Journal of Oral Implantology June 2013 - (Page 314)
RESEARCH
A New Approach to the All-on-Four Treatment Concept
Using Narrow Platform NobelActive Implants
Charles A. Babbush, DDS, MScD*
Ali Kanawati, DDS, MBA, MS
John Brokloff, DDS
Although a number of approaches to implant-supported restoration of severely atrophic maxillae and
mandibles have been developed, most of these treatments are costly and protracted. An exception is the All-onFour concept, which uses only 4 implants to support an acrylic, screw-retained provisional prosthesis delivered
on the day of implant placement, followed by a definitive prosthesis approximately 4 months later. After the
introduction of a new implant design in 2008, a new protocol was developed for provisionally treating patients
with severely atrophic jaws using the All-on-Four concept and 3.5-mm-diameter implants. This article describes
that protocol and reports on the results of 227 implants after 1 to 3 years of follow-up. The cumulative survival
rate was 98.7% at the end of 3 years, with a 100% prosthetic survival rate. Combining the 3.5-mm-diameter
NobelActive implants with the All-on-Four concept promises to become a new standard of care for severely
compromised patients.
Key Words: implant, severe atrophy, maxilla, mandible, All-on-Four
INTRODUCTION
O
ne of the greatest challenges in
implant dentistry is the treatment
of patients with severely atrophic
jaws (Figure 1a through c). Such
atrophy can be horizontal or vertical
or both; even if sufficient vertical bone is present,
lack of ridge width can still preclude treatment with
implants that are 4 mm in diameter or wider. Over
the years, many techniques, procedures, and
materials have been introduced to solve the
complex problems associated with treatment of
atrophic jaws. One early approach in the posterior
maxilla was to augment the sinus in conjunction
with the simultaneous placement of blade-vent
implants.1–3 To increase bone volume for reconstruction of both function and esthetics, the use of
autogenous bone blocks harvested from the
mandibular symphysis and/or posterior horizontal
mandibular ramus was documented early on by
Cleveland ClearChoice Dental Implant Center, Pepper Pike, Ohio.
* Corresponding author, e-mail: cab@thedentalimplantcenter.com
DOI: 10.1563/AAID-JOI-D-12-00223
314
Vol. XXXIX /No. Three / 2013
Collins and colleagues,4 Collins,5 Khoury,6,7 and
Khoury and colleagues,8 and later by Pikos.9,10 More
substantial defects requiring larger volumes of bone
have been reconstructed with autogenous bone
harvested from the tibia, iliac crest, calvaria, and
ribs.11,12 Graft material choices have also expanded
to include xenografts, allografts, and alloplasts, and
as they have expanded, the recipes for their use
have also evolved.13 Clinicians have reported
positive results from combining various forms of
bone with autogenous bone marrow, harvested
from the iliac crest.14 Platelet-rich plasma has also
been used to enhance the quality and quantity of
the augmentation materials.15
The high cost and the protracted treatment time
required for such approaches have limited their
application. A parallel development has been the
All-on-Four implant treatment concept. Introduced
´
by Malo et al in 2003, this concept for immediate
function involves the use of 4 implants, including 2
distally tilted ones in areas where bone height;
nerve proximity; or the proximity of the sinus,
inferior alveolar canal, and/or mental foramen have
precluded the placement of axially oriented im-
Table of Contents for the Digital Edition of Journal of Oral Implantology June 2013
Congratulations to Duke Heller, DDS, MS—Pioneer, Teacher, and Mentor
In Vitro Analysis of Resistance to Cyclic Load and Preload Distribution of Two Implant/ Abutment Screwed Connections
Mandibular Implant-Supported Overdenture: An In Vitro Comparison of Ball, Bar, and Magnetic Attachments
An Exploratory Study on Assessment of Gingival Biotype and Crown Dimensions as Predictors for Implant Esthetics Comparing Caucasian and Indian Subjects
A New Approach to the All-on-Four Treatment Concept Using Narrow Platform NobelActive Implants
Regular and Switching Platform: Bone Stress Analysis With Varying Implant Diameter
Comparison Between Immediate and Delayed Laser-Treated Implants Surface With Switching Platform: A Clinical Retrospective Study
Effect of a Multiporous Beta–Tricalicum Phosphate on Bone Density Around Dental Implants Inserted Into Fresh Extraction Sockets
The Effect of Varying Implant Position in Immediately Loaded Implant-Supported Mandibular Overdentures
Bone Regeneration Around Immediate Implants Utilizing a Dense Polytetrafluoroethylene Membrane Without Primary Closure: A Report of 3 Cases
Socket Preservation and Sinus Augmentation Using a Medical Grade Calcium Sulfate Hemihydrate and Mineralized Irradiated Cancellous Bone Allograft Composite
Implant Placement and Immediate Loading With Fixed Restorations in Augmented Sockets. Five-Year Results. A Case Report
Immediate Placement and Provisionalization With Buccal Plate Preservation: A Case Report of a New Technique
Clinical Importance of Recipient Site Characteristics for Vertical Ridge Augmentation: A Systematic Review of Literature and Proposal of a Classification
Postextraction Implant in Sites With Endodontic Infection as an Alternative to Endodontic Retreatment: A Review of Literature
Letter to the Editor
Journal of Oral Implantology June 2013
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