The All-on-4 treatment concept was developed to provide edentulous patients with an efficient and effective restoration using only four implants to support an immediately loaded full-arch prosthesis.
All-on-4 offers clinicians and their patients various clear benefits:
Stability even in minimum bone volume
By tilting the two posterior implants, longer implants can be used in minimum bone volume, increasing bone-to-implant contact and reducing the need for vertical bone augmentation. The tilted posterior implants can be anchored in better quality anterior bone, reducing cantilevers and thus improving support of the prosthesis.
Good clinical results
Biomechanical measurements show that tilted implants, when part of prosthetic support, do not have a negative effect on the load distribution. The tilting of implants has been used in clinical practice for over a decade and has shown good results.
With All-on-4, patients benefit from an immediate implant-supported restoration, as a provisional prosthesis is screwed onto the implants right after surgery. Final solutions for All-on-4 include both fixed prostheses, Implant Bridge Titanium with acrylic veneering, or individual crowns cemented to the bridge framework, and removable solutions, such as acrylic overdentures on anImplant Bar Overdenture.
Necrotizing Ulcerative PeriodontitisAlthough necrotizing gingivitis and necrotizing periodontitis may reflect the same disease entity, they are differentiated by the rapid destruction of soft tissue in the former condition and hard tissue in the latter. Necrotizing ulcerative periodontitis is a marker of severe immune suppression. The condition is characterized by severe pain, loosening of teeth, bleeding, fetid odor, ulcerated gingival papillae, and rapid loss of bone and soft tissue. Patients often refer to the pain as “deep jaw pain.” Treatment includes removal of dental plaque, calculus, and necrotic soft tissues utilizing a 0.12% chlorhexidine gluconate or 10% povidone-iodine lavage, and institution of antibiotic therapy (Table 2). Pain management is crucial, as is attention to nutrition in these patients. Timely referral to primary care is indicated to rule out other systemic opportunistic infections.
Oral Warts—Human Papilloma Virus
The incidence of oral warts due to human papillomavirus (HPV) has dramatically increased in the potent antiretroviral therapy era. Studies at the author’s institution indicate that the risk of HPV-associated oral warts is associated with a 1-log decrease in plasma HIV RNA level within the 6 months prior to oral HPV diagnosis, suggesting that the development 10 or greater of warts may be related to immune reconstitution. The warts may be cauliflower-like, spiked, or raised with a flat surface (Figure 11). Treatment may involve surgery, laser surgery, or cryotherapy. It should be noted that HPV survives in aerosol. Topical 5-fluorouracil treatment has been used on external lesions, but should be avoided in African-American patients since it can cause hyperpigmentation. It should be noted, however, that this is a specialized treatment and should only be used by those experienced with the use of this topical medication. Lesions tend to recur after treatment.
Are Dental Implants Covered by Insurance?
There are a few dental insurance companies providing coverage for dental implants, although at this time it is a rare occurrence. Typically, insurance companies consider implant surgery a cosmetic procedure, and do not provide payment. Some patients have found that medical insurance companies will pay for the procedure, if medical necessity is determined. In order to find out the details of your coverage with either your dental or medical plan, call your insurance company and ask for information regarding your coverage.