Nobel Biocare introduces the All-on-4® Treatment Concept

Posted on August 17, 2017

A revolution when it was first introduced, the multiple benefits of the All-on-4® treatment concept are now well proven.1-6 The concept was developed to efficiently provide edentulous patients and those with a failing dentition with an immediately-loaded, fixed full-arch prosthesis.* Today, Nobel Biocare continues to evolve the concept, with innovations designed to further enhance treatment results.

The clinically proven approach

The All-on-4® treatment concept enables the rehabilitation of fully edentulous mandibular or maxillary arches using just four implants. By tilting the two posterior implants, longer implants can be used in reduced bone volume, increasing bone-to-implant contact and reducing the need for bone augmentation. With the tilted posterior implants anchored in better quality anterior bone, cantilevers are reduced, improving support for the prostheses.7, 8 It’s an approach that is less invasive and cost-intensive for the patient than bone grafting, more efficient for the clinician and, most importantly, is clinically validated to work.1-6

Supported by almost 20 years of clinical success, the All-on-4® treatment concept offers a reliable solution for patients looking to escape the discomfort that so often comes from wearing a removable denture, or those with a failing dentition that do not want to spend even a day without teeth. Long-term success has been shown in both the edentulous maxilla and mandible, with long-term follow-up of 5–10 years showing cumulative survival rates of 94.8–98.0%.9,10

These results go hand-in-hand with patient satisfaction, as 98% of All-on-4® treatment concept patients would recommend the treatment. In a study, 95% of 250 patients said that they were satisfied with their new teeth, while 88% said they would definitely recommend similar treatment to friends and colleagues.11

Immediate Function

Today, Nobel Biocare offers more implant options than ever before for the All-on-4® treatment concept, helping clinicians choose the right implant for each case. With Nobel Biocare implants, a unique combination of implant design, surgical protocol and the proven TiUnite surface help to ensure primary stability and maintain it during the healing phase. As such, provided patient criteria are met and adequate primary stability is achieved, Nobel Biocare implants allow a fixed provisional restoration to be loaded on the day of surgery – a key benefit of the All-on-4® treatment concept.

NobelSpeedy, the original and widely documented implant for the All-on-4® treatment concept, is now available in more lengths and diameters for increased surgical flexibility. Shorter, longer and wider variants have been added to an expanded NobelSpeedy Groovy range designed to further help clinicians utilize a graftless approach and achieve cortical or bicortical anchorage where bone quality and quantity are limited, thus allowing more patients to benefit from the proven advantages of the All-on-4® treatment concept.12, 13 NobelActive is another proven implant system proven effective for the All-on-4® treatment concept, including when using narrow 3.5-mm-diameter implants.14

Precision during implant placement for the All-on-4® treatment concept can be maximized with digital diagnostics and guided surgery. Using the NobelClinician software, clinicians can benefit from digital treatment information and conduct prosthetic-driven implant planning for their All-on-4® treatment concept patients. NobelClinician also facilitates collaboration between members of the treatment team and allows easy ordering of all surgical components required for the planned treatment.

Once finalized in NobelClinician, the plan can be predictably transferred to clinical reality using the NobelGuide guided surgery concept, which provides the clinician with ready-to-use patient-specific surgical templates and instruments tailored for the surgery.

In cases where maxillary bone is severely resorbed, zygomatic implant placement may still allow graftless restoration of the full arch on four implants. Building on 25 years of success with Nobel Biocare’s zygomatic implants, the new NobelZygoma implants provide greater surgical and prosthetic flexibility than previous options, while a new tapered apex design has been added to support high primary stability for Immediate Function.

Create an accurate prosthesis in a snap

At the restorative stage of their All-on-4® treatment concept procedure, clinicians using conical connection implants can now take advantage of the new Multi-unit Abutment Plus** – an enhancement of the successful Nobel Biocare Multi-unit Abutment. It is designed to significantly reduce the chair time required to perform provisionalization processes such as a denture conversion – a procedure commonly used for the All-on-4® treatment concept. By introducing a snap-fit function between the temporary cylinders and the abutment, screws are no longer required during the try-in process. This means the common practice of removing the temporary cylinders and the denture several times during the conversion process can be done in a few snaps, with no need to tighten and loosen four screws each time. This new way to work provides a significant time-saving opportunity for the clinician. It can also dramatically increase patient comfort and eliminates worry about the screws potentially dropping out. 

