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Albaqawi AH. "All-on-4" and "All-on-6" treatment concept applied using computer-guided surgery in a patient: Case report with a 2-year follow-up. Clin Case Rep 2023; 11:e7101. [PMID: 36937624 PMCID: PMC10014524 DOI: 10.1002/ccr3.7101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
This case aimed to assess the clinical and radiographic outcomes of the All-on-4 and the All-on-6 concept using three-dimensional computer-assisted treatment planning, and computer-guided surgery. Two years after the treatment, the "All-on-4" and "All-on-6" concepts provided effective treatment for immediate restoration and showed predictable outcomes in a completely edentulous patient.
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Affiliation(s)
- Ahmed Heji Albaqawi
- Department of Restorative Dental ScienceCollege of DentistryUniversity of HaˈilHaˈilKingdom of Saudi Arabia
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Gaonkar SH, Aras MA, Chitre V, Mascarenhas K, Amin B, Rajagopal P. Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four™ concept: A systematic review. J Indian Prosthodont Soc 2021; 21:3-10. [PMID: 33835063 PMCID: PMC8061444 DOI: 10.4103/jips.jips_100_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of this review was to evaluate the survival rate of axial and tilted implants in rehabilitation of edentulous jaws using all on four concept. Setting and Design: Systematic Review. Materials and Methods: A literature review was performed in MEDLINE, PubMed Central (PMC), Google scholar, Embase, Cochrane Central Register of Controlled Trials. Hand searches were conducted of the bibliographic of related journals and systematic reviews. A total of 380 articles were obtained from the intial screening process. Of these articles, 25 articles fulfilled the inclusion criteria. The authors performed evaluation of articles independently as well as data extraction and quality assessment. Statistical Analysis Used: Qualitative analysis. Results: The major prosthetic complication was the fracture of the acrylic prosthesis. The mean cumulative survival rate of implants (72-132 months) were 94% to 98%. The prosthesis survival rate (12 months) was between 99% to 100%. The averaged bone loss was 1.3 ±0.4 mm (12-60 months). No Significant difference was found between survival rates of axial and tilted implants nor between maxilla and mandible. Conclusion: All on four concept can be employed successfully in the edentulous patients with resorbed ridges while improving their quality of life and reducing morbidity. However,randomized clinical trials with large sampling size and long term follow up should be incorporated.
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Affiliation(s)
| | - Meena Ajay Aras
- Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Vidya Chitre
- Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Kennedy Mascarenhas
- Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Bhavya Amin
- Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Praveen Rajagopal
- Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India
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Coskunses FM, Tak Ö. Clinical performance of narrow-diameter titanium-zirconium implants in immediately loaded fixed full-arch prostheses: a 2-year clinical study. Int J Implant Dent 2021; 7:30. [PMID: 33860375 PMCID: PMC8050379 DOI: 10.1186/s40729-021-00312-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim of this study was to evaluate the outcomes of immediate fixed full-arch prostheses supported by axial or tilted narrow-diameter Ti-Zr implants (3.3 mm) (Roxolid®, Institut Straumann® AG, Basel, Switzerland) (NDIs) in combination with standard-diameter implants up to 2 years’ follow-up. Materials and methods The study was conducted at Kocaeli University Faculty of Dentistry from 2016 to 2018. 37 jaws of 28 patients with an average age of 52 years were rehabilitated with fixed full-arch prostheses supported by 179 implants. Cumulative survival rate (CSR), implant success, marginal bone loss (MBL), and prosthetic survival rate as well as complications were analyzed. Results Total CSR of 99.4% and 98.5% for all and narrow implants respectively have been observed at 2 years’ follow-up. No prosthesis failures were observed, yielding a cumulative prosthetic survival rate of 100%. The NDIs achieved 0.63 mm MBL at 1 year and 1.02 mm at 2 years. The mean MBL at 1 year was 0.51 mm (mandible 0.63 mm/maxilla 0.41 mm) and 0.73 mm (mandible 0.90 mm/maxilla 0.43 mm) at 2 years. Both implant angulation and loading protocol did not influence the MBL. Conclusions The combination of narrow-diameter implants with standard-diameter implants in immediate fixed full-arch rehabilitation has a good prognosis to become a new standard of care for severely atrophic jaws. Clinical relevance The use of narrow-diameter implants in fixed full-arch rehabilitations in atrophic ridges would be a successful and predictable treatment approach.
