This page was last edited on 5 October 2017, at 22:35. The four implants support a fixed prosthesis with 10 to 14 teeth and it is placed immediately, typically within 24 hours of surgery. During this time this technique was also used by various other clinicians around the world. Australia, was the first to apply for osseointegration of dental implants pdf registration of All-On-4 as a protected trademark.
Dr Fibishenko is an educator and lecturer for Nobel Biocare, and today All-on-4 is a registered trademark of Nobel Biocare. The concept itself of the total rehabilitation of a full set of teeth supported by as few as four fixtures was not a new one. 70s with successful rehabilitation of a full arch supported by this number of fixtures. However, it was the angulation of the back implants that led to today’s All-on-4, and has been trialed by numerous clinicians simultaneously in the USA, Sweden, Portugal, and South America in the 1990s. The technique evolved when in an attempt to avoid certain anatomical limitations typically seen in the back of the upper and lower jaws have, clinicians successfully avoided bone-deficient areas with the use of angulated implants.
Anatomical limitations are more prevalent in patients with full dentures, and once the back implants are placed at an angle there is often only enough room left for two more implants in the front. This has led to the use of only four fixtures to support a full set of teeth. This image shows how Nobel Biocare’s All-on-4 solution works. Often, tooth loss is accompanied by loss of the jaw bone which poses the problem of reconstruction of the jaw bone requiring bone grafting.
The All-on-4 protocol is considered to be a graftless solution thereby avoiding the long and costly road of rebuilding bone when conventionally oriented implants are used. For the implementation to be successful a careful analysis of the bone structure needs to be made. The most ideal way to evaluate the bone is by a CBCT scan. The All-on-4 protocol is for at least four implants to be placed in a jaw.
The back implants are typically angled approximately 30 to 45 degrees from the biting plane. The head of the implant emerges in approximately the second premolar position. This will allow a molar tooth to be cantilevered posterior resulting in a denture or bridge with approximately 12 teeth. There is no patent for the All-on-4 technique. The price may vary for each country or region, and normally it is divided in two phases. 25,000 USD per jaw, dependent on the materials used such as Ceramic, Zirconia, or Acrylic denture base. In Europe the price of all-on-4 treatment varies by country.
In the UK the cost is comparable to US and price is about 15 000 USD per jaw. In Germany the price may reach 12 000 USD. The cheapest option for having all on 4 are eastern european countries. For example in Poland or Hungary the treatment costs around 6000-7000 USD per jaw, dependent on materials and type of restoration. It is important to note that when this treatment is completed by a single doctor, the treatment fees are much lower when compared to a team approach with two doctors, where both would charge separate fees, potentially increasing the cost of the treatment.
Clinics with suitable facilities, which are able to offer the entire treatment in one place, and who do these procedures regularly, are typically the most cost-effective. Many patients chose South Africa due to its medical tourism industry and very high standards of dental care. The All-on-Four Treatment Concept: A Systematic Review”. Implanting the edentulous jaws with “All-on-4″ immediate reconstruction: a preliminary clinical observation”. All-on-Four’ Immediate-Function Concept with Brånemark System Implants for Completely Edentulous Mandibles: A Retrospective Clinical Study”. All-on-4 Immediate-Function Concept with Brånemark System Implants for Completely Edentulous Maxillae: A 1-Year Retrospective Clinical Study”.