Implementation “All-on-4”: from diagnostics to the final result

/ Implementation “All-on-4”: from diagnostics to the final result

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Patients with full adentia, as well as patients whose dental status is close to such clinical conditions, suffer not only from a violation of the function of their maxillofacial apparatus but also from compromised general parameters of quality of life, low self-esteem and social uncertainty. In addition, such patients, as a rule, avoid eating foods with high nutritional value, such as raw fruits and vegetables because they have to chew and inadequately performed prostheses or periodontal disease, malocclusion and pathology of the temporomandibular joint exacerbate the already sad situation. On the other hand, restrictions in the diet lead to a decrease in the use of protein and other nutrients, which compromises the overall somatic state of the patient. Doctors often underestimate the serious condition of so-called "almost toothless patients", because they suffer not only from functional disorders but also from chronic inflammation, pain, halitosis, and other disorders, not to mention the fact that they are in constant fear of the risk of complete loss of teeth and the need to use a removable prosthesis.

The "All-for-4" concept with immediate loading is a promising solution for both patients themselves and a certain change in the clinical paradigm for dentists. This concept is based on the maximum use of bone tissue in the frontal and distal parts of the jaws, ensuring the best possible stability of the prosthesis due to the construction of long implants and their different degrees of inclination, while minimizing the geometry of the overhanging parts of the supra-elements. To achieve this goal, as a rule, only 4 implants are often required. With atrophy or other anatomical limitations, the number of intraosseous supports may be increased.

After the initial consultation of the patient, the treatment "All-for-4" started.

The stages of treatment:

The analysis of all parameters of the dentition according to clinical examination and cone-beam computed tomography.

The patient is not satisfied with the aesthetic appearance of his smile.


The correction of the cutting edge plane is needed and visualized on the model.

The wax reproduction after imitation of surgical intervention. The reposition of the cutting edge plane allowed us to recreate 15-17 mm of the interocclusal space for future prostheses based on 4 implants.

The performance of the procedure for the reduction of bone tissue in the lower jaw to recreate 13-15 mm of the interocclusal space.

A type of wax reproduction based on the “All-on-4” concept.

Sclar Protocol: The prosthesis is used as a template for implant placement and further prosthetic rehabilitation.

Using a template to check the volume of necessary bone reduction.

Installation of implants according to the template-prosthesis.

Prosthetic rehabilitation and laboratory fabrication of structures. Taken impressions: connecting transfers using plastic.

Trying on the spoon for moulding teeth.

After placement the spoon, unscrew the retentional screws and remove the impressions.

Checking and modifying the template in the area of the two front implants.

The imitations of soft tissues: modification of impressions using silicone material in the area of analogs before casting the model.

The model with a soft tissue imitation for indirect conversion method.

The modification of provisional prostheses for providing passive connection of cylinders in distal areas using hot polymerization plastic.

The photo of the patient before the begging of the treatment.

The intra-oral photo before the begging of treatment.

The photo of the patient 3 years after treatment.

The photo of the patient 3 years after treatment according to the “All-on-4” concept.


The key aspects of the modified All-on-4 Protocol are treatment planning based on the results of the diagnosis and prognosis of future prosthetic rehabilitation. The advantages of this concept include reduction of the surgical phase of treatment and the entire rehabilitation period; performing surgery based on the necessary prosthetic treatment goals; simplifying the iatrogenic procedure; minimization of trauma in the area of implantation; improved strength, durability, and aesthetics of pharmacy restaurants; increasing overall comfort for the patient during treatment, the simplicity of the use of the protocol for dentists.

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