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