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All On four Concept and Predicability in Edentulous Jaws
EAO Online Library. Lyra D. Oct 9, 2018; 232761; P-SU-66
Daniela Lyra
Daniela Lyra
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Severe atrophy of the alveolar ridge increases in severity over time in edentulous jaws. Implant-retained or -supported prostheses provide a higher degree of patient satisfaction than traditional removable denture. The all-on-four protocol can be predicable and safe concept in those (edentulous patients) who wish fixed and immediately-loaded prosthesis and to avoid grafting procedures.The aim of this systematic review was to summarize and update the all-on-four treatment concept, as well as the surgical and prosthetic topics based on clinical studies offering results after a follow-up of at least 36 months.**Case reports, literature reviews, letters or comments to the editor, expert reports, in vitro and animal studies, as well as finite element studies or biomechanical tests were excluded from the present systematic review. The three major electronic databases were screened- MEDLINE (via PubMed), EMBASE, and the Cochrane Library of the Cochrane Collaboration (CENTRAL). In addition, electronic screening was made of the ‘grey literature’ using the System for Information on Grey Literature in Europe - Open Grey, covering the period from January 2005 up to and including April 2016. The question format was established as follows- “In edentulous patients or with severely resorbed jaws that receive dental implants for immediate full-arch implant-supported restorations following the all-on-four concept in the mandible or maxilla, what are the most frequent clinical indications, surgical procedures, prosthetic protocols and complications?”Thirteen studies, including 4,804 dental implants (2,000 maxilla and 2,804 mandible) placed in 1,201 jaws met the inclusion criteria. Nine were prospective trials, three retrospective studies and one longitudinal trial. All studies except one were considered to be at high risk of bias. Seventy-four (37 axially, 37 tilted) dental implants failed, with most failures (74%) within the first 12 months. Fifty-seven out of 1,201 prostheses failed but were repairable. The major prosthetic complication was the fracture of the all-acrylic prostheses. At 36 months the mean cumulative survival rates for implants and prostheses were 99.0 ± 1.0% (SD) and 99.9 ± 0.3% (SD), respectively with an average bone loss of 1.3 ± 0.4 mm (SD). There were no statistically significant differences in the clinical outcomes between maxillary versus mandibular arches and axially versus tilted placed implants.The all-on-four treatment concept offers a predictable way to treat the atrophic jaw in patients that do not prefer regenerative procedures, which increase morbidity and the treatment fees. The available evidence shows a promising prognosis for the all-on-four treatment concept. The results indicate a high prosthesis and implant survival rate after 3 year follow - up. Adequate definition of the success survival criteria is thus necessary, due the high prevalence of peri-implant disease.
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