about dental implant. Dental Implant Cost in Jaipur

Comment by Cary Feuerman, DMD on May 9, 2013 at 8:12am

Steffany, thanks for your comments.  There is a lot of research to support the All-On-4 treatment protocol.  I have listed two fairly recent publications, and a brief summary of some literature from NobelBiocare. 

http://www.nobelbiocare.com/Images/en/i1548-1336-37-4-431_Babbush_0...

http://www.nobelbiocare.com/Images/en/GMT28317_All_on_4_Science_Fir...

http://www.nobelbiocare.com/Images/en/Mal%C3%B3%20JADA%202011_tcm26...

The "All-On-4" dental implant treatment protocol has proven to be a "life changer" for many patients. 

Comment by Dr. Steffany Mohan on April 18, 2013 at 6:33am

The "All-On-4" Implant/Prosthetic service for patients is a very good move and would benefit them tremendously. And yes, I would also be interested in knowing the long term results in the future. Please share it with us.

Comment by Cary Feuerman, DMD on September 21, 2012 at 9:17pm

Good comments Ira.  Thanks.  Can you elaborate on the fabrication technique of the cad cam framework?

Comment by Ira N. Dickerman, CDT on September 20, 2012 at 2:56am
There seems to be a renewed interest in the classic hybrid prosthesis. Denture teeth on a cad cam manufactured framework offer greater Economy of manufacture then conventional cast prosthesis The ability of this prosthesis to easily replace missing hard and soft tissues is key. The critical factor to determine suitability and application is the patient's smile line and ridge height. When these designs do not have an opportunity to bury the junction of the prosthetic margin below the lip line esthetic results can be very difficult. additionally leveling of the residual alveolus further enhances the esthetics and symmetry of these types of prosthesis.
Comment by Monique Mabry DMD on March 21, 2010 at 5:00pm
I welcome the opportunity to provide this "All-On-4" Implant/Prosthetic service to my patients. Over the years I have made fewer and fewer dentures for my senior patients but it takes something like this to spark up the interest in making dentures that far exceed my patients expectations. I am interested in the protocol and how to communicate to the lab once the case is treatment planned. Monique Mabry
Comment by Cary Feuerman, DMD on March 21, 2010 at 9:21am
Jim, thank you for your comments. Yes, every case has to be evaluated on its own merits to determine if the patient is truly a candidate for this protocol. Many cases require a traditional staged approach, as well as the use of additional implant fixtures. As you and I have been involved with the successful restoration of thousands of dental implant fixtures for over 20 years, we understand that there is no substitute for comprehensive evaluation, treatment planning, experience and expertise!
Comment by james m. stein on March 20, 2010 at 6:11pm
Cary, This is a great service for those patient's demanding an immediate implant supported fixed bridge prosthesis. While it is "simple" in expert hands like yours and Giovanni's , there are many diagnostic considerations. Some of these are the opposing occlusion, inter-arch and intra-arch dimensions, bone quality,implant length and spacing, cantilever length, prosthesis height and technical execution at the time of insertion. Please let us know your long term results in the future.

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