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Journal of Oral Science & Rehabilitation No. 2, 2016

Journal of Oral Science & Rehabilitation 24 Volume 2 | Issue 2/2016 T h r e e - y e a r r e s u l t s o f A l l - o n - 4 i n d a i l y p r a c t i c e according to the All-on-4 protocol.33 Twenty percent(168implantsoutof800)oftheimplants analyzed had afollow-up period ofthreeyears or more. Cumulative implant and prosthesis survi- valrates amountedto 97.3% and 99.0%, respec- tively. Grandietal.analyzed47patientstreatedwith 188 immediately loaded implants placed in the mandible according to the All-on-4 protocol in post-extraction sites.34 At the 18-month fol- low-up,noimplanthadfailedandalloftheresto- rations were stable. However, three patients experienced fracture of the provisional restora- tion. No significant differences in bone losswere found between axiallyplaced andtilted implants at the 18-month follow-up. Babbush et al. retrospectively examined 165 patients treated according to the All-on-4 pro- tocol.35 The cumulative implant survivalratewas 99.6% (99.3% in the maxilla and 100.0% in the mandible) for up to 29 months of loading. The definitive prosthesis survival rate was 100%. Recently, the same authors retrospectively ana- lyzed the patient-centered outcomes, including the cost of treatment, length of the treatment period and comfort provided by the provisional restoration, in patients treated according to the All-on-4 protocol and compared these results to a historical control group, which included com- plete-arch FDPs supported by natural teeth or implantsandimplant-supportedoverdentures.36 This studydemonstratedthatthe cost, length of treatment and comfort provided by the provisi- onalrestorationsignificantlyfavoredtheAll-on-4 treatment modality. In the present study, the overall percentage ofcomplications experiencedwas large (36.6%). Nevertheless,this result did not differfromthose normally encountered in oral rehabilitation in which implants are used as support for an FDP (33.6% at five years).37 Moreover, most of these complications were reported on the temporary restoration, during healing. The clinicians who carried out the procedures addressed all of the complicationschairside.Furthermore,thecondi- tion of the patients remained stable up to the completion ofthethree-yearfollow-up period. In ordertominimizetheincidenceofcomplications, dentalcliniciansshouldexertgreateffortinselect- ingpatients,respectingtheoriginalprotocols,and choosing reliable components and materials for implant-supported complete-arch FDPs. Patients with untreated periodontitis were not included in the study. Implant therapy in pa- tients with a history of chronic periodontitis and generalized aggressive periodontitis might be considered aviabletreatmentwith similarsurvi- val outcomes to those reported for healthy pa- tients. Periodontallycompromised patientswere includedafterbeingtreatedtoreducetheinflam- mation and halt the disease progression, before tooth extraction and implant placement. Accor- ding to Donos et al., it is necessary to treat and control the periodontal disease, regardless of its progression pattern and subtype, before implant therapy is initiated in order to improve the over- all implant success and achieve a more favor- able bone resorption pattern.38 Nevertheless, a comprehensive implant maintenance program has to be encouraged and continued in order to identify periimplant bone loss early on, particu- larlyin patientswith a historyofperiodontal dis- ease. Conclusion Within the limitations of the present study, the All-on-4 concept is a predictable and minimally invasivetreatmentconceptforthecomplete-arch rehabilitation of both jaws, regardless of jaw lo- cation and type of surgery. It may decrease the overalltreatmenttimeandre-establishadequate function in a cost-effective way. Further long- term prospective data (five years and more) and outcomes beyond cumulative survival rates are needed. Competing interests The authors declare that they have no com- peting interests. This study was completely self-financed and no funding was sought or ob- tained, not even in the form of free materials.

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