All‐on‐4 immediate function concept

Abstract

Background Nowadays the immediate loading procedure for the rehabilitation of edentulous jaws using osseointegrated implants has gained popularity among clinicians. However, the rehabilitation of edentulous jaws is often complicated by poor bone quality, especially in the posterior region and reduced bone volume due to longterm edentulism. Several clinical studies have reported that tilting of the implants may represent feasible treatment option. Such technique has several surgical and prosthetic advantages Aim/Hypothesis The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of immediate function of four implants supporting a fixed prosthesis in the completely edentulous jaws. Material and Methods This clinical case series included 10 patients with 72 immediately loaded implants (10 maxillary and 8 mandibular arch). Each patient received a full-arch fixed prosthesis supported by two distal tilted implants and two anterior axially placed implants. The provisional functional acrylic prosthesis and loading was applied within 48 hours from surgery. The patients were evaluated clinically and radiographically at implant placement, at 18 month follow-up examinations. Implant survival and prosthesis success were assessed. At follow-up plaque and bleeding score was assessed and radiographic evaluation of marginal bone level was performed. Results One immediately loaded tilted implant were lost in one patient before the 6-month follow-up. A total of 17 immediately loaded prostheses (10 in the maxilla and 7 in the mandible) were in function for at 18 months and were considered for the clinical examination. No further implant failure occurred to date. Total implant survival at 18 months was 98.6% (100% and 96.8% for the maxilla and the mandible, respectively). Marginal bone loss at 1 year averaged 0.59 mm in axial implants and 0.61 mm in tilted implants. 2 patients had a fracture of the provisional restoration, but all of the definitive prostheses remained stable throughout the study period without any complications. Conclusion and Clinical Implications The results of this clinical study show that the ìAll on Fourî immediate function concept is a viable treatment modality for the atrophic maxillae and mandibulae and there does not seem to be a different clinical outcome between tilted and axial implants.