“All-on-4” Immediate-Function Concept for Completely Edentulous Maxillae: A Clinical Report on the Medium (3 Years) and Long-Term (5 Years) Outcomes
Paulo Maló DDS, PhD
Oral Surgery, Malo Clinic, Lisboa, Portugal
Search for more papers by this authorCorresponding Author
Miguel de Araújo Nobre RDH
research and development, Malo Clinic, Lisboa, Portugal
Dr. Miguel de Araújo Nobre, Malo Clinic, Avenida dos Combatentes, 43, 8, Edificio Green Park, 1600-042 Lisboa, Portugal; e-mail: [email protected]Search for more papers by this authorCarlos Francischone DDS, PhD
Prosthodontics, Malo Clinic, Lisboa, Portugal
Search for more papers by this authorMauricio Rigolizzo DDS, PhD
Oral Surgery, Malo Clinic, Lisboa, Portugal
Search for more papers by this authorPaulo Maló DDS, PhD
Oral Surgery, Malo Clinic, Lisboa, Portugal
Search for more papers by this authorCorresponding Author
Miguel de Araújo Nobre RDH
research and development, Malo Clinic, Lisboa, Portugal
Dr. Miguel de Araújo Nobre, Malo Clinic, Avenida dos Combatentes, 43, 8, Edificio Green Park, 1600-042 Lisboa, Portugal; e-mail: [email protected]Search for more papers by this authorCarlos Francischone DDS, PhD
Prosthodontics, Malo Clinic, Lisboa, Portugal
Search for more papers by this authorMauricio Rigolizzo DDS, PhD
Oral Surgery, Malo Clinic, Lisboa, Portugal
Search for more papers by this authorABSTRACT
Background: Immediate implant function has become an accepted treatment modality for fixed restorations in totally edentulous mandibles, whereas experience from immediate function in the edentulous maxilla is limited.
Purpose: The purpose of this study was to report on the medium- and long-term outcomes of a protocol for immediate function of four implants (All-on-4™, Nobel Biocare AB, Göteborg, Sweden) supporting a fixed prosthesis in the completely edentulous maxilla.
Materials and Methods: This retrospective clinical study included 242 patients with 968 immediately loaded implants (Brånemark System® TiUnite™, Nobelspeedy™, Nobel Biocare AB) supporting fixed complete-arch maxillary all-acrylic prostheses. A specially designed surgical guide was used to facilitate implant positioning and tilting of the posterior implants to achieve good bone anchorage and large interimplant distance for good prosthetic support. Follow-up examinations were performed at 6 months, 1 year, and thereafter every 6 months. Radiographic assessment of the marginal bone level was performed after 3 and 5 years in function. Survival was estimated at patient level and implant level using the Kaplan–Meier product limit estimation with 95% confidence intervals.
Results: Nineteen immediately loaded implants were lost in seventeen patients, giving a 5-year survival rate estimation of 93% and 98% at patient and implant level, respectively. The survival rate of the prosthesis was 100%. The marginal bone level was, on average, 1.52 mm (standard deviation [SD] 0.3 mm) and 1.95 mm (SD 0.4 mm) from the implant/abutment junction after 3 and 5 years, respectively.
Conclusion: The high survival rates at patient and implant level indicates that the immediate-function concept for completely edentulous maxillae using the present protocol is viable in the medium- and long-term outcomes.
REFERENCES
- 1 Maló P, Rangert B, Nobre M. “All-on-Four” immediate function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res 2003; 5: S2–S9.
- 2 Tarnow DP, Emtiaz S, Classi A. Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants 1997; 12: 319–324.
- 3 Grunder U. Immediate functional loading of immediate implants in edentulous arches: two-year results. Int J Periodontics Restorative Dent 2001; 21: 545–551.
- 4 Fortin Y, Sullivan RM, Rangert BR. The Marius implant bridge: surgical and prosthetic rehabilitation for the completely edentulous upper jaw with moderate to severe resorption: a 5-year retrospective clinical study. Clin Implant Dent Relat Res 2002; 4: 69–77.
