Luc Vrielinck MD, DDS, Oral & Maxillofacial Surgery, Ziekenhuis Oost Limburg, Genk, Belgium

developed to provide edentulous patient with a fast and cost effective fixed restoration

using only 4 implants anchored in the anterior

segment 2 of the implants are tilted

distally (30°) Brånemark System®,

NobelReplace® or NobelActive® implants

Zampelis A, Rangert B ea. Tilting of splinted implants … J Prosthet Dent 2007;97:S35-43.

simple surgical and prosthetic solution only 4 implants needed for an implant

supported solution angulated implants have longer intrabony

trajectory cost benefit for the patient compared to

standard (eg 6) implant supported bridge

avoids sinus lifting or bone graft procedures in the upper jaw

avoids nerve transposition procedures or bone grafts dorsally in the lower jaw

documented results with early loading procedures

All-on-4™ System can be extended to severe atrophy cases using zygoma implants

Freehand placement All-on-4™ Guide NobelGuide™

30°

Hybrid All-on-4™Standard all-on-4™ Quad zygoma All-on-4™

Standard case Moderate/severe atrophy Extreme atrophy

Delayed loading Early loading Immediate loading

Benefits of tilted implants: avoid bone augmentation longer implants benefit of cortical bone implant shoulder at second

premolar optimal prosthetic support

Look at the Three Dimensions:Vertical / Transversal (13x6mm)

Horizontal

16 15 14 13 12 11 21 22 23 24 25 262,0 6,0 6,5 5,5 6,5 5,5 4,6 6,5 3,7 5.5 6,2 6,42,0 3,1 13 15,3 13,7 11,6 12,4 12 11 12 9,0 3,2Hg

ThN°

30°

For early loading: no extensions over one tooth on

each side for the immediate acrylic restoration (10-12 teeth)

existing removable prosthesis can be used as temporary bridge

for proper esthetics and function the definitive restoration should have 12 teeth

eventually change orientation of abutments

The ‘first’ bridge A definitive bridge

Malò P e.a. Clin Implant Dent Relat Res 2005; 7 (Suppl 1): 88 - 94

Maxilla and Mandible

Number Failures CSR

0-6 months 92 2 97.8

6-12 months 90 0 97.8

1-2 years 51 0 97.8

Frandetti e.a. Clin Implant Dent Relat Res 2008; 10: 255-263

Mandible Number Failures CSR

0-6 Months 248 0 100

6-12 Months 248 0 100

12-18 months 176 0 100

18-24 months 164 0 100

24-36 months 112 0 100

36-48 months 40 0 100

46 45 44 43 42 41 31 32 33 34 35 366.8 8.4 7.6 6.9 7.5 6.9 6.4 8.1 7.8 8.8 9.6 10.0

14.2 15.2 13.4 16.0 25.7 26.1 24.1 24.5 24.4 16.4 16.5 13.2Hg

Th

N°

46 45 44 43 42 41 31 32 33 34 35 3611.2 6.9 7.6 7.7 6.2 5.6 6.4 7.3 7.4 8.3 5.3 7.410.1 8.9 13.1 16.7 19.6 21.4 20.3 20.9 21.6 10.6 10.6 10.4H

g

Th

N°

16 15 14 13 12 11 21 22 23 24 25 266.2 6.1 5.1 4.0 6.0 6.4 7.4 5.1 5.6 7.0 5.5 3.87.4 11.5 13. 14.2 16.3 16.5 16.7 17.2 15.1 14.6 8.7 4.5

46 45 44 43 42 41 31 32 33 34 35 3611.2 6.9 7.6 7.7 6.2 5.6 6.4 7.3 7.4 8.3 5.3 7.410.1 8.9 13.1 16.7 19.6 21.4 20.3 20.9 21.6 10.6 10.6 10.4H

g

Th

N°

16 15 14 13 12 11 21 22 23 24 25 266.2 6.1 5.1 4.0 6.0 6.4 7.4 5.1 5.6 7.0 5.5 3.87.4 11.5 13. 14.2 16.3 16.5 16.7 17.2 15.1 14.6 8.7 4.5

X X X X X X X X

well documented long term results check dimensions of the bone

(bone-table) NobelGuide™ can be used for

additional accuracy

relative simple surgery and prosthetic work minimal use of implants for maximal

prosthetic benefit from easy cases to the most complex with

zygoma implants