Implantable System Research Articles

A data compression algorithm with the improved SRLE for high-throughput neural signal acquisition device.

Multi-channel acquisition systems of brain neural signals can provide a powerful tool with a wide range of information for the clinical application of brain computer interfaces. High-throughput implantable systems are limited by size and power consumption, posing challenges to system design. To acquire more comprehensive neural signals and wirelessly transmit high-throughput brain neural signals, a FPGA-based acquisition system for multi-channel brain nerve signals has been developed. And the Bluetooth transmission with low-power technology are utilized. To wirelessly transmit large amount of data with limited Bluetooth bandwidth and improve the accuracy of neural signal decoding, an improved sharing run length encoding (SRLE) is proposed to compress the spike data of brain neural signal to improve the transmission efficiency of the system. The functional prototype has been developed, which consists of multi-channel data acquisition chips, FPGA main control module with the improved SRLE, a wireless data transmitter, a wireless data receiver and an upper computer. And the developed functional prototype was tested for spike detection of brain neural signal by animal experiments. From the animal experiments, it shows that the system can successfully collect and transmit brain nerve signals. And the improved SRLE algorithm has an excellent compression effect with the average compression rate of 5.94%, compared to the double run-length encoding, the FDR encoding, and the traditional run-length encoding. The developed system, incorporating the improved SRLE algorithm, is capable of wirelessly capturing spike signals with 1024 channels, thereby realizing the implantable systems of High-throughput brain neural signals.

A multi-channel stimulator with an active electrode array implant for vagal-cardiac neuromodulation studies

BackgroundImplantable vagus nerve stimulation is a promising approach for restoring autonomic cardiovascular functions after heart transplantation. For successful treatment a system should have multiple electrodes to deliver precise stimulation and complex neuromodulation patterns.MethodsThis paper presents an implantable multi-channel stimulation system for vagal-cardiac neuromodulation studies in swine species. The system comprises an active electrode array implant percutaneously connected to an external wearable controller. The active electrode array implant has an integrated stimulator ASIC mounted on a ceramic substrate connected to an intraneural electrode array via micro-rivet bonding. The implant is silicone encapsulated for biocompatibility and implanted lifetime. The stimulation parameters are remotely transmitted via a Bluetooth telemetry link.ResultsThe size of the encapsulated active electrode array implant is 8 mm × 10 mm × 3 mm. The stimulator ASIC has 10-bit current amplitude resolution and 16 independent output channels, each capable of delivering up to 550 µA stimulus current and a maximum voltage of 20 V. The active electrode array implant was subjected to in vitro accelerated lifetime testing at 70 °C for 7 days with no degradation in performance. After over 2 h continuous stimulation, the surface temperature change of the implant was less than 0.5 °C. In addition, in vivo testing on the sciatic nerve of a male Göttingen minipig demonstrated that the implant could effectively elicit an EMG response that grew progressively stronger on increasing the amplitude of the stimulation.ConclusionsThe multi-channel stimulator is suitable for long term implantation. It shows potential as a useful tool in vagal-cardiac neuromodulation studies in animal models for restoring autonomic cardiovascular functions after heart transplantation.

A Biodegradable, Stretchable, Healable, and Self-Powered Optoelectronic Synapse Based on Ionic Gelatins for Neuromorphic Vision System.

Optoelectronic synapses have gained increasing attentions as a fundamental building block in the development of neuromorphic visual systems. However, it remains a challenge to integrate multiple functions into a single optoelectronic synapse that can be widely applied in wearable artificial intelligence and implantable neuromorphic vision systems. In this study, a stretchable optoelectronic synapse based on biodegradable ionic gelatin heterojunction is successfully developed. This device exhibits self-powered synaptic plasticity behavior with broad spectral response and excellent elastic properties, yet it degrades rapidly upon disposal. After complete cleavage, the device can be fully repaired within 1min, which is mainly attributed to the non-covalent interactions between different molecular chains. Moreover, the recovery and reprocessing of the ionic gelatins result in optoelectronic properties that are virtually indistinguishable from their original state, showcasing the resilience and durability of ionic gelatins. The combination of biodegradability, stretchability, self-healing, zero-power consumption, ease of large-scale preparation, and low cost makes the work a major step forward in the development of biodegradable and stretchable optoelectronic synapses.

