One question that has been repeatedly asked every day by our patients is “How many implants do you want to place in my edentulous jaw to replace the missing teeth; isn’t just 4 enough?”
To answer this, we need a clinical examination and a CBCT scan to assess the available bone. Sometimes virtual digital planning will give a correct dimension (size) and number of Implants required for the patients.
Over a decade, our FMS DENTAL Implantology team that consists of Implantologists, Maxillofacial surgeons & Prosthodontists, with the support of in-house CAD-CAM dental lab have treated hundreds of patients with different implant protocols depending on the available jaw bone.
Tilted (All-on-4 ) vs. Straight (All-on-8 )Dental Implants:
We always like to place 7-8 dental implants parallel to each other (straight) whenever sufficient bone is available in the jaw. Zirconia or composite teeth can be fixed over these implants either with a cementable or screwable option. For more than 20 years, this protocol has been followed where parallelism is given importance while placing implants.
But most of the time, patients delay in opting for full mouth rehabilitation with implants. As a result, the jaw bone keep resorbing and there will be hardly any bone left on the backside of the jaws because of maxillary sinus pneumatisation in the upper & the position of the mandibular nerve in the lower jaws. Apart from that, patients delay the removal of infected teeth till it loses all the bone and becomes totally mobile.
Earlier days, an additional surgery was required to graft the bone in these situations with sinus lift in the upper jaw and a block graft in the lower jaw by taking bone graft from Iliac Crest or any other site of the body. After a waiting period of 6-8 months, implant surgery used to be performed in the grafted area.
Now, with the revolutionary change in the implant and abutment (connector) designs, a new concept called All-on-4 has been developed. In this protocol, the support from the front & middle part of the jaw bone is taken and two straight Implants and two long tilted implants that emerge posteriorly are placed. These 4 Implants will be supporting 12-14 teeth based on its positioning and length.
In the hands of expert implantologists, whether it is all-on-4 tilted or all-on-8 straight implant protocol based on the available bone, patients will regain their chewing comfort, phonetics (speech) and lost self-esteem.