The All‐on‐4 concept for full‐arch rehabilitation of the edentulous maxillae: A longitudinal study with 5‐13 years of follow‐up

Abstract

Background: Full-arch immediate function protocols such as the All-on-4 concept need long-term validation.Purpose: To report the 5-13 year outcomes of the All-on-4 treatment concept for the rehabilitation of the edentulous maxilla. Materials and Methods: This retrospective case series study involved 1072 patients (4288 maxillary implants) rehabilitated through the All-on-4 treatment concept. Primary outcome measures were cumulative prosthetic and implant success (life table analysis). Secondary outcome measures consisted in marginal bone loss (MBL) at 5 and 10 years, biological and mechanical complications. The estimation of risk indicators was performed through multivariable analysis for the outcome variables implant failure (Cox regression to estimate hazard ratios and 95% confidence intervals [95% CI]), MBL > 2.8 mm at 5 years, MBL > 3.0 mm at 10 years, biological and mechanical complications (binary logistic regression to estimate odds ratios [OR] with 95% CI). Results: Eighteen patients deceased unrelated to the implant treatment (1.7%) and 219 patients (20.4%) were lost to follow-up. The prosthetic success rate was 99.2%; Implant cumulative survival and success rate was 94.7% and 93.9%, respectively, with up to 13 years of follow-up. Male gender (HR = 1.73), smoking (HR = 1.94), and mechanical complications (HR = 0.59) were significantly associated with implant failure.Average MBL at 5 and 10 years was 1.18 mm (95% CI: 1.16, 1.21) and 1.67 mm (95% CI: 1.58, 1.77) with age (OR = 0.97), male gender (OR = 0.58), smoking (OR = 1.73), and biological complications (OR = 2.1) associated with MBL > 2.8 mm at 5 years. The incidence of biological complications was 7.8% at implant level, with age (OR = 0.98) and smoking (OR = 1.53) significantly associated. The incidence of mechanical complications was 58.8% for the provisional prostheses and 7.3% for the definitive prostheses. Conclusions:The high success rates registered for both implants and prostheses together with the low MBL confirm the All-on-4 treatment concept is predictable and safe in the long term outcome.

Implant‐Supported Immediately Loaded Complete Arch Rehabilitations with a Mean Follow‐up of 10 Years: A Prospective Clinical Study

“…Our study showed that 11% of all implants were lost over time (representing 89% implant success rate). The finding is lower than some of previous 10‐year follow‐up success rates (93%, 95.5%, or 93‐96.9%), which needs future investigation. However, the observed implant success rate falls between rates observed in other previous studies .…”

“…No significant differences were observed between failure‐free survival rates of all‐resin and PFZ prostheses. The recent literature shows two different trends in long‐term survival rates of acrylic prostheses—high prostheses survival rates in 10‐ to 18‐years follow‐up study (99.6%), 94.8% at 10 years, 99.2 % at 13 years . On the other hand are studies reporting lower survival rates, such as (82%) .…”

“…In a long‐term follow up (10 years), the cumulative survival rates of implants vary among the studies from 78.3% to 98.9% . and the cumulative acrylic prosthetic survival rates range from 82% to 100%, with the most common complications being the same as in case of short‐ to mid‐range follow‐ups …”

Technical Complications and Prosthesis Survival Rates with Implant‐Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1‐ to 12‐Year Follow‐Up

“…The longitudinal effectiveness of the MR IFCDPs against maxillary complete dentures has been demonstrated in the literature, with considerably high rates of technical complications like wear and chipping encountered as a result of material fatigue and stress . Studies have also reported on the incidence of complications with ceramic type IFCDPs . While no studies have been identified directly comparing intra‐group ceramic IFCDPs to MR IFCDPs, it must be mentioned that there is paucity of reports on complications with ceramic IFCDPs for edentulous jaws with observation periods of at least 5 years conversely with the MR design …”

The Workflow of a New Dynamic Navigation System for the Insertion of Dental Implants in the Rehabilitation of Edentulous Jaws: Report of Two Cases

“…The All-on-4 treatment concept consists of an immediate function rehabilitation protocol for full-arch rehabilitation of edentulous arches with insertion of four implants in the anterior region (two axial implants inserted anteriorly and two distally tilted posterior implants) to support a fixed prosthesis [1,2]. This concept was further developed to include the use of zygomatic implants alone or in combination with standard implants in situations of extreme maxillary resorption (All-on-4 Extra-maxilla or All-on-4 Hybrid) [3,4].…”