All-on-4 Success

When people lose their back teeth, the jawbone quickly shrinks.  In the upper jaw, half of the residual bone can be lost in as little as one year, and with the way the sinus cavity enlarges at the same time, the amount of bone remaining is often not enough to hold implants.  In the lower jaw, the posterior ridge shrinks just as quickly.  Bone grafting to recapture this lost volume is unpredictable, costly and takes a long time.

All-on-4

For these reasons, a solution to the problem, called All-on-4, was developed by Dr. Paulo Malo.  He determined that the use of long, well-angulated posterior implants (as pictured above) both avoided vulnerable anatomical structures (upper sinuses and lower nerves) and offered improved support for the prosthesis by reducing cantilevers.  Together with straight anterior implants, from a bio-mechanical point of view, this arrangement was suitable to support an arch of 12 teeth.


Why only 4?

The use of four implants in an arch reduces treatment complexity, facilitates oral hygiene and allows for a more durable prosthesis.  By using NobelBiocare NobelSpeedy Groovy implants, the greatest variety of implant components is available to ensure a highly esthetic outcome.  In our office, we have found this solution to be favored by our patients.  It is a well-proven, scientifically validated, bone anchored alternative to the social, emotional and nutritional disappointments caused by removable dentures.


                                       As Per-Ingvar Branemark, dental implant pioneer says:
                 "No one should have to die with their teeth in a glass of water beside their bed."

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Lipstick Time

When all of your upper teeth are missing, it's important that your implant supported fixed bridge give you the necessary lip support for a natural look.  Check out this physician's upper All-on-4 bridge that we made in our office.

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Same Day All-on-4 Full Mouth Implants

Dental Implants

The All-on-4 technique allows four implants to be placed in the upper or lower jaw to anchor a permanent bridge of teeth.  It is especially good for patients who have limited bone and do not wish to have bone grafting performed, because the implants are placed in the front of the mouth where most patients tend to have enough bone remaining.  This technique can be used for denture patients, or for those who have to lose all of their teeth.

The implant placement is designed using a 3D scan of the jaws and computer software that programs the precise surgical position of the implants and the permanent teeth they will support.  Typically, when the bone is sufficient in amount and density, a provisional fixed bridge can be placed the same day as the implants.

Patients Testimonials

Here are some comments from satisfied patients:

• "No matter what I did, I just couldn't stop the bone loss around my teeth.  The same day they were removed, the implants were placed and I had permanent bridges.  They looked great, I could eat with them, and there was minimal discomfort.  After the weekend, I was back in the office." Dr. R.G.
• "I had an upper denture for many years and was losing my lower teeth.  I decided to have the implants and couldn't be happier.  I can eat anything." Sandra O.
• "I just couldn't afford to take care of my teeth when I was a kid.  Now I am working and Dr. Tupac took out my upper teeth and put in the bridge all at once.  I have my mouth back."   Brian T.

We have been providing this treatment for many years, with great success.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

All-on-4 Considerations

Dental Implant

If you are missing all of your teeth in your upper or lower jaw, the All-on-4 technique has been reported in this blog as an extremely successful method for placing dental implants and restoring them with a fixed bridge.  This technique allows the placement of four implants in the upper jaw in such a way as to avoid the maxillary sinus and not require bone grafting, and four in the lower jaw and avoid the mandibular nerve.  The posterior implants on both sides are tilted in such a way that there is excellent bone anchorage and load distribution and allows the final prosthesis to hold as many as 12 teeth with only short cantilevers.

Multiple studies in the literature, substantiate Dr. Tupac's All-on-4 experience with a cumulative implant survival rate of 92.2% to 100%.  Presurgical diagnosis includes a cone-beam computed tomographic scan to assess the bone volume and density.  It also allows development of a surgical guide to allow for optimal implant position.

Who is a candidate for Dental Implant treatment?

Besides not having any teeth in your upper or lower jaw, what makes you a candidate?  You must be generally healthy and have acceptable oral hygiene.  You must have a jawbone that is greater than 5mm  in width and greater than 10mm in vertical height.  The implants, when placed, must have sufficient stability for immediate function, as determined by the torque measures during placement.

From a facial standpoint, an evaluation of your smile line determines the visibility of the transition from the bridge to your tissues, which must be not visible.  Your lip contour reveals the possible need for a flange for support.  The height of the lower third of your face must allow for the dimensions of the prosthesis.  Inside your mouth, the character of the gum tissues is evaluated.  The height of your bite and jaw relationships need to have room for teeth and esthetic tooth display.

If you want to be examined for this successful procedure that allows you to walk in with a denture and walk out with an implant supported bridge in the same day, give us a call.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Analysis of 800 All-on-4 Implants

Full Arch Implants

Dr. Tupac has successfully used the All-on-4 technique to provide full arch prostheses for patients without any teeth in either the upper or lower jaw.  A recent study again substantiates the success of the technique.  An analysis of 800 implants placed following the All-on-4 protocol, from May 2005 until December 2011, at the PI Dental Center, was done.  The results of 152 patients showed the CSR (cumulative survival rate) of the implants was 97.3%, 96% in the upper jaw and 97.8% in the lower jaw, 98.1% in males and 96.9% in females and identical success rates (97.3%) for tilted and axial implants.  Prosthesis survival was 99%, whether opposing a complete denture or an arch of natural teeth.  These are the same success rates of Dr. Tupac's patients.

The advantage of the All-on-4 technique is that tilted implants are used to take advantage of the bone in front of the maxillary sinus and in front of the mandibular foramen, negating the necessity for complicated and expensive bone grafting procedures.

Source:  jopr


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309