Method: Following patient evaluation and treatment planning a surgical prescription and guide prescribing required ostectomy and approximate B-L location of implants aiming for 4 implants was utilized. Based on bone quality, local infections, if opposing natural dentition, bruxism, A-P spread and initial insertion torques, the surgeon and prosthodontist would decide if additional implants were needed. Same factors would determine if an immediate fixed acrylic provisional restoration would be fabricated following surgery. A working guideline requiring over 120 Ncm total combined implant insertion torque to proceed with immediate fixed provisionalization. Surgical data and implant information were recorded and conditions documented at conversion, post-op appointments, and final impressions.
Result: A total of 1,914 NobelSpeedy® and NobelActive® implants were placed using 30 and 17 degree, and multi-unit abutments. Percentage of arches of screw-retained immediate provisional prostheses supported by number of implants were: 3=3%, 4=84%, 5=9.5%, 6=3.5%. Complete dentures were delivered at surgery for 2.3% of arches. Early implant failure defined as the osseointegration phase up to final impressions for definitive prostheses were 11 (0.73%) implants. The most frequent technical problem was acrylic provisional prosthesis fracture near anterior temporary cylinder in a small number of patients that were bruxers opposing natural dentition.
Conclusion: Using a Center-based surgeon-prosthodontist-lab technician team approach resulted in a 99.3% implant success rate demonstrating that the All-On-4 immediate load implant protocol was highly reliable for clinical practice.