Dental Implants

Planning Fixed Prostheses on Four Implants in Fully Edentulous Jaws

All-on-4 is a treatment approach in which a fixed prosthesis is planned on four implants in suitable fully edentulous jaws. Usually, two implants are placed vertically in the front and two at an angle in the back to provide support. This arrangement can help make efficient use of available bone. It provides fully fixed teeth in cases where fixed teeth were previously impossible, or eliminates most of the lengthy, difficult major surgical procedures otherwise required.

For patients who have been fully edentulous for a long time or lose all their teeth at once, it restores teeth throughout the mouth in a very short time. However, it may not eliminate additional surgery for everyone, particularly patients who have worn complete dentures for a very long time. Implant positions, bone quantity and anatomical structures are assessed using detailed imaging.

When adequate initial stability and other conditions are achieved, a temporary fixed prosthesis may be fitted on the same day. In particular, extraction, immediate implant placement and often the fitting of pre-prepared temporary resin teeth can take place at one appointment. After three months of integration with bone, or osseointegration, the definitive restoration may be made as zirconia teeth with a titanium framework, secured to the implants by occlusal screws. Cleanability and bite arrangement are particularly important at this stage.

Plans using six implants are another option and are not classified as All-on-4, which means four implants. The number of implants and prosthesis type are determined entirely by the patient's clinical condition.

Successful implant treatment depends on more than integration with bone; it also depends on completely reproducing the natural tooth being replaced together with its surrounding tissues. Simple precautions may be important, but the dentist must also be able to apply advanced techniques, and both the implant and its restoration must offer the technological variety needed to reproduce nature.

What Are the Basic Precautions?

a. The dentist must work atraumatically and have a thorough command of implant positioning, surgical knowledge and experience.

b. If possible, the implant should be placed immediately after extraction. It has been scientifically demonstrated that bone in the extraction area resorbs by 30–60% within six months. This causes bone loss and gum recession in the ridge where the implant is placed.

c. The extraction of the tooth to be replaced must be atraumatic, using specific techniques for this purpose.

d. If immediate placement is not possible, the extraction socket must be filled and preserved using special materials and techniques to counter bone resorption.

Advanced Techniques

If extraction took place long ago and bone loss is extensive, different operations are performed to restore the gum appearance known as pink aesthetics.

a. The bone around the implant and adjacent teeth provides support and a framework for the gums. To form the gum tissue and prevent long-term recession, bone must first be reconstructed. This is achieved through advanced techniques involving grafting and guided tissue regeneration.

b. Once bone support has been established, connective tissue and gum grafts are performed.

After achieving pink aesthetics through these procedures, achieving white aesthetics over the implant with a successful prosthetic restoration becomes very easy.

Implants for a removable denture are used to increase its retention or support. In a fully edentulous mouth, denture movement can cause difficulties with chewing and use. An implant-connected denture may be considered for suitable individuals. This is not the same as a fixed bridge; the person can remove the denture for cleaning.

The number of implants, whether treatment concerns the upper or lower jaw, bone quantity and the attachment system are assessed together. Some dentures attach to individual components, while others connect to a bar joining the implants. The proportion of support provided by implants and oral tissues depends on the design. The same implant number or attachment is not appropriate for every jaw.

After placement, healing and loading times depend on initial stability and clinical findings. The denture's fit, attachments and bite are then checked. Not every existing denture can be adapted directly to implants; modification or replacement may be necessary.

The denture and attachments need regular cleaning. Retentive components can wear and may require replacement. Reviews assess the tissues around the implants, denture fit and chewing relationships. Implant support does not guarantee that the denture will never move or need maintenance.

Same-Day Implant and Temporary Tooth Placement

When conditions are suitable, there is no infection or chronic lesion in the extracted tooth, and bone support is adequate, the dentist's assessment may allow extraction, implant placement and even a temporary tooth during the same appointment. Placing an implant at the extraction appointment and fitting a tooth to it on the same day are separate decisions; special implants and temporary materials should be selected for this purpose.

Although this approach is not suitable for everyone, it is possible when the necessary conditions are met. Bone quantity and quality, initial implant stability, bite forces and surrounding tissues are particularly important. In suitable cases, the benefits are considerable: while conventional approaches await healing after extraction, this method minimises gum and bone loss.

A temporary restoration does not mean that the entire healing process is complete; instructions for use and diet must be followed and subsequent reviews attended. Under optimal conditions, this approach preserves aesthetics and hygiene by preventing loss of the triangular gum tissue between the teeth, known as the papilla. The definitive crown replacing the temporary crown emerges from beneath the gum in an ideal tooth form, reproducing natural tissue much more closely.