Author: Marin Karabaić, dr.med.dent.
All-on-4 therapy procedure
All on 4 is currently one of the most well-known surgical methods of dental implant placement in dentistry. It indicates the placement of 4 dental implants, on which prosthetic work is fixed, restoring the patient's natural appearance and improving their quality of life.
All on 4 is a medical procedure of dental implant placement intended for all people who are toothless or have advanced periodontitis with the remaining teeth being in poor condition, regardless of whether it is the upper or lower jaw.
The most important thing during the first visit is to define a treatment plan with the patient himself. Upon arrival at the clinic, a 3D X-ray is made for the most accurate planning of the procedure. Based on analysis of the X-ray and the clinical condition in the patient's mouth, a therapy plan is developed and explained in detail to the patient. It is important to talk to the person undergoing the procedure about his/her expectations and define the aesthetics of the final prosthetic work.
Once the patient has agreed to a treatment plan, surgery is performed.
The remaining teeth, should there be any, are surgically removed and 4 dental implants are placed.
The surgery itself lasts 2 hours and is completely painless. Immediately after the placement of the dental implants, an impression is taken and the laboratory makes a fixed temporary prosthetic work, which is fastened with screws to 4 previously placed dental implants on the same day. The great advantages of this method are that only one operation performs all the surgical work, it is a minimally invasive method, the recovery time is short, and the patient immediately walks away with fixed teeth, restoring both his/her smile and self-confidence.
The patient returns home with temporary fixed teeth thanks to which his/her quality of life is immediately restored, following the dentist's instructions on the rules of conduct with the temporary teeth and with oral hygiene.
After the process of adhesion of the implant with the bone is complete, the patient must return to the clinic on the next agreed date.
The period of adhesion of implants with bone (the process of osseointegration) in the upper jaw usually takes 3-4 months, depending on the quality of the bone, while for the lower jaw it takes 2-3 months. This period of osseointegration is necessary for two reasons; one is the process of adhesion of the implant with the bone, and the other is that the hard and soft tissue achieve stability in order for the definitive prosthetic work to be of the highest quality and stability.
We can further speed up and shorten the process by using special implants that have an accelerated osseointegration feature.
On the second visit, the patient's existing temporary teeth are removed and a definitive impression is taken. During the second visit, it is very important to define the lines of the patient's face with special devices so that the definitive work is as natural as possible and follows the lines and shape of the face.
The procedure itself is completed in half an hour, after which the patient returns to temporary work. The definitive impression is processed in the laboratory, and on the basis of it a digital image of the situation of the patient's condition and the relationship of the jaw is obtained. A computer program makes templates for the future patient's smile with the cooperation of a dental technician and a dentist. When the computer program designs the work that meets all the set rules and guidelines, the milling of teeth is approached using the CAD-CAM method, which will be used for aesthetic testing. This phase is followed by the third arrival of the patient at the clinic or as it is professionally known, the aesthetic testing.
During aesthetic testing, the patient’s teeth, previously prepared with a digital design, are fixed, and the first time, the patient is able to see a realistic image of the definitive work, and the dentist is able to check the length and width of the teeth, the smile lines, and the coincidence of the middle of the bridge with the middle of the face.
Aesthetic testing is necessary because in agreement with the patient we can make corrections on the work in order to achieve better definitive work and meet the patient's requirements. Once the patient confirms that everything is in line with his expectations, dental technicians make the definitive work. Materials for creating definite teeth in the "All on 4" method are metal-ceramic, titanium-composite, zircon ceramic.
The fourth visit is also the last one, in which the definite teeth are fixed and the patient is given additional instructions related to oral hygiene and check-ups. If the patient follows the instructions on oral hygiene and comes for regular check-ups, this simple method of placing dental implants and making fixed teeth will last a lifetime.