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Immediate Loading in All-on-Four

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Atlas of Immediate Dental Implant Loading

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Abstract

Severe bone atrophy of the upper maxilla (Cawood and Howell class V and VI) is associated with certain problems such as reduced perioral tissue support, the impossibility of wearing complete dentures, chewing and speech alterations, and difficulties in placing dental implants due to the limited amount of available bone.

The “all-on-four” treatment concept was developed to maximize the use of available remnant bone in atrophic jaws, allowing immediate function and avoiding regenerative procedures that increase the treatment costs and patient morbidity, as well as the complications inherent to these procedures. The protocol uses four implants in the anterior part of complete edentulous jaws to support a provisional, fixed, and immediately loaded prosthesis. The two most anterior implants are placed axially, whereas the two posterior implants are placed distally and angled to minimize the cantilever length and to allow the application of prostheses with up to 12 teeth, thereby enhancing masticatory efficiency. From a biomechanical point of view, the rationale for the use of only four implants is that when the force is applied to the more distal part of the prosthesis, the 90% of the strength is absorbed by the more distal implants. The rest (10%) is absorbed by the two more anterior implants.

For this chapter we reviewed the literature, and this approach showed implant survival rates around 93.8–100% up to 10 years for both jaws, based on a sample of 11,627 implants. Regarding the jaw, an implant survival rate of 95.4–100% is expected for the mandible up to 7 years. For the maxilla, an implant survival rate of 95.7–100% is expected up to 6 years.

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Authors and Affiliations

  1. Oral Surgery Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain

    Miguel Peñarrocha-Diago, Javier Aizcorbe-Vicente, David Soto-Peñaloza & David Peñarrocha-Oltra

  2. Private Clinical Practice, Clínica Drs. Ruz., Montilla, Cordoba, Spain

    Vicente Ruz-Domínguez

Authors
  1. Miguel Peñarrocha-Diago
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  2. Javier Aizcorbe-Vicente
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  3. Vicente Ruz-Domínguez
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  4. David Soto-Peñaloza
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  5. David Peñarrocha-Oltra
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Correspondence to David Peñarrocha-Oltra .

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Editors and Affiliations

  1. Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain

    Miguel Peñarrocha-Diago

  2. Versilia General Hospital, Lido di Camaiore, Italy

    Ugo Covani

  3. i2 Implantología Dental and Learning Center, Madrid, Spain

    Luis Cuadrado

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Peñarrocha-Diago, M., Aizcorbe-Vicente, J., Ruz-Domínguez, V., Soto-Peñaloza, D., Peñarrocha-Oltra, D. (2019). Immediate Loading in All-on-Four. In: Peñarrocha-Diago, M., Covani, U., Cuadrado, L. (eds) Atlas of Immediate Dental Implant Loading. Springer, Cham. https://doi.org/10.1007/978-3-030-05546-2_12

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