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Affiliation(s)
- Fatih Mehmet Coskunses
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Kocaeli, 41190, Kocaeli, Turkey.
| | - Önjen Tak
- Department of Prosthodontics, Faculty of Dentistry, Istanbul Okan University, Tuzla, Istanbul, Turkey
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Daudt Polido W, Aghaloo T, Emmett TW, Taylor TD, Morton D. Number of implants placed for complete‐arch fixed prostheses: A systematic review and meta‐analysis. Clin Oral Implants Res 2018; 29 Suppl 16:154-183. [DOI: 10.1111/clr.13312] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/03/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Waldemar Daudt Polido
- Department of Oral and Maxillofacial SurgeryIndiana University School of Dentistry Indianapolis Indiana
| | - Tara Aghaloo
- Department of Oral and Maxillofacial SurgeryUCLA School of Dentistry Los Angeles California
| | - Thomas W. Emmett
- Ruth Lilly Medical LibraryIndiana University School of Medicine Indianapolis Indiana
| | - Thomas D. Taylor
- Department of Reconstructive SciencesUniversity of Connecticut School of Dental Medicine Farmington Connecticut
| | - Dean Morton
- Department of ProsthodonticsIndiana University School of Dentistry Indianapolis Indiana
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Abstract
OBJECTIVE This systematic review evaluated survival rates, marginal bone loss (MBL), and complications of using 2 to 4 implants to support full-arch fixed prostheses in the mandible. MATERIALS AND METHODS An electronic search was performed in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify relevant articles published until March 2015. Articles were critically reviewed to determine the level of quality. RESULTS The initial search resulted in 910 articles from PubMed/MEDLINE, 162 titles from the Cochrane Central Register of Controlled Trials, and 363 from the Web of Science. After an initial assessment and careful reading, 19 studies published between 1999 and 2014 were included in this review. CONCLUSIONS The results of this review suggest that full-arch fixed dental prosthesis in mandible supported by 2 to 4 implants exhibited a low rate of failures for implants and prostheses, a low rate of MBL, and a low rate of biomechanical and biological complications.
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Soto-Penaloza D, Zaragozí-Alonso R, Penarrocha-Diago M, Penarrocha-Diago M. The all-on-four treatment concept: Systematic review. J Clin Exp Dent 2017; 9:e474-e488. [PMID: 28298995 PMCID: PMC5347302 DOI: 10.4317/jced.53613] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
Objectives To systematically review the literature on the “all-on-four” treatment concept regarding its indications, surgical procedures, prosthetic protocols and technical and biological complications after at least three years in function. Study Design The three major electronic databases were screened: MEDLINE (via PubMed), EMBASE, and the Cochrane Library of the Cochrane Collaboration (CENTRAL). In addition, electronic screening was made of the ‘grey literature’ using the System for Information on Grey Literature in Europe - Open Grey, covering the period from January 2005 up to and including April 2016. Results A total of 728 articles were obtained from the initial screening process. Of these articles, 24 fulfilled the inclusion criteria. Methodological quality assessment showed sample size calculation to be reported by only one study, and follow-up did not include a large number of participants - a fact that may introduce bias and lead to misleading interpretations of the study results. Conclusions The all-on-four treatment concept offers a predictable way to treat the atrophic jaw in patients that do not prefer regenerative procedures, which increase morbidity and the treatment fees. The results obtained indicate a survival rate for more than 24 months of 99.8%. However, current evidence is limited due the scarcity of information referred to methodological quality, a lack of adequate follow-up, and sample attrition. Biological complications (e.g., peri-implantitis) are reported in few patients after a mean follow-up of two years. Adequate definition of the success / survival criteria is thus necessary, due the high prevalence of peri-implant diseases. Key words:All-on-four, all-on-4, tilted implants, dental prostheses, immediate loading.
