All on 4 Procedure

The “All-on-4” Procedure is a simple surgical technique, developed by a Portuguese doctor along with Nobel Biocare. It commenced in the beginning of the 1990´s, in order to rehabilitate the edentulous maxilla and mandible with fixed prostheses.

In this technique, 4 implants are placed in the anterior region of the jaw, which has the highest bone density and thus also represents the highest success rate. This allows the fitting of a fixed prosthesis with 12 to 14 teeth immediately on the day of surgery.

Through this technique, the rehabilitation of aesthetics and dental function can be achieved. Furthermore, the use of fewer implants simplifies and speeds up the surgical and prosthetic procedures. Hygienic maintenance is also favored, thus increasing the longevity of the rehabilitation.

Description

The “All-on-4” technique allows a full arch bridge to be place on four implants in the anterior region of the jaw. Two of these are off-centre at an angle of 30 to 45 degrees, thus allowing the maximum bone support.

The “All-on-4” technique allows doctors to place implants in patients with poor bone levels, who would normally require a bone graft prior to implant placement. The use of the “All-on-4” technique makes it possible for a dentist to achieve the complete reconstruction of a patient’s mouth, by fitting a dental prosthesis attached onto four points on implants.

During the procedure, a gum flap is raised and a small hole is drilled into the jaw-bone. This hole has exactly same length and width as needed to place the implant. The implant’s orientation must be very precise and it should be already determined before the surgery starts.

This procedure permits the patient to achieve the immediate functioning of the mandible and the maxilla and it will be done in two phases:

1st Phase

Surgical--In this phase, the patient will undergo surgery where the remaining teeth are removed, bone is contoured, and 4 implants are placed in positions predetermined during the treatment planning. Then, an interim full acrylic prosthesis is placed and fixed to these implants in the maxilla and mandible. This temporary full acrylic prosthesis has a life expectancy of between 6 months to 1 year.

2nd Phase

Prosthesis--This 2nd phase usually takes place 4 to 6 months after the 1st phase is finished. The goal is to install the final prosthesis, which can be made of ceramic or acrylic with titanium infrastructure, which is fabricated by the lab to be fixed by your dentist. It is the choice of the patient to decide whether to install the final prosthesis in ceramic or acrylic.

Risks, complications and side effects

The “All-on-4” surgical technique has the usual risks associated with any kind of oral surgery or other implant procedures. To prevent infections, the patient must always takes proper medication, including antibiotics and anti-inflammatory drugs. This medication is selected according to the patient’s general health condition and allergies.

Side effects associated with this procedure include bruising and swelling--which disappear after 5 to 10 days depending on the patient’s health condition and the type of surgery technique: “All-on-4”, “All-on-4 Hybrid”, “All-on-4 Zygoma”.

Patients receiving anti-clotting medication will tend to have a longer recovery time. Temporary numbness may also occur in some cases. The DSI specialist gives every patient appropriate medication, as well as an oral hygiene and a maintenance protocol before the surgery.

Below are the basic protocols to be followed. These protocols are adapted whenever necessary. By following these protocols, it reduces post-surgical discomfort and it helps to improve wound healing.

Post-operative care, Convalescence

The post-operative experience of an “All-on-4” surgery does not compromise “normal” life. However, some precautions are recommended, such as: apply ice on the post-operative area and eat soft and cold food during the first 48 hours after surgery.

It is also recommended to avoid exposure to sunlight and to adjust the sleeping position so that the patient’s head is kept higher than the body. The post-operative medication protocol must be followed because this has been planned to ensure a quicker healing process and a better control of pain and bruising.

Recovery time

Depending on the patient’s general health condition, recovery time for an “All-on-4” surgery varies from 5 to 10 days. From a systemic point of view, one day is usually all that is necessary for surgery recovery.

Aesthetically, because bruising and swelling may appear, the full recovery period ranges can be a little more prolonged - going from 5 up to 10 days. Usually, the patient is aesthetically recovered by the time that the stitches are removed during an appointment, 10 to 15 days after surgery.