Dentaltown March 2018 - 54

Fixed-Implant
Rehabilitation
A contemporary approach

by Dr. Andonis Terezides
Dr. Andonis
Terezides
graduated
from the
University of
Maryland School of Dentistry and
completed his residency training
in oral and maxillofacial surgery
at Jackson Memorial Hospital/
University of Miami.
Terezides, a diplomate of the American Board of Oral &
Maxillofacial Surgery, enjoys practicing the broad scope of
the specialty, with special emphasis in facial trauma and
reconstructive surgery, tissue engineering, digital implant
workflows, minimally invasive techniques, and full-arch
and immediate-load implant rehabilitation. He is also a
contributor to the Digital Dentistry Institute.

by Dr. Sundeep Rawal
Dr. Sundeep
Rawal
graduated
from the
University of Florida College of
Dentistry in 2006. He completed
his training in prosthodontics
in 2009 at the University of
California San Francisco, where he
was exposed to the most current
technologies shaping dentistry. Rawal worked extensively
to utilize CAD/CAM technologies within the scope of clinical
dentistry and enhance his patients' restorative treatments.
Rawal has lectured extensively across the U.S. and
internationally, and has published papers in numerous
dental journals. He is a co-founder of, and frequent
contributor for, the Digital Dentistry Institute. He is in
private practice in Orlando, Florida, and east to the Beaches.

54

MARCH 2018 // dentaltown.com

Introduction
Despite monumental advances in
modern dentistry and implantology, the
number of fully edentulous patients and
those with failing or nonrestorable terminal
dentitions has not significantly decreased.
This is in part because the dental field
has been unable to keep up with the sheer
volume of patients requiring full-mouth
rehabilitation. Estimates from the World
Health Organization and other research
organizations indicate that there are more
than 60 million fully edentulous people
in the Western world and upward of
more than 250 million fully edentulous
people in Asia.
In the 1990s, Professor Per Ingvar
Brånemark and a team of forward-thinking clinicians embarked on a scientific
journey and mission to simplify treatment
techniques to provide edentulous patients
with a fi xed full-arch implant rehabilitation. The initial studies involved the
mandible. Paulo Malo and others began
work on what was eventually known as
the All-on-4 concept. As few as four
implants could be used to support an
immediate/interim fi xed acrylic bridge
implant prosthesis converted from a
denture, which could be used for four

to six months before proceeding on to a
definitive fi xed prosthesis.
At the same time, Brånemark and
his colleagues introduced the Novum
concept, using only three implants in
the mandible that were placed by a standardized surgical template to support a
prefabricated two-piece framework for a
definitive screw-retained fixed prosthesis
that could be delivered within 24 hours.
Both techniques had high success rates
and patient satisfaction. These concepts
paved the way for further improvement
in implant design, surface treatment,
prosthetic components, and eventual
adaptation of the immediate implant/
immediate provisionalization and loading
of at least four implants in the maxilla.
Today, the All-on-4 treatment concept
is considered a predictable and efficient
treatment used daily to rehabilitate edentulous patients and those with a terminal
dentition (Fig. 1).
There are, however, some anatomic
challenges in the severely resorbed/atrophic
maxilla that make the All-on-4 concept
impossible without additional posterior
implant anchorage. These have been
successfully overcome in keeping with a
graftless and immediate load approach
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Table of Contents for the Digital Edition of Dentaltown March 2018