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Affiliation(s)
- David Soto-Penaloza
- Collaborating Lecturer, Master in Oral Surgery and Implant Dentistry, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Regino Zaragozí-Alonso
- Dentist, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - María Penarrocha-Diago
- Assistant Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Miguel Penarrocha-Diago
- Professor and Chairman of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
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Horita S, Sugiura T, Yamamoto K, Murakami K, Imai Y, Kirita T. Biomechanical analysis of immediately loaded implants according to the "All-on-Four" concept. J Prosthodont Res 2016; 61:123-132. [PMID: 27615425 DOI: 10.1016/j.jpor.2016.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 07/06/2016] [Accepted: 08/08/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to investigate the biomechanical behavior of immediately loaded implants in an edentulous mandible according to the "All-on-Four" concept. METHODS A 3D-finite element model of an edentulous mandible was constructed. Four implants were placed between the bilateral mental foramen according to "All-on-Four" concept. A framework made of titanium or acrylic resin between the bilateral first molars was modeled. Immediate loading and a delayed loading protocol were simulated. A vertical load of 200N was applied at the cantilever or on the abutments region of the distal implants, simulating the absence of a cantilever. RESULTS The peak principal compressive strains in the immediate loading models resulted in 24.0-35.8% and 26.4-39.0% increases compared with the delayed loading models under non-cantilever loading and cantilever loading, respectively. The loading position greatly affected the principal compressive and tensile strain values. The peak principal compressive strains in non-cantilever loading resulted in a 45.3-52.6% reduction compared with those in cantilever loading. The framework material did not influence the peak compressive and tensile strain. The maximum micromotion at the bone-implant interface in the immediate loading models was 7.5-14.4μm. CONCLUSIONS Mandibular fixed full-arch prostheses without cantilevers may result in a favorable reduction of the peri-implant bone strain during the healing period, compared with cantilevers. The maximum micromotion was within the acceptable limits for uneventful implant osseointegration in the immediate loading models. Framework material did not play an important role in reducing the peri-implant bone strain and micromotion at the bone-implant interface.
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Affiliation(s)
- Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
| | - Tsutomu Sugiura
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Yuichiro Imai
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan
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Niedermaier R, Stelzle F, Riemann M, Bolz W, Schuh P, Wachtel H. Implant-Supported Immediately Loaded Fixed Full-Arch Dentures: Evaluation of Implant Survival Rates in a Case Cohort of up to 7 Years. Clin Implant Dent Relat Res 2016; 19:4-19. [PMID: 27196731 DOI: 10.1111/cid.12421] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/11/2016] [Accepted: 03/15/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The treatment of severely atrophied and edentulous jaws by means of fixed implant supported solutions is a challenging procedure. PURPOSE The immediate loading of four to six axial and tilted implants offers the possibility to overcome elaborate hard tissue augmentation procedures but lacks implant and patient related data on implant survival rates. MATERIALS AND METHODS This retrospective 7-years clinical trial investigated the implant survival rates of 2,081 implants (380 patients, 482 jaws) using an immediate loading protocol with either 4, 5, or 6 implants per restoration. Survival rates were calculated concerning implantation related factors (jaws/number of supporting implants/angulations/diameters/lengths) and patient related factors (medical status/smoking). RESULTS Overall survival of 2,081 implants was 97.0% on implant level. Survival rates of implantation related factors did not yield significant differences. Significant differences were yield between healthy patients and patients with osteoporosis (p = .002) and the medical status group "other" (p = .032), respectively. Smokers yielded a significantly higher survival than nonsmokers (p = .002). CONCLUSIONS It is assumed that four implants per jaw serve as a sufficient implant number for full arch restorations in both, the mandible and the maxilla. Osteoporosis under the medication with bisphosphonates seems to be a risk factor for implant survival. The authors suggest that the effect of smoking on ISRs remains controversial within this treatment concept.