- 5 Rocci A, Martignoni M, Gottlow J. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations. A restrospective 3-year clinical study. Clin Implant Dent Relat Res 2003; 5: S29–S36.
- 6 Olsson M, Urde G, Andersen E, Sennerby L. Early loading of maxillary fixed cross-arch dental prostheses supported by six or eight oxidized titanium implants: results after 1 year of loading, case series. Clin Implant Dent Relat Res 2003; 5: S81–S87.
- 7 Fischer K, Stenberg T. Early loading of ITI implants supporting a maxillary full-arch prosthesis: 1-year data of a prospective, randomized study. Int J Oral Maxillofac Implants 2004; 19: 374–381.
- 8 Payne AGT, Tawse-Smith A, Thomson WM, Duncan WD, Kumara R. One-stage surgery and early loading of three implants for maxillary overdentures: a 1-year report. Clin Implant Dent Relat Res 2004; 6: 61–74.
- 9 Malo P, Rangert B, Nobre M. All-on-4 immediate-function concept with Brånemark system implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res 2005; 5: S88–S94.
- 10 van Steenberghe D, Glauser R, Blombäck U, et al. A computed tomographic scan–derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res 2005; 7: S111–S120.
- 11 Balshi SF, Wolfinger GJ, Balshi TJ. A prospective study of immediate functional loading, following the Teeth in a Day protocol: a case series of 55 consecutive edentulous maxillas. Clin Implant Dent Relat Res 2005; 7: 24–31.
- 12 Ostman PO, Hellman M, Sennerby L. Direct implant loading in the edentulous maxilla using a bone density-adapted surgical protocol and primary implant stability criteria for inclusion. Clin Implant Dent Relat Res 2005; 7: S60–S69.
- 13 Malo P, Nobre Mde A, Petersson U, Wigren S. A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: case series. Clin Implant Dent Relat Res 2006; 8: 223–232.
- 14 Fischer K, Stenberg T. Three-year data from a randomized, controlled study of early loading of single-stage dental implants supporting maxillary full-arch prostheses. Int J Oral Maxillofac Implants 2006; 21: 245–252.
- 15 Degidi M, Perrotti V, Piattelli A. Immediately loaded titanium implants with a porous anodized surface with at least 36 months of follow-up. Clin Implant Dent Relat Res 2006; 8: 169–177.
- 16 Ostman PO, Hellman M, Sennerby L. Immediate occlusal loading of implants in the partially edentate mandible: a prospective 1-year radiographic and 4-year clinical study. Int J Oral Maxillofac Implants 2008; 23: 315–322.
- 17 Tealdo T, Bevilacqua M, Pera F, et al. Immediate function with fixed implant-supported maxillary dentures: a 12-month pilot study. J Prosthet Dent 2008; 99: 351–360.
- 18 Bergkvist G, Nilner K, Sahlholm S, Karlsson U, Lindh C. Immediate loading of implants in the edentulous maxilla: use of an interim fixed prosthesis followed by a permanent fixed prosthesis: a 32-month prospective radiological and clinical study. Clin Implant Dent Relat Res 2009; 11: 1–10.
- 19 Krekmanov L, Kahn M, Rangert B, Lindström H. Tilting of posterior mandibular and maxillary implants of improved prosthesis support. Int J Oral Maxillofac Implants 2000; 15: 405–414.
- 20 Aparicio C, Perales P, Rangert B. Tilted implants as an alternative to maxillary sinus grafting: a clinical, radiologic, and periotest study. Clin Implant Dent Relat Res 2001; 3: 39–49.
- 21 Duyck J, Van Oosterwyck H, Vander Sloten J, De Cooman M, Puers R, Naert I. Magnitude and distribution of occlusal forces on oral implants supporting fixed prostheses: an in vivo study. Clin Oral Implants Res 2000; 11: 465–475.