NobelProcera – For an optimized final result

When it comes to the final restoration, NobelProcera offers a wide variety of precision-milled fixed and fixed-removable restorations for the All-on-4® treatment concept patients.  Patients looking for maximum esthetics can opt for individualized crowns on an implant bridge, while those requiring a cost-effective restoration can select a removable denture in acrylic on an implant bar. Regardless which option is chosen, NobelProcera offers easy handling for the clinician and excellent esthetics and function for the patient.15,16

Restoring more than a smile

The All-on-4® treatment concept puts dental professionals at the forefront of their profession. In fact, 24% of those that attended a Nobel Biocare All-on-4® treatment concept course grew the number of implants they placed by 50% the following year.17

Such success is largely thanks to the popularity of the All-on-4® treatment concept among patients.11 Reduced cost, less trauma, Immediate Function and excellent esthetic results are all clear patient benefits, as is the prospect of a solution that feels like natural teeth. Greater chewing ability, improved speech, increased comfort, less bone resorption – the list of attributes that can help drive patient acceptance goes on and on. Above all, these benefits in combination lead to a potentially life-changing result: the return of a patient’s self-confidence.

References

1.     Patzelt SB, Bahat O, Reynolds MA, Strub JR (2014) The all-on-four treatment concept: a systematic review. Clin Implant Dent Relat Res 16(6):836-55.

2.     Lopes A, Maló P, de Araújo Nobre M, Sanchez-Fernández  E(2015) The NobelGuide® All-on-4® Treatment Concept for Rehabilitation of Edentulous Jaws: A Prospective Report on Medium- and Long-Term Outcomes. Clin Implant Dent Relat Res. doi: 10.1111/cid.12260.

3.     Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I (2016) All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level. Clin Implant Dent Relat Res. doi: 10.1111/cid.12282.

4.     Mozzati M, Arata V, Gallesio G, Mussano F, Carossa S. Immediate postextractive dental implant placement with immediate loading on four implants for mandibular full-arch rehabilitation: a retrospective analysis. Clin Implant Dent Relat Res 2013;15:332-40.

5.     Weinstein R, Agliardi E, Fabbro MD, Romeo D, Francetti L. Immediate rehabilitation of the extremely atrophic mandible with fixed full-prosthesis supported by four implants. Clin Implant Dent Relat Res 2012;14:434-41.

6.     Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I (2016) Complete Edentulous Rehabilitation Using an Immediate Function Protocol and an Implant Design Featuring a Straight Body, Anodically Oxidized Surface, and Narrow Tip with Engaging Threads Extending to the Apex of the Implant: A 5-year Retrospective Clinical Study. Int J Oral Maxillofac Implants 31 (1) 153-61.

7.     Malo P, de Araujo Nobre M, Lopes A. The use of computer-guided flapless implant surgery and four implants placed in immediate function to support a fixed denture: preliminary results after a mean follow-up period of thirteen months. J Prosthet Dent. 2007 Jun; 97(6 Suppl): S26-34. Erratum in: J Prosthet Dent. 2008 Mar; 99(3): 167.

8.     Aparicio, C., Perales, P. & Rangert, B. (2001) Tilted implants as an alternative to maxillary sinus grafting: a clinical, radiologic, and periotest study. Clinical Implant Dentistry & Related Research 3: 39–49.

9.     Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report  on the medium (3 years) and long-term (5 years) outcomes. Clin Implant Dent Relat Res. 2012 May;14 Suppl 1:e139-50. doi: 10.1111/j.1708-8208.2011.00395.x. Epub 2011 Oct 18. PubMed PMID: 22008153.

10.  Malo P, de Araújo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011 Mar;142(3):310-20. PubMed PMID: 21357865.

11.  Babbush CA, Posttreatment quantification of patient experiences with full-arch implant treatment using a modification of the OHIP-14 questionnaire. J Oral Implantol 2012; 38:251-60.

12.  Malo P, de Araujo Nobre MA, Lopes AV, Rodrigues R. Immediate loading short implants inserted on low bone quantity for the rehabilitation of the edentulous maxilla using an All-on-4 design. J Oral Rehabil epub ahead 2015.

13.  Vicent et al. (2016), Clinical outcome of extra-long tilted for the rehabilitation of complete edentulous atrophic maxilla using the all-on-four concept. Implant Therapy Outcomes, Surgical Aspects. Clin. Oral Impl. Res., 27: 269. doi:10.1111/clr.267_12958

14.  Babbush CA, Kanawati A, Brokloff J. A new approach to the All-on-Four treatment concept using narrow platform NobelActive implants.J. Oral Implantol 2013; 39(3):314-25.

15.  Katsoulis J, Mericske-Stern R, Rotkina L, Zbären C, Enkling N, Blatz MB. Precision of fit of implant-supported screw-retained 10-unit computer-aided-designed and computer-aided-manufactured frameworks made from zirconium dioxide and titanium: an in vitro study. Clin Oral Implants Res. 2014 Feb;25(2):165-74.

16.  Katsoulis J, Mericske-Stern R, Yates DM, Izutani N, Enkling N, Blatz MB. In vitro precision of fit of computer-aided design and computer-aided manufacturing titanium and zirconium dioxide bars. Dent Mater. 2013 Sep;29(9):945-53.

17.  Data on file: Comparing annual increase in customer net sales (2013-2014)

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