The All-on-4® treatment concept was developed in the 1990s as a way to best restore the full arches of the upper and lower jaws. The procedure uses only four implants to secure all teeth in place, hence the name “All-on-4.”
CBCT guided implant planning and surgery is a facially driven treatment plan. It first involves planning an ideal dental restoration for a patient; this may be a complete denture or, for a partially edentulous patient, a digital diagnostic wax-up of the planned restorations.
This virtual treatment plan is then sent to a laboratory (in this case the DSD lab in Madrid) for fabrication of an appliance that is used at the time of surgery to accurately place the implants in their planned position(s). Most larger implant manufacturers offer guided surgery-specific instrumentation for flapless implant placement. When desired and indicated, techniques and armamentarium are available for extractions, bone reduction, immediate implant placement, and immediate loading, all of which are commonly used in the All-on-4 protocol.
At surgery, the surgical guide was properly positioned and stabilized using stabilization pins. Implant-specific instrumentation was used to place the four planned implants to full depth and accurate direction using guided-surgery techniques with implant mounts .
Guided surgery and dental CAD/CAM are complementary technologies that can make the surgical and restorative phases of implant therapy more efficient and predictable.
Conclusion
The use of CT-guided surgery to perform the All-on-4 procedure is a combination of technologies that is still not very in common practice. We @drkamsiah prefer the combination of these two techniques, together with the digital smile design concept to improve the aesthetic outcome as well.—-drkamsiah