Triphasic Pulse Stimulation Pattern in Cochlear Implant Users Assessed with Ecap Measure

The rationale for the use of three-phase stimulation for programming the processor of the cochlear implantation system (CI) in patients with deafness is presented. To study the possibilities of using a new type of stimulation, we selected patients after cochlear implantation, with signs of facial nerve stimulation (FNS) in postoperative period. All subjects were previously fitted with an audio processor with individual fitting maps based on traditional biphasic stimulation. The use of three-phase stimulation to prevent FNS is caused by the geometry of the electric current pulses, which allows to reduce the penetrating power of the charge in the tissues and eliminate the effect on the facial nerve, without resorting to reducing the levels of stimulation necessary to create a dynamic range of sound perception. Comparative data of the parameters and the results of audiological testing in 21 patients with symptoms of FNS with traditional (two-phase) and three-phase electrical pulses in the stimulation algorithm of the CI system are presented. The positive effect of three-phase stimulation has been established. The results of the study show a significant increase in sound perception indicators when switching to a three-phase stimulation algorithm.

Comparison of Different Implant Systems by Stress and Resistance of Prosthetic Screws: An Original Research

ABSTRACT Introduction: For the best possible clinical results, dental implant systems must have their biomechanical characteristics thoroughly evaluated. These systems are essential to restorative dentistry. The purpose of this study was to analyze the resistance and stress distribution of prosthetic screws across five distinct implant systems. Methods: The stress distribution on prosthesis screws was evaluated, and loading conditions were simulated using finite element analysis (FEA). To assess the screws’ resistance to torque forces, mechanical testing was done. Findings: Among the implant systems, there were notable differences in torque resistance and stress distribution. System A had the least amount of stress and the most torque resistance, whereas System E displayed the most stress and the least torque resistance. Conclusion: The results emphasize the significance of taking biomechanical characteristics into account when choosing implant systems for clinical usage, which has ramifications for patient care and treatment planning. Additional investigation concentrating on thorough clinical assessments is necessary to confirm these results and enhance treatment plans.

Single-Piece Implant Systems and its Longterm Stability: An Evaluative Research.

The objective of this research was to compare the longstanding stability of single-piece implant systems to typical two-piece systems by analyzing patient records retrospectively. A retrospective examination of patient records from January 2010 to December 2020 was undertaken at the Department of Oral Implantology, University Hospital. The research included dental rehabilitation patients who got single- or two-piece implant systems. Patient demographics, implant features, surgical procedures, and follow-up results were extracted. Implant success rates, stability defined by resonance frequency analysis (RFA) utilizing Osstell ISQ®, and peri-implant bone loss evaluated by standardized periapical radiographs at baseline and follow-up visits were the main outcomes. The research involved 320 patients (160 per cohort). The average patient age was 52.7 years, with 55% men. The mandibular region received 65% of implants, and the maxillary region the rest. Single-piece cohort A had 94.6% implant success, and two-piece cohort B 96.2%. Implant success rates were similar between cohorts (P = 0.412). The mean ISQ scores were 72.4 ± 4.8 in cohort A and 74.8 ± 5.1 in cohort B (P = 0.086). Peri-implant bone loss was 1.8 ± 0.7 mm in cohort A and 1.4 ± 0.6 mm in cohort B (P = 0.031). Single-piece implant systems provide a stable and successful alternative to classic two-piece systems. However, patient selection, surgical technique, and monitoring are essential to reduce peri-implant problems and improve clinical results. To improve implant dentistry patient care and evidence-based clinical practice, single-piece and two-piece implant systems' design, biomechanical features, and longstanding performance should be studied.

Two-year Pivotal Study Analysis of the Safety and Efficacy of Implantable Tibial Nerve Stimulation With eCoin for Urgency Urinary Incontinence

ObjectiveTo evaluate the continued effectiveness and safety of the eCoin Implantable Tibial Nerve Stimulator system (ITNS) for urgency urinary incontinence in patients with overactive bladder.The one-year pivotal study was extended through two years. The ITNS is a novel and recently FDA-approved therapy. MethodsA prospective, multicenter, single-arm trial was conducted on 137 subjects with refractory urgency urinary incontinence to evaluate eCoin ITNS therapy. A 3-day voiding diary was collected along with the overactive bladder questionnaire, Patient Global Impression of Improvement, and a custom Likert scale on subject satisfaction. The primary efficacy measure was the proportion of subjects who achieved at least 50% reduction from baseline in number of urgency urinary incontinence episodes. The primary safety measure was device-related adverse events. Results72 subjects completed the 96-week evaluation. 78% (95% CI: 67% - 87%) experienced at least 50% reduction in urgency urinary incontinence episodes; 48% (95% CI, 36%-60%) experienced at least 75% reduction, and 22% (95% CI, 13%-33%) were dry on a 3-day diary. Subjects reported a decrease from baseline in their urgency urinary incontinence episodes/day of 2.61 (SD 2.97) and 2.97 (SD 2.64) at 48 weeks and 96 weeks, respectively. 91.3% did not require additional medications for overactive bladder. No serious or unanticipated adverse events were reported in this extension phase. ConclusionsThe eCoin ITNS demonstrated consistent continuing effectiveness and safety in treating overactive bladder patients with urgency urinary incontinence. The findings support it as an excellent treatment option for refractory patients.