- 22 Rangert B, Jemt T, Jörneus L. Forces and moments on Brånemark implants. Int J Oral Maxillofac Implants 1989; 4: 241–247.
- 23 Zampelis A, Rangert B, Heijl L. Tilting of splinted implants for improved prosthodontic support: a two-dimensional finite element analysis. J Prosthet Dent 2007; 97: S35–S43.
- 24 Cooper LF, Rahman A, Moriarty J, Chafee N, Sacco D. Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading. Int J Oral Maxillofac Implants 2002; 17: 517–525.
- 25 Brånemark P-I, Svensson B, van Steenberghe D. Ten-year survival rates of fixed prostheses on four or six implants ad modum Brånemark in full edentulism. Clin Oral Implants Res 1995; 6: 227–231.
- 26 von Elm E, Altman DG, Egger M, Pocock SJ, Gotzche PC, Vandenbroucke JP, STROBE Initiative. STROBE statement. http://www.strobe-statement.org/index.php?id=checklist. (Accessed May 20, 2009).
- 27 Vanden Bogaerde L, Pedretti G, Dellacasa P, Mozzatti M, Rangert B, Wendelhag I. Early function of splinted implants in maxillas and posterior mandibles, using Brånemark System TiUnite implants: an 18-month prospective clinical multicenter study. Clin Implant Dent Relat Res 2004; 6: 121–129.
- 28 Kokkevold PR, Han TJ. How smoking, diabetes and periodontitis affect outcomes of implant treatment. Int J Oral Maxillofac Implants 2007; 22: S173–S202.
- 29 Lindh J, Meyle J, et al. Peri-implant diseases: consensus report of the sixth european workshop on periodontology. J Clin Periodontol 2008; 35: S282–S285.
- 30 Heitz-Mayfield LJ. Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol 2008; 35: S292–S304.
- 31 Strietzel FP, Reichart PA, Kale A, Kulkarni M, Wegner B, Kuchler I. Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol 2007; 34: 523–544.
- 32 Chow J, Hui E, Liu J, et al. The Hong Kong bridge protocol. Immediate loading of mandibular Brånemark fixtures using a fixed provisional prosthesis: preliminary results. Clin Implant Dent Relat Res 2001; 3: 166–174.
- 33 Engstrand P, Gröndahl K, Öhrnell L-O, Nilsson P, Nannmark U, Brånemark P-I. Prospective follow-up study of 95 patients with edentulous mandibles treated according to the Brånemark Novum concept. Clin Implant Dent Relat Res 2003; 5: 3–10.
- 34 Hatano N, Yamaguchi M, Suwa T, Watanabe K. A modified method of immediate loading using Brånemark implants in edentulous mandibles. Odontology 2003; 91: 37–42.
- 35 Brånemark P-I, Engstrand P, Öhrnell L-O, et al. Brånemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res 1999; 1: 2–16.
- 36 Wolfinger JG, Balshi JT, Rangert B. Immediate functional loading of Brånemark System implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols. Int J Oral Maxillofac Implants 2003; 18: 250–257.
- 37 Nikellis I, Levi A, Nicolopoulos C. Immediate loading of 190 endosseous dental implants: a prospective observational study of 40 patient treatments with up to 2-year data. Int J Oral Maxillofac Implants 2004; 19: 116–123.
- 38 Cooper LF, Rahman A, Moriarty J, Chaffee N, Sacco D. Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading. Int J Oral Maxillofac Implants 2002; 17: 517–525.
- 39 Smerek J, Brunski JB, Wolfinger G, et al. Implant loading with all-acrylic vs metal-supported-acrylic prostheses. J Dent Res 1997; 76: S263.
- 40 Duyck J, Van Oosterwyck H, Vander Sloten J, De Cooman M, Puers R, Naert I. Influence of prosthesis material on the loading of implants that support a fixed partial prosthesis. An in vivo study. Clin Implant Dent Relat Res 2000; 2: 100–109.
