Inspite of numerous innovations tooth loss is still a reality for many individuals, this is often accompanied by bone loss due to lack of stimulation from the chewing forces that are transmitted to the bone via the missing tooth roots.

Are you wondering why implant supported dentures are favored ??

Removable dentures are not only inconvenient to talk, smile or chew food, ending up in lowered self esteem but also do nothing to arrest the bone loss leading to collapse in the Bite and also giving the patient an aged appearance.

“All on 4” is an affordable graftless solution developed to overcome the problems associated with removable dentures, by providing a fixed option where in the dentures will be secured to the jaw bone by attaching them to the underlying implants there by providing better health benefits. This concept was initiated to utilize the remanent bone in a resorbed jaw instead of subjecting the patient to additional and time taking surgeries like sinus lifts & bone grafting techniques and delaying the treatment.

INITIAL CONSULTATION

After a comprehensive clinical examination, required diagnostics like full mouth x ray and three dimensional scans will be taken to understand the bone better and also visualize the nerves along with the sinus cavities as each treatment is planned on an individual basis. This is followed by a detailed discussion with the patient to understand their expectations and requirements from the treatment, to provide a comprehensive treatment plan. However, an overseas patient cannot Come down twice that is, for initial consultation and for the treatment again, in such cases we do a complimentary online video consultation and discuss the treatment plan and if the patient is not able to provide any xray, we quote a ball park figure, looking at the pictures and understanding their condition through the discussions carried out. The required x rays will be taken here after landing in Hyderabad and discuss the case details with them, with not much discrepancy in the cost factor. This is possible as our chief implantologist Dr. K A Reddy is well versed with all the bone types and can manage any case with equal ease. In highly resorbed bone cases we do zygomatic implants in the upper arch and nerve bypass in the lower arch.

PROCEDURE:

On the day of the procedure, existing damaged teeth if any will be removed and properly debrided under local anesthesia or under nitrous oxide sedation for apprehensive patients, this is also called as sleep dentistry.

In “All on 4” concept, 4 implants are strategically placed in each arch to permanently secure the dentures. The implants here are Tilted at 30 to 45 degrees angulation to evade :

1. Portion of the jaw with low dentistry.
2. Avoid anatomical structures there by aiding in immediate loading of teeth.
3. Avoid additional surgical procedures like Sinus lift and Bone grafts.

   Implant placement will then be followed by specialized fixtures called multiunit abutments that act as a base for crowns and bridges when an implant is placed at an angulation and also for full arch replacement to

4. Balance the restoration.
5. With the help of these multiunit abutments various systems of implants can be used in conjunction with each other.
6. Allows to straighten the angulated implant for proper distribution of forces.
7. Reduce soft tissue disturbances.

The use of Multi unit abutment ( MUA) is a significant step when it comes to full arch replacement, placement of an MUA is followed by scanning of the implants to prepare the final prosthesis.

The prosthesis thus prepared on a cobalt chromium frame work will be fixed in the patients mouth and the patient will be good to go. He can have the food of his choice, talk and smile confidently.

PRO’S:

• Affordable.
• Immediate loading of teeth.
• No Bone Grafting or sinus lift required.
• High success rate.
• Easy to maintain.

CON’S:

• Cannot avoid cantilevers as teeth are fixed on only 4 implants, which in most of the cases will be placed in the anterior portion of the jaw to avoid anatomical structures.
• Acrylic dentures and not ceramic bridges are fixed on the 4 implants which are prone to wear and tear. These Acrylic teeth might have to be replaced every 4 to 5 years without disturbing the implants.

CONCLUSION:
All on 4 concept is universally admitted as a preferable alternative to removable dentures to rejuvenate patients health and self confidence but any day, All on 6 is a better choice over All on 4, given its additional benefits such as

1. Added support to the prosthesis (Two additional implants in each arch).
2. Can avoid cantilevers, as the last two implants are placed in the distal most end.
3. Can go for computerized DMLS prosthesis, which lasts longer than the Acrylic bridges.

We at LBR Dental & Implant Center, Hyderabad, India, since our inception have provided patients with finest dental care and dental tourism services, our team of skilled specialists led by Dr. K A Reddy is committed to excell in the field of implantology. We provide complete patient care with individual attention.