| Objective: The concept of ALL ON 4 was conjunction of Implantation of dentures with missing cases and immediate prosthetic implant prostheses.Under rational distribution conditions,only four implants should be implanted in the anterior jaw of superior mandibular qualityof using tilted implants to extend the abutment to further distal where the vertical dimension of the bone was poor.In this study we would discuss the application of Southern Implants Co-axis implants system in ALL ON 4 cases as a treatment modality for future reference.Materials & methods:10 cases were selected for ALL ON 4 operation in this study,while 2 of them were edentulous in the upper arch only and the rest 8 of the cases were edentulous in both upper & lower arch.All the above 10 cases were done during the period from April 2014 to November 2016 in HBO Implant center located in Taiwan.They were first evaluated thoroughly by the chief dental physician and followed by extensive ALL on 4 surgery and then cross-arch provisional & final prosthesis.First of all,the medical & dental history were checked and recorded,then followed by oral examination and CBCT scan.Initial intra-oral & facial photos were taken pre-operatively.The condition of each case were thoroughly analyzed for bone quantity& quality,systemic factors,patient compliances,oral hygiene etc.before the treatment plan was finalized.Based on the information we had received from the CBCT,the Malo's guide was utilized in this study to ensure the location & angle of insertion forthe tilted implants,while the thickness of the soft tissue would determine the height of multi-unit abutment.A total of 26 bone-level implants were used in these 10 cases of full arch re-construction,comprising 8 males and 2 females with age between 4065years of range.31 pieces of bone level implants of Southern Implants Co-axis were used in this study,including 27 pieces of Southern Implants-Co-axis 4.3x12dx16,and 4 pieces of Co-axis4.3x12dx13;1 piece Nobel SpeedyTMGroovy RP 4.0x10 mm,and 1 piece SpeedyTM Groovy RP 4.0x13 mm,and 3 pieces SpeedyTMGroovy RP 4.0x15 mm,and 3 pieces SpeedyTMGroovy RP 4.0x18 mm.10 pieces of Multi-unit abutmentstraight 3.5mm x2 mm and 2 pieces of Multi-unit abutmentStraight 3.5mm x 3mm.17 pieces of 17°Angulation 3.5mm-17 d x 2mm and 2 pieces of 17°Angulation 3.5mm-17 d x 3mm;1piece RP 0°2mm,and 1 piece RP 17°2mm,and 4 pieces RP 17°3mm,and 1 piece RP 30°4mm,and 1 piece RP 30°5mm.Results:31 pieces of Southern Implants-Co-axis implants were planted in 10 cases of full-arch re-construction under the clinical follow-up period of 10-14 months.2 of the implants had failed 6 months post-operatively.Re-implantation were done a month after the removal of failed implants in which the tilted implants were re-inserted to achieve primary stability.A promising bone healing was noted during the follow-up conducted using Periotest M tests and osseointegration was achieved,while the pathological bony resorption was not found.Conclusion: In general,the success rate of ALL ON 4 surgery technique was relatively high.This study utilized Co-axis dental implant system on ALL ON 4immediate rehabilitation cases.The advantage of this system relied on its built-in angle within the implant itself,which simplified the angle correction procedure during the operation,although it meant to be more technical sensitive.However,one of the casehad resulted 2 failed implants one in each arch?#24#45?.The most probable causes of this,according to the overall condition of the patient and the diagnosis of his chief dental physician,was due to the strong occlusal load and the night bruxism habit which resulted in the occlusal load inbalance/overload,whereas the position #24#45 were the turning points of the arch where lateral forces were received most.Other factors such as inadequate angle of tilting,short implant length and lack of keratinized gingiva should also be accounted for the failed implants.Although future clinical follow-up and references were still required to support this theory. |
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