Sample Case For All-On-4 Implant Placement 1

Patient’s details:

Male, 55 years old

Consultation and treatment plan:

Overall examination

Overall condition: Good

Heart related diseases: No

Diabetes: No

Intra-oral examination:

  • The patient has lost both 2 jaws for more than 20 years. There was major bone deterioration, and the denture after years has been loosened and cannot be used anymore.

all on 4 1

all on 4 2

all on 4

  • CT X-Rays was taken at Dr Hung & Associates Dental Center to analyse and evaluate the overall jaw and soft tissue conditions.

all on 4 3.jpg  The patients CT Cone Beam X-Rays

  • As the patient has lost teeth for a long period of time, bone has deteriorated a lot in both the upper and lower jaw. Bone has deteriorated to some important surgical areas or lower jaw nerves.

Setting treatment plan:

  • The patient did not want to have traditional denture anymore and has chosen implant placement instead.
  • After discussion with the patient, we have decided to apply All-On-4 implant placement for the patient in this case.

Treatment plan:

  • Upper jaw: 4 implant placement by Implant Nobel CC using All-On-4 techniques
  • Lower jaw: 4 implant placement by Implant Nobel Active using All-On-4 techniques

Bone examination and digital implant placement using Nobel Clinician software

all on 4 4all on 4 5

all on 4 6

all on 4 7

Making Surgical guide

all on 4 8all on 4 9

all on 4 10

Surgical guide after designed on computer will be produced using CAD/CAM techniques

Implant placement procedure:

  • Because the patient has lost teeth for a long period of time (20 years), there has been major bone deterioration, especially in the back teeth where bone has deteriorated close to the nerves of the lower back teeth, so we have decided to install the implants as followed:
  • Front teeth: 2 implants placed straight at the 2 central incisors
  • Back teeth: 2 implants placed tilted at the 2 first premolars
  • The patient had been notified about the conditions and position for implant placement prior to the surgery.

all on 4 11.jpg

Implant placement surgery using Surgical guide

  • With the support of our anesthetist, our doctors and assistants finished placing 8 implants after 2 hours 46 minutes
  • After the surgery, all the implants will be re-checked on Panorama X-Rays again to avoid problems that may occur.

all on 4 12

Panorama image of the All-On-4 implants

Temporary prosthesis

  • Temporary prosthesis was carried out using the patient’s old denture. Using the patient’s old denture allow them to adapt better and feel more comfortable than making a new one.

all on 4 13

Old denture was used as temporary crown

Post-surgery

  • Doctors will check and clean the wound within a week after the surgery. 
  • Eighth day: Remove stitches
  • Tenth day: Final check-up

Permanent prosthesis

  • Approximately 6 months after the surgery when the implants have combined with the bone, permanent prosthesis will be carried out.
  • CT X-Rays will be taken to identify the level of bone integration
  • Remove temporary prosthesis, take impression for study cast to make permanent prosthesis
  • Dental crowns were made of zirconia materials on a titanium frame 910 crowns/jaw) in our Lab in-house within 3 days.
  • Permanent prosthesis was placed on the fourth day
  • Chewing testing took place in few days while the patient was on holiday in Hoi An City.
  • The patient returned for final check-up on the eighth day. The patient was completely comfortable and satisfied with the new teeth.

all on 4 14

all on 4 15

Dentists’ comments after the treatment was been complete:

  • The patient’s overall health condition was good.
  • Implants combined well with the jaw bone and worked well under pressure.
  • Crowns on implants matched well with each other, the color and size of which also matched the patient’s skin tone and face structure.
  • The patient was satisfied with the aesthetic factors as well as functionality of the results.