The inventor of this technique is a Portuguese dentist: Dr. Paulo Malo, who has taken up the concepts of implant surgery developed in the 90s, which suggested the possibility of avoiding complex and invasive interventions, such as bone grafts or maxillary sinus elevations, inclining the implants in a way to anchor them in the patient’s residual bone.
Table of contents
- 1 About Implantology All on 4 and implantology All on 6
- 2 Implantology: removal of alveolar bone
- 3 A minimal-invasive alternative
- 4 AllonSix Prettau® protocol with respect to implantology All on 4 and implantology All on 6: What are the advantages?
About All-on-4 implantology and implantology All-on-6
The relative ease of these techniques has made it very popular with dentists all over the world and most dental implant companies have helped to promote it by promoting its diffusion around the World.
The All on 4, the first protocol used for the immediate loading protocol in edentulous patients, began to be increasingly used also in patients where it was necessary to extract the teeth and place the implants simultaneously.
The diffusion of these techniques, which always include the presence of a false gingiva , unfortunately, in our opinion, led to clinical results that were not always comfortable for patients, especially from an aesthetic point of view.
One thing is in fact to treat an edentulous patient and another thing is to treat a patient with his teeth still present, even if irretrievable and therefore must to be extracted.
The edentulous patient is obviously a patient with a total removable prosthesis (denture), which is an artifact made of resin with false gingiva (with the pink color to imitate the natural gum) from which resin or ceramic teeth come out. It is clear that for this type of patient to pass from a said mobile prosthesis to a similar, but fixed, a prosthesis is always an undoubted advantage.
The patient with residual teeth to be extracted is instead a patient to be evaluated in a completely different way.
For this type of patient where the teeth, as mentioned, although compromised, come out of the natural gums, an All on 4 or All on 6 rehabilitation (with teeth coming out of an artificial gum flange) could be an aesthetically unacceptable solution, especially with regard to the rehabilitation of the upper arch.
The All on 4 or the All on 6 alternative was born as an effective, rapid and inexpensive dental implant solution but always involves the use of a false resin gingiva so it is a fixed denture .
Implantology All-on-4 and implantology All-on-6 removal of alveolar bone
The protocol was drawn up also in post-extractive cases, therefore, it provides, after the extraction of the teeth, and sometimes important removal of alveolar bone (the bone that supports the teeth) in order to create space for a flange of false artificial gingiva.
So before proceeding with the All on 4 or All on 6 protocol in a patient with teeth to be extracted it would be important, in our opinion, to evaluate various parameters well. The most important of which are:
- Patient’s age
- Their smile line
- Their aesthetic needs
A minimal invasive alternative
Always aware of this evidence, in our Clinic, we have been dedicating ourselves to less and less invasive techniques in order to preserve the residual alveolar bone and make the teeth come out of the patients’ natural gums.
As in the All on 6 technique we use a limited number of implants, 6 in the upper arch (maxilla) and 6 in the lower arch (mandible), we tilt them to anchor them in the patient’s residual bone (in order to avoid complex bone graft operations) and proceed with the immediate post-extractive loading protocol.
This type of protocol developed by Dr. Alejandro Freer has been called All-on-Six Zirconia Prettau®.
Similarly to the All on 4 the prosthesis with which we rehabilitate the patient, both as regards the temporary phase (prosthesis 24 hours after surgery) and the definitive one (prosthesis 6-8 months after surgery), is always screwed and never cemented; this is undoubtedly an enormous advantage for the patient as, due to any eventuality (such as fracturing dental elements, checks on the implants, etc.), it can be removed by the dentist simply by unscrewing it with special screwdrivers.
This technique is totally different from the All on 4 or from the All on 6 as, once the teeth are extracted, the gums are not detached and, after placing the implants directly in the post-extraction sockets, no portion of the teeth is removed. alveolar bone.
The alveolar bone is not only not amputated but is reconstructed with synthetic bone, in order to create a gingival morphology that allows the release of the new teeth in the most natural way possible.
Obviously, since it operates in the closed sky and guided only by the patient’s Cone Beam TAC, this type of surgery presents much higher difficulties for the surgeon, which is extremely longer than that of the All on 4.
This type of operation, surgically more refined and difficult, has been developed and perfected over the years by Dr. Alejandro Freer; now a days it’s requested directly by the patients themselves and by the dentist colleagues who send them to us.
Their degree of appreciation for the aesthetic results obtained with this type of rehabilitation is giving us considerable satisfaction and is pushing us to improve more and more in this direction.
Above: Rehabilitation with false gingiva: All-on-4
Above: Final rehabilitation with natural gingiva
Only One Protocol with respect to All on 4 implantology and All on 6 implantology: what are the advantages?
To support the rightness of our All-on-6 technique, which is much less invasive and much more conservative than the All on 4 technique, there are further considerations to be made:
- During the postoperative period, the patient does not feel pain and have very little swelling
- Oral hygiene is greatly facilitated since, being preserved the correct alveolar bone height, the patient does not have to resort to difficult maneuvers such as those required at times by the presence of an artificial gingiva flange rather conspicuous
- Today in implantology we are talking more and more and with really worrying percentages of peri-implantitis, an infectious-inflammatory pathology that leads over time to the loss of bone supporting the implant and therefore of the implant itself. At this point we believe it is correct to say that every surgeon implantologist, when choosing the All-on-4 technique, before easily amputating the alveolar bone in order to create space for an artificial gum flange, should ask this question: