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Noble Biocare All on 4

Denture Alternative: New All-On-Four Teeth Replacement

For people who hate dentures, for good reason, or want to avoid dentures altogether, there is a new choice available for most patients.

All-on-fourNobel Biocare developed a hybrid tooth replacement protocol that incorporates the best of what CAD/CAM technology (computer aided design and engineering) offers and coupled it with the precision diagnostics generated by 3 Dimensional Imaging that is setting new standards in reconstructive dentistry.

The All On Four concept refers to a Nobel Biocare treatment consisting of a custom milled titanium framework that attaches to strategically placed rock solid implants (4 or more) and provides the foundation of replacing an entire arch of teeth.

Lower and upper jaws can be rehabilitated and restored with diagnostic and technical accuracy that was not possible just a few years ago.

Common Treatment Choice for Denture Wearers

Denture wearers are all too familiar with the events that take place after having a full arch of remaining teeth removed.

Sloppy Extractions Cause
Unnecessary Additional Bone Loss

Discounting the expected initial discomforts of being toothless and becoming accustomed to wearing a denture, the average denture wearer begins the process of making changes in eating habits, create new choices of what to eat, monitor changes in certain speech sounds, refrain from smiling too broadly and being careful about spontaneous laughter.

Depending on how often denture products are relined (to compensate for loosening fit due to gum tissue loss) or replaced (again, to overcome a loose fit) the majority of dentures wearers can maintain decent dental function and cosmetics for 10 – 15 – 40 years or more.

The Extremes of Bone and Gum Tissue Loss

NobelGuide Four Implant Prosthesis Surgery
Click picture to view

New or recently new denture wearers have an awareness they will have tissue loss, but not really the extent or extremes of it. Long term denture patients are fully aware. Too many, in fact.

There is a certain irony in assuring oneself with frequent denture relines and upgrades that guarantees tissue loss will assuredly continue. More and more denture wearers are facing the possibility of enduring so much tissue loss that wearing their favorite denture is no longer possible

Years and years of benign friction and grip wear away the gum tissues while unstimulated bone resorbs to a level where common implant dentistry has to be specialized.

Precision Reconstructive Tooth Replacement vs Dentures

Titanium Implant Framework
Sample: Custom Milled Titanium

The All-On-Four concept refers to the creation of a titanium framework that is developed from technical data that is generated from a Cone Beam Catscan. Oral surgeons, periodontists and general dentists whose primary focus is remaining abreast of available technologies (and having immediate access to them) use cone beam scanner that matches the diagnostic and treatment planning software they have. 

Digital Imaging Removes the Mystery

Dentists and specialists who have their own scanner oftetimes teach patients (easy and entertaining) how to interpret the 3 Dimensional images. The patient (with the doctor) reviews the health of single or multiple tooth structures, condition of gum tissues and overall health and density of bone tissue.

Nobel Guides
Click picture to watch live surgery

Current denture wearers are able to see, first hand, the effects of long term denture use. Ordinarily, bone loss across an entire arch occurs at different rates, creating an effect of hills and valleys within different areas of the jawbone.

The unevenness of bone loss results from the bone density values of different sections of the jaw. In the lower jaw, for example, the anterior (front most) is denser than the posterior areas.

Most denture wearers typically have a mix of bone densities across an entire arch.

Implant Site Selection

The 3-D imaging software enables the doctor and the patient to easily analyze the entire arch and select the dental implant sites that will assure the osseointegration (the fusing process of implant into live bone tissue) and provide the best opportunities for maintaining ongoing bone stimulation.

Clear Choice Treatment
Placement Example: Implant Positioning
in a Stone Model

The choice of the implant sites is configured to provide the strongest support for the titanium reinforced bridge and simultaneously distribute the strong biting and chewing forces we all have, especially when eating our favorite foods.

The adjacent photo of a stone model shows the recommended implant sites for one of our patients.

Managing Biting – Chewing Forces

The redistribution of biting forces is a hallmark of the All On Four tooth replacement protocol.

Patients who have had unusual histories of uneven bone loss across a given arch and underwent tooth replacement with common implant supported dentures frequently experience breakage.

Patient #2: Framework and Procera Bridge – 4 Implant Interface

Prosthesis cracking or breakage can also occur with many types of fixed bridges that have not been optimized for managing biting forces.

Nobel Biocare's custom titanium milling process, combined with the technical data generated by the doctor's 3-D imaging software generates a bridge product that manages biting and occlusal forces so well that prosthesis cracking, breakage and implants becoming loose are a thing of the past.

The photo pictured here shows how the titanium frame work forms the base of the prosthesis and provides the interface for attaching directly to the implants that were positioned in the previous photo of the stone model.

Zero Lateral Forces

Procera Bridge
Patient #2: Framework and Procera Bridge

Discounting oral infections and poor site preparation for implant placements, one of the most frequent causes of implant failure is lateral movement of the implant device (implants cannot withstand lateral forces).

Uneven occlusal planes and improperly placed implants will cause normal "up and down" biting forces to become shifted into a lateral (sideways) force, which will eventually destroy the fused state and cause failure. 

Implants that have lost their osseointegrative properties have the potential of causing an onslaught of other costly problems. 

It is the diagnostic precision of 3-D imaging and precision titanium milling that overcomes (eliminates) this common are of failure.

Popularity of the All On Four Solution

Procera Implant Bridge
Patient #2: Framework and Procera Bridge – Lingual View

Nobel Biocare has been a principal developer and provider of dental technologies for decades. They are especially known by dental professionals world wide for creating and maintaining the Gold Standard of Tooth Replacement.

It is the recent marriage of several leading edge technology advancements that include digital imaging, 3-D specialty software products, the development of immediate function (one day) implants and CAD/CAM Engineering concepts that have made the treatment protocol described on this page as one of the most popular and most sensible tooth replacement choices for edentulated patients in the United States.

Denture wearers, old and new, are encourage to research the availability of these technologies and products in their area. Larger metropolitan areas, as compared to smaller rural communities, will probably have these resources.