Evaluation of Long-Term Stability in Single-Piece Implant Systems: An Original Research.

Because of its integrated design and possible benefits over conventional two-piece systems, single-piece implant systems have grown in favor in the field of dental implantology. There is, however, still a dearth of information about their long-term stability and clinical results. The purpose of this study was to assess the clinical results, such as implant survival rates, peri-implant tissue health, and marginal bone levels, to determine the long-term stability of single-piece implant systems. About 127 individuals who got single-piece implants at the tertiary care center were the subject of a retrospective analysis. Standardized procedures were followed for implant implantation, and patients were monitored for at least five years afterward. Through radiographic analysis and clinical tests, clinical indicators such as marginal bone levels, peri-implant tissue health, and implant survival rates were evaluated. With low marginal bone loss and good peri-implant tissue health, the research showed a high implant survival rate of 96.5%. A statistical study revealed significant relationships between marginal bone loss (P < 0.01), peri-implant tissue health (P < 0.05), and implant survival. In this study, single-piece implant devices showed good long-term durability and clinical results. These results confirm its effectiveness as a dependable dental rehabilitation alternative, highlighting the significance of preserving the health of the peri-implant tissue and reducing marginal bone loss to guarantee implant success.

The Advances in Phospholipids-Based Phase Separation Gels for the Sustained Release of Peptides, Proteins, and Chemotherapeutics.

Implantable drug delivery systems formed upon injection offer a host of advantages, including localized drug administration, sustained release, minimized side effects, and enhanced patient compliance. Among the various techniques utilized for the development of in situ forming drug implants, solvent-induced phase inversion emerges as a particularly promising approach. However, synthetic polymer-based implants have been associated with undesirable effects arising from polymer degradation. In response to this challenge, a novel category of drug delivery systems, known as phospholipids-based phase separation gels (PPSGs), has emerged. These gels, characterized by their low initial viscosity, exhibit injectability and undergo rapid transformation into in situ implants when exposed to an aqueous environment. A typical PPSG formulation comprises biodegradable components, such as phospholipids, pharmaceutical oil, and a minimal amount of ethanol. The minimized organic solvents in the composition show good biocompatibility. And the relatively simple composition holds promise for industrial-scale manufacturing. This comprehensive review provides an overview of the principles and advancements in PPSG systems, with specific emphasis on their suitability as drug delivery systems for a wide range of active pharmaceutical ingredients (APIs), spanning from small molecules to peptides and proteins. Additionally, we explore the critical parameters and underlying principles governing the formulation of PPSG-based drug delivery strategies, offering valuable insights on optimization strategies.

Implantable trilayer microneedle transdermal delivery system to enhance bioavailability and brain delivery of rivastigmine for Alzheimer treatment: A proof-of-concept study

Alzheimer’s disease (ALZ) is a neurological disorder characterized by cognitive decline. Rivastigmine (RV), an acetylcholinesterase inhibitor, is commonly used to treat ALZ. Unfortunately, RV is availablein capsule form, which is associated with low drug bioavailability, and in patch form, which can lead to skin irritation upon repeated use. This study successfully fabricated a trilayer dissolving microneedle (TDMN) containing RV with adequate mechanical strength by using the molding method. In vitro release and ex vivo permeation showed that the release and permeation of RV were significantly sustained compared to control without PCL. The release and permeation percentages were 91.34 ± 11.39 % and 13.76 ± 1.49 μg/cm2, respectively. In addition, the concentration of RV in plasma and brain after 168 h was measured to be 0.44 ± 0.09 µg/mL and 1.23 ± 0.26 µg/g, respectively, which reached the minimum concentration to inhibit AcHE and BuChe. Pharmacokinetic testing revealed higher AUC values after administration of TDMN, indicating better bioavailability and RV concentrations in the brain were twice as high as those achieved with oral administration. This study suggests TDMN may enhance the bioavailability and brain delivery of RV.

