All On 4
- initial procedure is done within 24 hours
- only highest quality materials: metal ceramics and zircon ceramics
- all the functionality of having your own teeth and a completely natural look after procedure
ALL ON 4 is a concept for the treatment of complete edentulousness and includes the installation of four implants in the jaw and the creation of a fixed dental bridge within 24 hours. This method is revolutionary due to the reduced number of required implants (before this method it was necessary to install at least 6-8 dental implants for a fixed bridge), the speed of making fixed teeth and reducing the cost for the patient. Nowadays, it is especially important that the patient can return to his life obligations with the complete aesthetic and masticatory function of the teeth on the second day after the procedure.
When is ALL ON 4 done? Two basic situations are successfully solved by the ALL ON 4 method. Patients who already have a edentulous jaw, but don’t want or cannot wear a total denture (irritation on vomiting, displacement of the prosthesis due to the shape of the jaw), are candidates for ALL ON 4. In patients whose remaining teeth cannot be repaired and included in prosthetic work, the solution is also: ALL ON 4. Such teeth are extracted immediately before the installation of dental implants. This is another great advantage of this method because in one treatment, tooth extraction procedures and implant placement are performed.
The procedure is planned in the morning, so that a temporary bridge can be built by the next day. The duration of the procedure is about 120-180 minutes and is performed under local anesthesia. The required procedure can also be performed under short-term general anesthesia. If the remaining teeth are extracted, modeling of the jaw ridge is also required. This procedure levels the level of the jawbone, which is important for the aesthetics and functionality of the bridge on the implants. Four implants are placed below the level of the bone to which the angular Multi-unit abutments are fixed. Multi-unit abutments allow the parallelization of implant outlet profiles that are installed at different angles. Parallelization of the implant outlet profiles is a prerequisite for a smooth and passive fit of the bridge structure, which effortlessly connects the implants and is fixed to them with screws.
Construction of a temporary bridge
After fixing the Multi-unit abutment, a jaw impression is taken and the intermaxillary relationships are determined to make a temporary bridge. A few hours after the implantation procedure, the patient comes to a test of a temporary bridge on which the shape and size of the teeth, the bite, the relationship to the jaw ridge are assessed. The next day, the temporary bridge is fixed to the implants with screws, thus completing the first phase. The temporary bridge is made of acrylate and is worn for six months.
Hygiene and cleaning The cleaning of the bridge on four implants is specific and differs from the techniques of cleaning natural teeth. Because the bridge is a one-piece structure and there are no gaps between individual teeth, the bridge is cleaned as a single unit. All accessible surfaces of the bridge are cleaned with a toothbrush. The areas around the implant should be additionally cleaned with an interdental brush and an oral shower. It is especially recommended to use an oral shower that cleans the basal side of the bridge that rests on the gingiva (gums), it is definitely recommended to use dental floss with an extension to clean the bridge that sits on the gums. At the regular annual inspection, the bridge can be removed, professionally cleaned and polished as needed. Sometimes it is necessary to replace the fixation screws of the bridge for the dental implant. It is recommended to use non-alcoholic mouthwash once a day to disinfect the oral cavity.
ALL ON 4 planning
The ALL ON 4 method was developed in response to the impossibility of direct implant placement in the posterior parts of the jaw. The reasons for this were the resorption of the jawbone and the proximity of anatomical structures (maxillary sinus, mandibular nerve). In order to obtain sufficient bone volume for implant placement, previous bone augmentation procedures (addition of artificial bone) or nerve displacement were required. Due to the length of such multi-stage procedures and high costs, a large number of patients have given up on such procedures.
In the ALL ON 4 method, two implants are placed vertically in the central part of the jaw, in the position of two. The posterior implants are placed at an angle of 30-45 degrees so that the implant protrudes from the jaw in the area of the second premolar. Such an oblique position of the implant in the jaw bypasses critical areas for reduced bone volume; the maxillary sinus in the upper jaw and the mandibular nerve in the lower jaw. A 3D CBCT image of the jaw is required to plan the procedure. Such an image allows precise planning of the position of the implant with respect to the volume and density of the jawbone. A prerequisite for making a temporary bridge is the primary stability of the implant. The length, shape and surface of the implant on the one hand, and the quality of the bone on the other hand are decisive factors for achieving the primary stability of the implant and the possibility of making a temporary bridge within 24 hours. For ALL ON 4 we use only AnyRidge by MEGAGEN implants.
ALL ON 4 durability
After the process of osseointegration, dental implants become part of the organism and as such remain permanently in the jaw. The bridge on the implants changes after approximately 10 years, depending on changes in the surrounding tissues.
Construction of a permanent bridge
A permanent bridge is built six months after the implants are placed. This period is necessary for the hard and soft tissues of the jaw to assume their stable shape. The temporary bridge is easily and painlessly dismantled by removing the screws and a jaw impression is taken for the permanent bridge. A total of four arrivals are required to build a permanent bridge; two arrivals in two days, after 14 days two more arrivals in two days. During the construction of a permanent bridge, the patient wears a temporary bridge so that he is not without teeth at any time.
Materials for making a permanent bridge
The materials for making a permanent bridge are hybrid metal acrylate, metal composite, metal ceramics and zircon ceramics. The bridge construction connects the implants and has openings for fixing the screw to the implant. The construction is made of metal or zircon. The working model with laboratory implants is digitized by the scanning process and the construction is planned in the computer software. The metal construction is made using a 3DPrinter, because in this way the most precise constructions without internal tension of the metal are obtained, which are created by the classical casting process due to a large thermal oscillation. The zircon construction is obtained by milling from a zirconceramic block.
The aesthetic material applied to the structure can be composite or ceramic. A composite is a hybrid material obtained by mixing ceramic particles into polymer resins (plastics). It combines the good properties of both materials. Ceramic particles give the composite strength, wear resistance and aesthetics, while polymer resins give ease of handling, fast polymerization and a more favorable price. The composite is a very good aesthetic material for ALL ON 4 works due to its good aesthetics and the ability to characterize the color of teeth and gingiva (gums). In addition, it is characterized by the absorption of chewing stress, which is comfortable for the patient when chewing harder food. Ceramics is uncompromisingly the best material for the highest aesthetic requirements, regardless of whether it is applied to a metal or zircon construction. The advantage of the zircon construction is the deep, three-dimensional color effect of the entire work as it absorbs rather than reflects the light passing through the ceramic layers.