All-on-4, 6, and 8 & ZYGOMATIC Implants/Pros and Cons

The most international patient visit we get is from full arch or single arch implant patients and full mouth zirconium smile design patients.

All-on-4, 6, and 8 implants are advanced surgical and prostatic solutions that enable the natural teeth of patients requiring complete back restoration to be replaced in a short, stable and aesthetic manner.

The names of these solutions are derived from the number of implants placed to provide prosthetic support (4, 6 or 8), and were promoted by clinicians who wanted to offer an effective and cost-effective alternative to traditional full-ark or full-mouth implant restoration. These systems are most suitable for patients with damaged teeth, who are completely toothless, and those who have been diagnosed with multiple tooth loss in the short term, or who are in the current state.

The All-on-4 protocol is a registered trademark of Nobel Biocare and was developed by Paulo Malo in the late 1990s. This protocol is a system of implant placement and an immediate loading concept involving placement of a full-arch fixed provisional prosthesis in edentulous jaws. The All-on-4 concept was developed with the purpose of simplifying treatment for edentulous patients (who among other issues, often suffer with poor quality of life and have ill-fitting, uncomfortable complete dentures) and reducing the treatment complexity, treatment time, and cost usually associated with conventional implant protocols using more implants and often extended treatment duration.

With the All-on-4 system, bone grafting is often avoided due to the ability to use the anterior (front) jawbone and thereby bypass more complicated implant surgery. Though it was originally a system developed with the use of 4 implants, the term "All-on-4" has now been adopted more loosely to refer to any implant system that involves placement of a full-arch fixed prosthesis over a minimal number of implants, even if it exceeds 4.

Community need is important as it is a guideline to what treatment is to be assessed. At the moment, there is a high failure rate for dental implants with patients who have a history of chronic periodontitis, and 8% of the population are edentulous. Brånemark has developed a method that involves the placement of 4 implants in edentulous jaws with a fixed prosthesis, claiming that this only requires minimal intervention and effective results provided with the all on 4 concept. This use of a simple ridden treatment with a predictable positive outcome can also be applied to patients with various states of bone resorption. He is widely known as the father of modern dental implantology because of his milestone contribution in the field of implant dentistry; Per-Ingvar Branemark was born on the 3rd of May 1929. He studied at Lund University in Sweden and he became a professor of Anatomy at Gothenburg University in 1969.

These drawbacks have been the interest of periodontists and prosthodontists who have been looking into hybrid dentures that seek full arch rehabilitation in a fixed prosthesis with immediate loading. This concept was made a success with Brånemark's first patient, in which four titanium dental implants were placed into the mandible of a patient with a full bridge prosthesis. This patient was pleased with the results, as this removed a previous full denture that he was not comfortable with and he could utilize a fixed prosthesis. This method has shown to be a success with the added stability of the prosthesis; however, the cost is taxing and places 6-8 implants at risk of atrophied bone.

Important notes about dentures & prosthesis with immediate loading.

Our international patients must carefully consider crucial factors when it comes to immediate loading systems. Not all types of implant surgery are compatible with immediate loads. In the frontal region, the bone tissue possesses excellent capacity and height, ensuring a satisfactory structure that should not be soft when observed during the operation. Otherwise, if these implants are not successful, our patient may need to undergo additional procedures due to the initial failure, while the second one can be prevented. For our international patients, opting for the two-visit system is the most secure option. Prosthesis is required for the application of immediate loading systems. , but they are still same material with temporaries. Unlike the Temporaries, these have a hole specifically designed for screw placement. You won't find a better performance, no matter how high the quality.

The majority of our international patients opt for ceramic or zirconium materials due to their cost-effectiveness.

Despite the RCT or dental fillings for patients who have lost their teeth, they will realize the drawbacks of preserving teeth in the long term.

Why different systems?

The All-on-6 concept is simply an extension of the original All-on-4 treatment concept to support more implants when additional support is needed. The inherent disadvantage to All-on-4 is the cantilever effect with the restoration that can compromise the prosthesis over time. There are times when placement of four implants will not line up with prosthetic demands, and an implant is placed to aid in support. An example would be placement of six implants to support a prosthesis that is wider than what can be supported by four implants due to an elongated palate. For some we can only load 10 crowns over All-ON-FOUR, while we can place 12 on ALL-ON-6 and ALL-ON-EIGHT allows us to place 14 crowns on top of them.

The procedure and number of restorations for system can vary based on clinician preference based on medical reasons and patient treatment goals. When elderly people can be ok with fixed denture system, a 30 year old patient should and would will prefer ALL-ON-8 system with natural teeth looking zirconium crowns.

In today's world, experts know it is beneficial for our patients to receive the appropriate number of implants, regardless of their age. Ultimately, the best course of action is to place as many implants as possible in order to wean our patient off of temporeries for the rest of their lives if they have adequate height and thickness of bone in their mouth, adjacent areas, or in these areas,even this can be achieved through procedures like membrane grafting, open/closed sinus lift procedures, and bone grafting.

