All On 4 Protocol & Our Office Standards

The All on 4 protocol was design for patients with a terminal dentition were most or all of the remaining teeth are failing due to severe bone loss, infection or generalized caries rendering these teeth non restorable with conventional treatment. It provides a fix solution were the teeth are removed, the implants are placed and loaded the same day, eliminating the need for removable teeth.

How to choose an office that fits your needs and expectations is often a challenging task.Here are some things to consider:

I) The provider training and experience.

These cases are often very challenging because there is either very little bone or the quality of the bone is very poor. Also the occlusion (bite is often collapsed) or not ideal. Since this is a restorative driven procedure the most qualified specialist to handle this cases are Prosthodontists. A Prosthodontist that has surgical training will do both the surgery and the restorative part of the treatment which will provide the most desirable and predictable results. Other options are Prosthodontists collaborating with Oral Surgeons and Periodontist.

A well Trained PROSTHODONTIST with many years of experience will provide the Best Results.

2) Quality of the implants and restorative materials

There are over 100 implant companies. Choosing a provider/office that uses premium implants is very important. Most offices use second rated implants and materials to reduce cost. This will impact the long term survival and quality of the case. Most offices that focus on volume and not quality don’t use premium implants. In our view Nobel Biocare implants are the Gold Standard for this type of restorations.
After all they area the Pioneer of the All-on-4 Protocol.

We use Nobel Implants for all of our implant applications: All on 4’s, Single Crowns, Bridges , Overdentures, etc..

When addressing the material for the final restoration there is many to choose from. The choice should be based on which material will last longer, have the least amount of
maintenance, is kinder to the bone and the opposing dentition and provides the best aesthetics and natural feel.

1) Resin teeth over a milled titanium bar:

This is a poor choice for the final restoration and have the most maintenance. In the short term they function well but in the long run the teeth tend to brake are come of the prosthesis They also wear and stain with time and many need replacement after a few years.

2) Monolithic Zirconia:

They are stronger than choice # 1 but are very heavy and don’t have good translucency. This are milled in a solid color and then stained to the desired color. They are not kind to the bone and opposing dentition.

3) Layered Zirconia:

This material has some valuable applications specially for the patients with parafunction (severe clenchers and grinders). Is lighter that the monolithic Zirconia and has improved aesthetics because the front of the teeth are layered with high translucency porcelain.

4) PFM (Porcelain fused to Metal):

This material poses great qualities. Is very strong, very aesthetic and kind to the bone and opposing dentition

5) Individual Porcelain crowns over a Titanium framework:

This is the Best of the Best and not used often because is more expensive to make and also because it requires precise implant placement and an excellent and experience ceramist. It’s light, extremely aesthetics, very kind to the bone and opposing dentition. Requires very little to no maintenance. It’s definitely the Best Choice for cases of severe bone resorption and to restore Zigoma implants because it provides a strong and durable solution and is very light despite the fact that the restorations are typically very large because of the severe amount of bone loss.

Most offices use choices # 1 and # 2 to reduce cost. We do not use or recommend choice # 1 or 2 as final restorations.

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