Surface Topography Has Less Influence on Peri-Implantitis than Patient Factors: A Comparative Clinical Study of Two Dental Implant Systems.

This study aims to assess the risk of peri-implantitis (PI) onset among different implant systems and evaluate the severity of the disease from a population of patients treated in a university clinic. Furthermore, this study intends to thoroughly examine the surface properties of the implant systems that have been identified and investigated. Data from a total of six hundred and 14 patients were extracted from the Institute of Clinical Dentistry, Dental Faculty, University of Oslo. Subject- and implant-based variables were collected, including the type of implant, date of implant installation, medical records, recall appointments up to 2022, periodontal measurements, information on diabetes, smoking status, sex, and age. The outcome of interest was the diagnosis of PI, defined as the occurrence of bleeding on probing (BoP), peri-implant probing depth (PD) ≥ 5 mm, and bone loss (BL). Data were analyzed using multivariate linear and logistic regression. Scanning electron microscopy, light laser profilometer, and X-ray photoelectron spectroscopy were utilized for surface and chemical analyses. Among the patients evaluated, 6.8% were diagnosed with PI. A comparison was made between two different implant systems: Dentsply Sirona, OsseospeedTM and Straumann SLActive, with mean follow-up times of 3.84 years (SE: 0.15) and 3.34 years (SE: 0.15), respectively. The surfaces have different topographies and surface chemistry. However, no significant association was found between PI and implant surface/system, including no difference in the onset or severity of the disease. Nonetheless, plaque control was associated with an increased risk of developing PI, along with the gender of the patient. Furthermore, patients suffering from PI exhibited increased BL in the anterior region. No differences were observed among the evaluated implant systems, although the surfaces have different topography and chemistry. Factors that affected the risk of developing PI were plaque index and male gender. The severity of BL in patients with PI was more pronounced in the anterior region. Consequently, our findings show that success in implantology is less contingent on selecting implant systems and more on a better understanding of patient-specific risk factors, as well as on implementing biomaterials that can more effectively debride dental implants.

Fabrication and Optimisation of Alumina Nanoporous Membranes for Drug Delivery Applications: A Comparative Study.

Neurodegenerative disorders cause most physical and mental disabilities, and therefore require effective treatment. The blood-brain barrier (BBB) prevents drug molecules from crossing from the blood to the brain, making brain drug delivery difficult. Implantable devices could provide sustained and regulated medication to solve this problem. Two electrolytes (0.3 M oxalic acid and 0.3 M sulphuric acid) were used to anodise Al2O3 nanoporous membranes, followed by a third anodisation in concentrated H2SO4 to separate the through-hole membranes from the aluminium substrate. FTIR, AFM, and SEM/EDX were used to characterise the membranes' structure and morphology. The effects of the anodisation time and electrolyte type on the AAO layer pore density, diameter, interpore distance, and thickness were examined. As a model drug for neurodegenerative disorders, donepezil hydrochloride (DHC) was loaded onto thin alumina nanoporous membranes. The DHC release profiles were characterised at two concentrations using a UV-Vis spectrophotometer. Oxalic acid membranes demonstrated an average pore diameter of 39.6-32.5 nm, which was two times larger than sulphuric acid membranes (22.6-19.7 nm). After increasing the anodisation time from 3 to 5 h, all of the membranes showed a reduction in pore diameter that was stable regardless of the electrolyte type or period. Drug release from oxalic acid-fabricated membranes was controlled and sustained for over 2 weeks. Thus, nanoporous membranes as implantable drug delivery systems could improve neurodegenerative disease treatment.

Vertical Mouth Opening Requirements for CAD/CAM Fully Guided Implant Surgery: An Analysis of Different Implant Systems.

To determine the vertical space required for implant osteotomy preparation when utilizing a CAD/CAM fully guided surgical template. A total of 14 surgical osteotomy drills (individual and sequential drills) were collected and measured individually using a digital caliper, as well as the total length when the drills were positioned in a surgical handpiece. The height of the surgical guide sleeves and the offset of 14 implant systems in the market were also collected. The vertical dimension of the drills included in this study ranged from 28.2 to 46.3 mm. When these drills were inserted into the handpiece, the total length ranged from 30.0 to 49.5 mm. The height of the surgical guide sleeve and the offset required for the guide had a range of 3.2 to 7.0 mm and 5.0 to 13.5 mm, respectively. This dimension resulted in the total vertical space required for CAD/CAM fully guided surgical templates for each implant system, which ranged from 30.0 to 58.5 mm. Limited mouth opening can pose challenges and limitations in both guided and nonguided dental implant surgery. It can affect the accessibility of surgical implant placement and may result in increased patient discomfort, surgical implant positioning errors, and postoperative complications. Clinicians should determine the patient's mouth opening capabilities during the treatment planning phase prior to deciding on the appropriate implant system to be used and the implant placement technique.

