Comprehensive Comparison of the 5-Year Results of All-on-4 Mandibular Implant Systems With Acrylic and Ceramic Suprastructures

Abstract

The objective of the present study was to evaluate the comprehensive 5-year results of fixed mandibular dentures fabricated from metal-acrylic or metal-ceramics according to the All-on-4 protocol. Twenty-seven patients who received immediately loaded All-on-4 fixed mandibular dentures in 2006 were included in the study, and they were evaluated up to 5 years after denture integration. Endpoints were chosen in accordance with the 2007 Pisa consensus and included bone resorption, the Oral Health Impact Profile (OHIP), the sulcus fluid flow rate (SFFR), and prosthodontic complications. The initial situation in both groups was largely identical. Bone loss remained under 2 mm after 5 years in all implants and showed no group difference. The SFFR showed a gradual increase in both groups, and acrylic-bearing implants showed a substantially and significantly higher flow rate from the third year onward. The subjective improvement as expressed by the OHIP score was immediate and dramatic, and it showed no group differences. All acrylic restorations showed some extent of abrasion, and veneer fractures occurred in 4 patients (28.6%). Besides a single fracture of a fixation screw, there were no prosthetic complications in patients with ceramic suprastructures. According to bone loss and subjective outcome, acrylic and ceramic suprastructures appeared to be equivalent after 5 years; however, sulcus flow and prosthodontic complications suggest that the economic advantage of acrylic dentures may be specious. The rational choice of implant suprastructures requires comprehensive, long-term observation. Short-term economic benefits might be cancelled out in the long term.

The all-on-four treatment concept: Systematic review

“…Maló et al (2015) (28,37) reported distal implant placement at 30° degrees, though in some cases they reached an inclination of up to 45° degrees, depending on the situation and anatomical location - in coincidence with other authors (18-20,22,31). The insertion torque of the implants described in the studies varied between 25 and 50 Ncm.…”

“…Bone quality was assessed according to the criteria established by Lekholm & Zarb in 1985 (39) in some studies (6,22,26,35). …”

“…Moreover, two reports placed importance on jaw width and height in the interforaminal crest area as an indication on placing implants, these reports describe, a minimum required height of 6 mm, and at least >5 mm width and >8 mm height, respectively (21,22). …”

“…The insertion torque of the implants described in the studies varied between 25 and 50 Ncm. Three authors described a torque of 30 Ncm (25,27,30,37), while 10 authors applied a torque of between 32 and 37 Ncm (18,20,22,26,34,38). In turn, other studies reported a torque between 40 and 50 Ncm (17,19,21,32,33), though few authors inserted the implants with a torque of 50 Ncm (5,23).…”

“…Immediate loading protocols were used after 48 hours in 6 studies (17,21,23,25,33,36), after 24 hours in other studies (22,34,37), and on the same day a minimum of two hours to a maximum of 8 hours after surgery (5,18,26,29,31,32). Only three studies did not offer information on this aspect.…”