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Case 3

"All-on-4"

HISTORY - Mary was tired of having to wear an upper denture and wanted to have a fixed set of upper teeth.

PLANNING - Careful planning of Mary's options using 3-Dimensional scanning was completed. She chose the All-on-4 option as it did not involve any bone grafting and the work could be completed in such a short period of time. Diagnostic impressions were then taken and a mockup of the final bridge made ready for her surgery.

SURGERY (DAY 1) - Under local anaesthetic Dr Mallorie removed Mary's remaining upper teeth and placed 4 dental implants into her upper jaw. The back ones are angled to increase the distance between the heads of the implants which gives the final bridge a more stable support. Impressions are also taken inorder to enable construction of her bridge (N.B. her lower implants had been placed a few years before by another surgeon)

SURGERY (DAY 2) - The day after her surgery she returns for a short appointment to try in the new bridge and for any final adjustments to be made.

SURGERY (DAY 3) - The next day the final bridge is ready. The bridge in the "All-on-4" process has a cobalt-chrome frame and acrylic teeth and is screwed permanently onto the 4 implants. She must now maintain a soft diet for 3 months whilst her bone is healing onto the implant surfaces.

SURGERY (DAY 3) - The next day the final bridge is ready. The bridge in the "All-on-4" process has a cobalt-chrome frame and acrylic teeth and is screwed permanently onto the 4 implants.

FINAL RESULT - Three months after surgery Mary can now chew whatever she wants and doesn't have to remove her teeth at night.

ADVANTAGES - This technique has the advantage of avoiding grafting of the sinuses which traditionally delayed the process of having a fixed set of upper teeth. It is also all completed in 3 days and enables patients to throw their dentures away. This procedure was designed to make the fixed implant bridge option affordable to more people. The aesthetic and functional change can be life changing for patients.

 

LIMITATIONS - Due to the lack of implants at the back of the jaw it is generally not possible to replace the second molars with this technique as teh resultant cantilever is too great - that can only be accomplished with the addition of extra implants, usually with bone grafting required. Because of the forces patients can bite with this fixed bridge, the acrylic wears quicker than a denture would. The acrylic bridge with cobalt-chrome frame has a lifespan of 5 to 8 years before repairs or replacement may be required. The implants would not need replacing, just the bridge. At this stage there would be options then to upgrade to a CAD-CAM titanium frame which has a 20-year warranty with either acrylic or porcelain teeth.

 

* initial discussion about the process of "All-on-4" / "Teeth-in-a-day" only.