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All-on-4 Treatment Concept

For total edentulous rehabilitation — safely, securely, affordably and fast

In this case of moderate bone resorption, the All-on-4 concept—with NobelGuide in the maxilla and the flap approach in mandible— provided complete rehabilitation with a minimally invasive solution.

The totally edentulous female patient depicted here was a removable denture wearer in her early 50s, and in good general health. At the time she approached our clinic for alternative treatment, she had had her dentures for 15 years and was complaining about poor retention and the general instability of her removable dentures.In addition to the discomfort she experienced, the patient found it difficult to speak clearly and chew well, and she was unhappy with the overall appearance of her mouth. She was well-motivated for the fixed, implant-supported rehabilitation that we subsequently proposed.

Our oral examination showed moderate bone resorption in the maxilla (at least 5 mm width and 10 mm bone height between the canines in the maxilla) and severe bone resorption in the mandible (at least 5 mm width and 8 mm bone height between the mental foramina in the mandible). The patient presented a low smile line.

We implemented fixed, implant-supported, bimaxillary rehabilitation through the All-on-4 concept, following the NobelGuide protocol (flapless) in the maxilla, and the conventional flap approach with the All-on-4 Guide in the mandible.

Four NobelSpeedy Groovy Implants were placed in each of the jaws, followed by immediate placement of provisional, fixed, all-acrylic bridges, providing the patient with an immediate function solution.

In the maxilla, a NobelProcera Implant Bridge Titanium framework with individually designed and cemented zirconia crowns and pink acrylic was used. In the mandible, a Nobel Procera Implant Bridge Titanium framework wrapped in pink acrylic and denture teeth was used. (Both placed six months after surgery according to the Malo Clinic protocol.)

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