What is All-on-4 / Fast and Fixed?
All-on-4 / Fast and Fixed is a new type of fixed implant-based prosthesis, a better alternative to total prosthesis. An alternative that gives full function to the patient almost immediately after the procedure. It consists in a full-arch prosthesis with 12 or 14 teeth (acrylic-based for the first 6 to 9 months; composite or porcelain based on a BioHPP skeleton). Fixed on 4 implants (for the mandible) or 6 implants (for the maxilla), at which, for the perfect fix. Abutments will be placed for each implant.
Types: Differences and similarities
All-on-4 is the generic name of this surgical procedure, mainly because it is based on the first system of this kind, made by Nobel Biocare. The other important system of this kind is Fast and Fixed by Bredent. In essence, both of them are very alike. The difference consists in the fact that Nobel Biocare invested more time in perfecting the technique, the implant system. This difference can be seen in the price, Bredent being a little cheaper than Nobel Biocare. Also, both are very good systems. Therefore, opting for one or another depends mainly on the doctor’s specialization and preference.
Conditions and limitations for the treatment.
The All-on-4 treatment is meant for: edentulous (no teeth), soon-to-be edentulous patients or simply for those who suffer from loose teeth or denture or wish to drop wearing removable dentures.
It is also ideally that the edentulous part of the arch to be recent. The opposite situation of this is usually leading to bone atrophy. This means that a bone graft might be needed (usually for the jaw) or even sinus lifting (for the maxilla). This helps prevent the damage of the nerves around the inserted implant. Or prevent the infection that might appear when an implant is breaking into the sinus cavity.
Another condition: the patient should be healthy, not having any chronic disease, especially cardiovascular diseases. For this surgical treatment, you need a complete blood-work test. And for patients over 50 years a cardiovascular check will be required. These are important for both the surgical procedure and for the general anaesthesia.
We need to add the fact that you will not be completely unconscious. The medical team needs your attention and your response during the procedure. This is possible with the analgo-sedation. Which is something like a sedative that it is administered intravenous along with anti-inflammatories and antibiotics. As a result, the All-on-4 procedure will run smooth. When it comes to analgo-sedation the patient is into a state of calm, well-being and having pain-free intervention.
How does it work?
First phase- The pre-op
Before coming to our clinics, we will ask images with your remaining teeth and a CBCT (Cone Beam Computer Tomograph). We need this for the first personalised treatment plan.
Upon arriving at the clinic, you will have the first examination. The doctors will observe if there are some things that they had omitted. They will explain to you the procedure, the alternatives and what complications can appear. They will also answer all of your questions and they will let you know the following steps.
As we said previously, a complete blood-work will be requested. You will be asked to do it after the first examination. If everything is within the normal values, the next step is taking care of the hygiene. Scaling, professional brushing, air flow, extraction of the root residues if present (using local anaesthesia). In the same session, the prosthetist will be taking an impression of your dental arches, so that he can start working at your future teeth.
Second Phase- The surgery
The surgery itself consists to:
- measure and make the vertical dimension of the occlusion – the role of this step is to adjust the angulation of the implants.
- extract the remaining teeth and the readjustment of the ridge(in some cases)
- placement of the dental implants – the implants are placed in the arch, equally distributed and angulated. So that the natural anatomy of the head (sinuses and nerves) would be avoided.
- placement of the multi-unit abutments for perfecting the angulation of the implants.
This is all done under analgo-sedation along with local anaesthesia. The procedure takes up to 4 hours depending on the number of remaining teeth, the complexity of the case, and the implant system. After this, anti-inflammatory medications alongside antibiotics are prescribed for 5 to 7 days.
Third Phase- Attaching the temporary prosthesis
In 24 hours, the temporary fixed detachable prosthesis will be attached to the implants through the abutment system. Small adjustments might be made which is normal. The patient has his smile back in 24 hours, with nothing but a normal sore that passes in a couple of days.
A little eating routine is also required. In the first two months you must eat soft food so that you can adjust with the new denture. Then you can try to have diverse meal, but still, no hard food in the first 6 months. Furthermore, you have to do a professional cleaning after 6 months.
Fourth Phase- The permanent Prosthesis
In case that you have a sinus lift intervention, you must return after 9 months to get the permanent prosthesis. But in the normal cases, you have to return after 6 months. The new permanent denture will be superior comparing to the temporary one, when it comes to quality, materials and its aesthetics.
Advantages and disadvantages of All-on-4 dental procedure
As a primary advantage, the All-on-4 Implant Fixed Prosthesis improves functionality to 90% compared to natural teeth while eliminating the need for bone grafting. It also gives the patient the capacity of eating (soft foods) in the same day as the surgery through the temporary prosthesis. It also has a 95% success rate over 30 years, never decaying, while preserving the natural-looking aesthetics.
There are disadvantages too: it is a surgical procedure and also the time of healing and restorative time is long compared to a removable denture.
In the long run, your new smile will make make the procedure worthwhile.
The clip below is a visual guide of the procedure, made by Nobel Biocare. We recommend watching it so that you can better understand. Also, check our story about our U.S. patient that travelled to Romania to smile again.