Mechanical Integrity of All-on-Four Dental Implant Systems: Finite Element Simulation of Material Properties of Zirconia, Titanium, and PEEK

Mechanical Integrity of All-on-Four Dental Implant Systems: Finite Element Simulation of Material Properties of Zirconia, Titanium, and PEEK

Toward high-resolution 3D-printing of pharmaceutical implants – A holistic analysis of relevant material properties and process parameters

In this work, filament-based 3D-printing, the most widely used sub-category of material extrusion additive manufacturing (MEAM), is presented as a promising manufacturing platform for the production of subcutaneous implants. Print nozzle diameters as small as 100 µm were utilized demonstrating MEAM of advanced porous internal structures at the given cylindrical implant geometry of 2 mm × 40 mm. The bottlenecks related to high-resolution MEAM of subcutaneous implants are systematically analyzed and the print process is optimized accordingly. Custom synthesized biodegradable phase-separated poly(ether ester) multiblock copolymers exhibiting appropriate melt viscosity at comparatively low printing temperatures of 135 °C and 165 °C were utilized as 3D-printing feedstock. The print process was optimized to minimize thermomechanical polymer degradation by employing print speeds of 30 mm∙s−1 in combination with a nozzle diameter of 150 µm at layer heights of 110 µm. These results portray the basis for further development of subcutaneous implantable drug delivery systems where drug release profiles can be tailored through the adaption of the internal implant structure, which cannot be achieved using existing manufacturing techniques.

Naringenin-loaded poly(3-hydroxybutyrate-co-3-hydroxyvalerate)-based devices have an anti-inflammatory activity on microglia

Retinal degenerative diseases, such as retinitis pigmentosa, represent a significant fraction of the burden of blindness. This kind of diseases involves the activation of microglial cells which causes neuroinflammation. Flavonoids, such as naringenin (Nar), are able to modulate the pro-inflammatory behavior of the microglia cells but their low bioavailability often hinders this activity. In this context, the aim of this research activity was the development of implantable drug delivery systems through Nar encapsulation into a polymeric matrix, as a valuable way to increase its bioavailability. For this purpose, a blend between microbial poly(3-hydroxybutyrate-co-3-hydroxyvaerate) (PHBV) and poly(d,l-lactide-co-glycolide (PLGA) was processed by means of two different fabrication techniques, i.e., melt-spinning and wet-spinning, to fabricate rods designed for ocular implantation. The two developed kinds of rod had different morphology and thermal properties, as demonstrated by scanning electron microscopy, thermogravimetric analysis, and differential scanning calorimetry. In addition, an increase in Nar concentration in the starting polymeric mixture (1–5 wt% respect to device weight) determined a higher drug encapsulation efficiency, with a resulting drug loading increasing from 0.5 to 3.5 % and from 0.4 to 4.4 % for melt- and wet-spun rods, respectively. A significant effect of processing technique and drug loading on the resulting release kinetics was also observed, with the devices loaded with a higher percentage of Nar reaching a 100 % cumulative drug release after 38 and 73 days in the case of wet- and melt-spun rods, respectively. In addition, the wet-spun rods showed a first order drug release kinetics while the melt-spun rods a zero order one. The bioactivity of the wet-spun rods was tested on lipopolysaccharide-activated BV2 as well as primary murine microglia cells, thus demonstrating the ability of the released flavonoid to favor cell maturation from a pro-inflammatory to an anti-inflammatory phenotype.

Biocompatible Electrical and Optical Interfaces for Implantable Sensors and Devices.

Implantable bioelectronics hold tremendous potential in the field of healthcare, yet the performance of these systems heavily relies on the interfaces between artificial machines and living tissues. In this paper, we discuss the recent developments of tethered interfaces, as well as those of non-tethered interfaces. Among them, systems that study neural activity receive significant attention due to their innovative developments and high relevance in contemporary research, but other functional types of interface systems are also explored to provide a comprehensive overview of the field. We also analyze the key considerations, including perforation site selection, fixing strategies, long-term retention, and wireless communication, highlighting the challenges and opportunities with stable, effective, and biocompatible interfaces. Furthermore, we propose a primitive model of biocompatible electrical and optical interfaces for implantable systems, which simultaneously possesses biocompatibility, stability, and convenience. Finally, we point out the future directions of interfacing strategies.