The main goal of implementing ALL-ON SYSTEMS is to provide our patients with a permanent solution, eliminating the need for temporary replacements throughout their lifetime.

If one implant in a 4 system implant fails, the entire fixed dental system can collapse. If there's no space available for an additional implant, our patient will be required to rely on a temporary solution indefinitely. Our body tends to prioritize the areas where the implants are placed or where the tooth root exists, and missing any of those in the areas, resulting in neglect and lack of nourishment in these areas. As a result, bone loss can significantly increase over time. It achieves extraordinary heights. That's why it's unrealistic to expect me to do it ahead of time.

Advantages & DisadvanategesOverview and Each system

Disadvantages Despite the advantages of All-on-4, 6, and 8 dental implants, it is clear from the case studies and literature that there are several disadvantages and potential pitfalls to these implant systems.

The first major disadvantage of using fewer implant posts is the inherently reduced number of prosthetic teeth that can be supported. While the use of fewer teeth can often be a cost-effective measure, especially in full arch rehabilitation, it has been shown that the insufficient number of teeth distributed over too wide an area can result in greater bite forces on individual teeth, causing failures of the restorative work.

Advantages It has been stated that All-on-4, 6, and 8 dental implants have a range of advantages over other more traditional dental implant systems. The primary advantage of these minimally invasive techniques is that they are less likely to require bone grafting, a technique which can add a 9-12 month waiting period to individual dental implants.

Better Aesthetic

This also has the added benefit of reducing the cost of dental implants because bone grafting is both an expensive and often uncomfortable procedure. The second advantage of these new implant technologies is that they can be minimally invasive even for patients who require multiple teeth extracted. Studies have shown that implant-supported overdentures have benefits in terms of patient comfort and aesthetics, as compared to traditional dentures.

With this in mind, aiming to replace not just single teeth but spanning areas of teeth with long bridges or even dentures and minimizing post-operative discomfort and recovery times must be a goal in the improved provision of dental implant services. Another potential advantage of All-on-4, 6, and 8 dental implants is increased long-term implant prognosis of anterior teeth and ease of locating implants in the correct position for optimizing treatment outcomes.

ZYGOMATIC IMPLANT

Traditionally, if you did not have sufficient bone mass in your jaws, the only option was bone graft surgery to regenerate and/or rebuild enough bone mass to create a sufficient foundation for traditional dental implants. Zygomatic implants are used in the upper jaw when there is insufficient bone for ordinary implants.

Our patients who need ZYGOMA implants have suffered bone losses that are too large for bone grafting to be used. And if he tries, he's sure he'll fail. The ZYGOMA implant requires an adequate thickness and size of the apple bone.

These implants provide support for implant dentures when there has been a substantial amount of bone loss from the upper jaw and ordinary implants cannot be used on their own to support a denture.

The Zygomatic implants are longer than ordinary dental implants and “anchor” to the very strong bulk of the bone that forms the cheekbone, or zygomatic arch ... hence their name. This means that the implants can be used as an alternative to complex bone grafting operations.

Typically, dental implant placement is most difficult in the upper back region of the mouth due to missing teeth that increase the progression of bone loss. In the past, in addition to bone grafting, a patient might have to have a sinus lift procedure as well, prior to getting his or her implants.

The development of the Zygoma implant presents a unique alternative for patients who wish to avoid bone grafting and sinus lifts, but still get dental implants, because the implants can be placed with only one surgical procedure and eliminate the need for grafting.

Prior to Zygomatic implant surgery, a three-dimensional (CBCT) scan will be taken to assess the amount of bone available in the upper jaw to allow us to plan the placement of these implants. It is also possible to make an anatomical model of your jaw, which enables us to visualize the precise shape of the jaw and cheekbone, without having to carry out wide surgical exposure. Typically, two Zygomatic implants are used along with two to four ordinary implants.

After the long Zygomatic implants are anchored on the upper jaw inside the zygomatic bone, a provisional prosthesis can be fixed immediately after placement of the implants, until the complete restoration is achieved. Patients leave with a temporary prosthesis which allows them essentially to have “Teeth in a a few!”

The final prosthesis is fabricated after adequate healing time and integration of all implants placed during surgery.

Combining Straumann Zygomatic and BLX Implants:

A clinical case report describes a technique that combines Straumann Zygomatic implants with Straumann BLX implants for immediate full arch rehabilitation.

Zygomatic implants are typically considered for severe bone atrophy resulting from long-term edentulism and denture wearing.However, other factors, such as odontogenic pathology, sinus anatomy, and iatrogenic issues, can also contribute to bone loss.

Early planning and treatment, including Zygomatic implants, can be advantageous for patients before they become fully edentulous.

The case report details the successful rehabilitation of a partially dentate patient using Zygomatic and BLX implants, resulting in fixed implant-supported restorations within 24 hours after surgery.

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