All-on-four: Six Full Arch Replacement and Reconstruction

Virtual — Computerized Dentistry became increasingly popular after Nobel BiocareĀ® pioneered the popular treatment solution of “all-on-four” teeth replacement several years ago.

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Originally, the all-on-four procedure was deliverable as a manual method where CTscan-based surgery guides were not used. A second preferred method of delivery included a full set of cone beam CTscans, the use of virtual treatment planning software, and CTscan-based surgical guides, which assured the highest degree of treatment accuracy that never existed before.

During these early days of development, removable prosthetics (denture products) were the most common restoration, anchored with dental implants.

Dental professionals from nearly all general and specialty areas rapidly adopted the all-on-four treatment paradigm.

staff-xray-square Technological advancements were also rapid. Cone beam x-ray equipment and diagnosis/treatment software choices enabled dentists to provide the best that dentistry could provide, including the use of traditional crown and bridge products attached to a virtually-designed implant anchoring system that eliminated the failure issues of old fashioned dental implant procedures.

A patient’s ENTIRE implant and teeth replacement treatment plan is designed BEFORE treatment begins. Soft tissue conditions, bone level and bone quantity issues, implant type and implant placement all become known entities via the use of CTscans and planning software, thereby eliminating the prospect of “surprises” during treatment.



Superior Benefits – Dentistry Under One Roof

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A small, unique group of reconstructive dentists, nationwide, now have the ability to provide full mouth (or single arch) reconstruction in one appointment.

Dr. Nazarian and a few other reconstructive dentists within the U.S.A. are able to diagnose and successfully treat any range of treatment need with minimal inconvenience. Outside referrals to specialists are eliminated.

Despite the level of treatment need or severity, patients leave the office with a full set of new teeth. Being toothless is a thing of the past. Follow-up visits are scheduled as needed for follow-up and placement of final restorations.


Representative Severe Treatment Case

This particular patient had a significant history of gum tissue loss and bone loss that destroyed bite dynamics. Uneven tooth wear further accelerated the loss of function and overall comfort.

While gaping holes of bone loss did exist along certain areas of the upper and lower jaw bones, other areas had an abundance of healthy bone.

Virtual Diagnosis – Treatment Advantage – Maxilla – Upper Jaw

Upper Jaw Implant Placement

Upper Jaw Implant Placement

Specialized CTscan software assesses bone quantity and quality in 3 dimensions. Locating the best areas for implant placement no longer depends on guesswork.

Custom selection of dental implant characteristics (width and length) enabled Dr. Nazarian to create a solid foundation of six (6) implants for the upper jaw that would overcome variances in bone height and density.

Virtual Diagnosis – Treatment Advantage – Mandible – Lower Jaw

Lower Jaw Implant Placement

Lower Jaw Implant Placement

A CTscan of the lower jaw revealed, not only the obvious bone loss, but more importantly the areas of the bony ridge that had ideal density of healthy bone.

For this patient, a series of seven (7) implants of differing sizes were recommended for obtaining the best advantage for solid anchoring AND deriving maximum benefit of bone stimulation necessary for halting future bone loss.

Bone leveling (trimming of excess bone height) is provided, as needed, during implant surgery to assure that bone level across the treatment plane is even and homogenous, further assuring overall treatment success.


CTscan Guided Implant Surgery Guides – Upper Jaw

Upper Jaw Implant Surgery Guide

Upper Jaw Implant Surgery Guide

The upper jaw surgery guide is also created from the virtual treatment planning session that creates an idealized occlusal plane with the lower jaw.

Special design of the lower jaw crown and bridge, incorporating a cantilivered placement of “new teeth” successfully addresses an area of bone loss that normally would not accommodate natural teeth.

CTscan Guided Implant Surgery Guides – Lower Jaw

Lower Jaw Implant Surgery Guide

Lower Jaw Implant Surgery Guide

Pictured here is the surgical guide that will assure an accurate implant placement configuration that corresponds to the technical data generated by the treatment planning software.

The guide is designed to fit snuggly against the bony ridge of the upper jaw. Temporary anchor pins are used to prevent movement of the guide during preparation of each implant site.


Bridgework Placements

Porcelain Reconstruction Completion

Porcelain Reconstruction Completion

At the completion of the treatment appointment, patients are provided temporary versions of the new teeth replacements.

The use of temporaries enable the patient and Dr. Nazarian to make final adjustments in sizing, color and natural fit before the final, porcelain versions are made.

The final treatment photo pictured here demonstrates the degree of perfection a patient can achieve with Dr. Nazarian. Overall cosmetics are essentially perfect, as well as bite characteristics that are necessary for maintaining a comfortable bite that does not deteriorate over time.


Questions?

patient-front-desk-rec Contact Dr. Nazarian directly (via our Ask The Dentist form) to learn more about our all-on-four one appointment dentistry procedure. Dr. Nazarian will personally respond to you to address questions or concerns about the treatment or about any content on this webpage.