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Affiliation(s)
- Robert Niedermaier
- Dentist, Implaneo Dental Clinic, Private Institute of Periodontology and Implantology, Munich, Germany.,Department of Restorative Dentistry, Charité-Medical University Berlin, Germany
| | - Florian Stelzle
- Dentist, Implaneo Dental Clinic, Private Institute of Periodontology and Implantology, Munich, Germany.,Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Max Riemann
- Dentist, Implaneo Dental Clinic, Private Institute of Periodontology and Implantology, Munich, Germany
| | - Wolfgang Bolz
- Dentist, Implaneo Dental Clinic, Private Institute of Periodontology and Implantology, Munich, Germany
| | - Paul Schuh
- Dentist, Implaneo Dental Clinic, Private Institute of Periodontology and Implantology, Munich, Germany
| | - Hannes Wachtel
- Dentist, Implaneo Dental Clinic, Private Institute of Periodontology and Implantology, Munich, Germany.,Department of Restorative Dentistry, Charité-Medical University Berlin, Germany
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Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I. All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level. Clin Implant Dent Relat Res 2014; 17 Suppl 2:e531-41. [PMID: 25536438 DOI: 10.1111/cid.12282] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies are needed to evaluate long-term outcomes of the All-on-4® treatment concept (Nobel Biocare AB) for rehabilitation of edentulous mandibles by assessing marginal bone levels and risk indicators for implant failure. PURPOSE To evaluate 7-year clinical outcomes and 5-year radiographic outcomes of the All-on-4 treatment concept. MATERIALS AND METHODS This retrospective case series included patients admitted for implant rehabilitations in the mandible, who were followed for 7 years clinically and 5 years radiographically. Primary outcome measures were cumulative prosthetic and implant survival using patient as the unit of analysis (Kaplan-Meier product limit estimator). Secondary outcome measure was marginal bone level (MBL) at 5 years. Variables associated with implant failure were analyzed using the Cox proportional hazards regression model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Binary logistic regression was used to compute odds ratio (OR) with 95% CIs for variables associated with MBL ≥2.8 mm at 5 years. RESULTS A total of 324 patients (194 women, 130 men, average age = 58.9 years) were rehabilitated with 1,296 implants supporting 324 full-arch fixed immediately loaded mandibular prostheses. Sixty-four patients (19.8%) were lost to follow-up. Prosthetic survival was 323/324 (99.7%), and 14 patients lost 18 implants, with an estimated cumulative survival rate of 95.4% at 7 years. Variables associated with implant failure were smoking (HR = 5.28; 95% CI: 1.33, 20.91]) and the learning curve effect (0.69 < HR < 0.33 for more experienced levels). Mean MBL at 5 years was 1.81 mm (95% CI: 1.70, 1.92), and smoking was associated with MBL ≥2.8 mm (OR = 2.4; 95% CI: 1.02, 5.62). CONCLUSIONS The high implant and prosthetic survival rates and excellent MBL outcome confirm the predictability and safety of the All-on-4 treatment concept over a longer term than previously reported.
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Affiliation(s)
- Paulo Maló
- Oral Surgery Department, Maló Clinic, Lisbon, Portugal
| | | | - Armando Lopes
- Oral Surgery Department, Maló Clinic, Lisbon, Portugal
| | - Ana Ferro
- Oral Surgery Department, Maló Clinic, Lisbon, Portugal
| | - Inês Gravito
- Oral Surgery Department, Maló Clinic, Lisbon, Portugal
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Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. A Retrospective Analysis of 800 Brånemark System Implants Following the All-on-Four™ Protocol. J Prosthodont 2013; 23:83-8. [DOI: 10.1111/jopr.12089] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Thomas J. Balshi
- Founder and Prosthodontist; PI Dental Center at the Institute for Facial Esthetics; Fort Washington PA
| | - Glenn J. Wolfinger
- Prosthodontist; PI Dental Center at the Institute for Facial Esthetics; Fort Washington PA
| | - Robert W. Slauch
- Research Associate; PI Dental Center at the Institute for Facial Esthetics; Fort Washington PA
- Dental Student, University of Maryland; Baltimore College of Dental Surgery; Baltimore MD
| | - Stephen F. Balshi
- Director of Research; PI Dental Center at the Institute for Facial Esthetics; President, CM Prosthetics, Inc; Fort Washington PA
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Patzelt SBM, Bahat O, Reynolds MA, Strub JR. The All-on-Four Treatment Concept: A Systematic Review. Clin Implant Dent Relat Res 2013; 16:836-55. [DOI: 10.1111/cid.12068] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sebastian B. M. Patzelt
- Department of Prosthodontics; School of Dentistry; University Hospital; Freiburg Germany
- Department of Periodontics; School of Dentistry; University of Maryland Baltimore; Baltimore MD USA
| | | | - Mark A. Reynolds
- Department of Periodontics; School of Dentistry; University of Maryland Baltimore; Baltimore MD USA
| | - Joerg R. Strub
- Department of Prosthodontics; School of Dentistry; University Hospital; Freiburg Germany
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