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cost-effective and durable product. • Phonetics – with a one-piece structure, involving a palatal bite plane, phonetic changes are always likely and, in a small number of patients, may never resolve fully. The above is a summa- tion of the most common problems encountered and should not be seen as a definitive list. Dilemmas still exist, such as young patients with advanced periodontal disease (Figure ıı). While All-on-4 can be an attractive, cost-effective solution, these patients have an expected lifespan longer than all current data on implant survival. As a practice, we meet


regularly to discuss the merits of treatment in such cases before offering defini- tive planing to patients. Advice on longevity of any


“While All-on-4 can be an attractive, cost-effective solution, these patients have an expected lifespan longer than all current data on implant survival”


treatment offered has to be realistic and guarded.


Summary With a well-trained and experienced team, using a well-researched and docu- mented implant system, the All-on-4 technique is a predictable and cost- effective solution to full arch rehabilitation. It is not, however, a panacea and where possible, addi- tional implants should be


planned for. Problems can and do occur, patients need to be carefully counselled about the treatment journey, expected outcomes and long-term management. These three articles have


given a brief overview of the All-on-4 concept. In the scheme of implant dentistry, it is an advanced concept and should only be undertaken after the required training and experience has been gained.


REFERENCES


1. Attard and Zarb: Long-term treatment outcomes in edentu- lous patients with implant fixed prostheses: the Toronto study. Int. J.Pros 2004


2. Wennerberg and Albrektsson: current challenges in successful rehabilitation with oral implants. J.Oral Rehab 2011


3. ADI Guidelines; On Peri- implant monitoring and maintenance. 2013 4. Statements from the Estepona Consensus Meeting on Peri-implantitis. Feb 2-4 2012. Clin.Oral.Imp.Dent & Related Research 2012 5. Albrektsson, Buser, Sennerby: On crestal/marginal bone loss around dental implants. Clin.Oral.Imp.Dent & Related Research 2012


6. Quian, Wennerberg, Albrektsson: Reasons for marginal bone loss around oral implants. Clin.Oral.Imp.Dent & Related Research 2012 7. Parel: a risk assessment treatment planning protocol for the four-implant immediately- loaded maxillae: preliminary findings. J.Pros.Dent 2011 8. Pjetursson: A system- atic review of the survival and complication rates of implant-supported fixed dental prosthesis after a minimum observation period of five years. Clin.Oral.Imp.Res 2012


46 Scottish Dental magazine


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