Soft-Template-Based Manufacturing of Gold Nanostructures for Energy and Sensing Applications.

Implantable and wearable bioelectronic systems can enable tailored therapies for the effective management of long-term diseases, thus minimising the risk of associated complications. In this context, glucose fuel cells hold great promise as in- or on-body energy harvesters for ultra-low-power bioelectronics and as self-powered glucose sensors. We report here the generation of gold nanostructures through a gold electrodeposition method in a soft template for the abiotic electrocatalysis of glucose in glucose fuel cells. Two different types of soft template were used: a lipid cubic phase-based soft template composed of Phytantriol and Brij®-56, and an emulsion-based soft template composed of hexane and sodium dodecyl sulphate (SDS). The resulting gold structures were first characterised by SAXS, SEM and TEM to elucidate their structure, and then their electrocatalytic activity towards glucose was compared in both a three-electrode set-up and in a fuel cell set-up. The Phytantriol/Brij®-56 template led to a nanofeather-like Au structure, while the hexane/SDS template led to a nanocoral-like Au structure. These templated electrodes exhibited similar electrochemical active surface areas (0.446 cm2 with a roughness factor (RF) of 14.2 for Phytantriol/Brij®-56 templated nanostructures and 0.421 cm2 with an RF of 13.4 for hexane/SDS templated nanostructures), and a sensitivity towards glucose of over 7 μA mM-1 cm-2. When tested as the anode of an abiotic glucose fuel cell (in a phosphate-buffered solution with a glucose concentration of 6 mM), a maximum power density of 7 μW cm-2 was reached; however the current density in the case of the fuel cell with the Phytantriol/Brij®-56 templated anode was approximately two times higher, reaching the value of 70 μA cm-2. Overall, this study demonstrates two simple, cost-effective and efficient strategies to manipulate the morphology of gold nanostructures, and thus their catalytic property, paving the way for the successful manufacturing of functional abiotic glucose fuel cells.

Pathogen inactivation mechanism with application in implantology

At the present time, a special attention is given to the large-scale using of implant treatments. Modern implants have a good rate of success, reliability and longevity, they are minimally invasive, delicate and resistant. Due to the development of some forms of pathogens at the implant-tissue contact, there are situations of poor adhesion of the implant surface to the organic tissue. The application of chemical or surgical methods in such situations are difficult. But in order to solve these phenomena, new techniques are needed to be implemented. That why it is proposed to apply ultraviolet radiation on the optical system (photonic crystals and photonic fiber crystals) of modern implants to treat the infection that can appear on the surface between the implant and the cellular tissue in the process of poor adhesion. These combinations of periodic quartz optical structures are deposited and regularly arranged (set of fibers or spheres) on the implant surface, which can be used as a large volume dispersion of ultraviolet C radiation to treat the infection at the surface between the implant and adhesion tissue. The proposed periodic optical structure contributes considerably to increasing the adhesion of the implant to the cellular tissue, thus stimulating cellular growth between the elements and the implant.

Assessment of various treatment techniques in restoring articulatory balance in the mastication center of occlusion

In clinical practice, due to various factors, we are facing patients with few teeth left in the lower jaw, often without any perspective. As a result of the reduced load capacity, they are loosened and can be completely lost. On the other hand, prosthodontics has a great potential for a unique implant - prosthetic rehabilitation. The goal is to preserve the alveolar ridge and slow down its resorption. With the advancement of the technology, conventional dentures are being replaced with more sophisticated therapeutic methods, such as modern prosthodontic superstructures. One of the latest solutions for this problem is the application of the Brånemark system (Nobel Biocare). These restorations that are applied represent a multi-unit system of implants and one hybrid prosthesis. This represents a mobile prosthetic suprastructure, which can be fixed with specific attachments on 4 implants. This combination of placement of a hybrid prosthetic structure on 4 implants is known as „all on four“. There are many discussions and writings about this multidisciplinary concept in the professional world. Over these 4 implants, a suprastructure with maximum 12 teeth can be immediately placed. The prosthetic construction circularly covers the entire toothless mandibular ridge. The data obtained from the patients show difference in the development of the bite force in the mastication center. The results have also shown a better quality of life in patients using a hybrid denture compared to the conventional prosthetic rehabilitation