A full arch implant, All-on-6 technique: A solution for complete toothlessness
All-on-6 is an approach used to deal with complete edentulism (toothlessness) which is a technique most commonly used in Cvejanović Clinic. We are typically approached by patients who are either completely toothless or who only have a few teeth which cannot function properly and need to be extracted anyway. These patients want the most effective solution which will grant them a presentable smile and a full set of artificial teeth. The simplest, fastest and safest way to achieve this is the All-on-6 technique.
Options for the placement of implants in case of complete toothlessness: full arch bridges fixed on implants, All-on-4, All-on-6, custom designs.
There are several ways to use implants with patients who have lost all their teeth in order to create a fresh smile and restore all the dental functions:
– Prosthesis anchored to implants is the simplest and the most cost-effective solution, representing a half-way approach between a classic plastic acrylic denture and a full dental implant. It is a good transitional option, since in certain patients it may be upgraded to a full implant construction.
– All-on-6 is the best option for most patients, because six implants per jaw guarantee full stability, and because they are aligned parallel to one another, it enables simpler prosthetic solutions with crowns to be used. All-on-6 technique requires sufficient jaw bone tissue to place six implants, i.e. that the jaw has not degraded because of a long period without any teeth.
– All-on-4 is a technique using which a patient may still get a whole implant arch despite the jaw bone being in poor condition. It utilizes special long screws, set in an inclined position along the hind region of the jaw. This technique enables the patient to retain all dental functions even though they do not have enough jaw bone tissue, and they do not wish to undergo the complicated bone grafting procedure.
– Custom designs.In certain cases, the solution for a complete edentulism may include using five, seven or even eight implants in one jaw, which is a not widely used custom made compromise.
The ALL ON 6 work on the outside looks identical to the ALL ON 4 work, but is far more reliable and easier to repair
The procedure of placing All-on-6 implants
The first step of placing the implants is making 3D images of the jaw, so that the dentist gets a detailed picture of the condition the jaw bone is in, as well as the position of sinuses and nerves in relation to the jaws. If it is determined that the patient has enough bone tissue to proceed with All-on-6 technique, a precise plan of implant positions is created using a 3D model. Once this initial process has been finished, the teeth indicated for extraction are pulled out, after which the screws may be placed immediately. If there is any sort of bone defect in the jaws region, the specialists make sure to avoid it. In certain rare circumstances is it necessary to wait for a while for the wounds to heal in order to place the implants.
All implants in both jaws can be placed in a single day, and they are mostly placed in the position where the 2s, 4s and 6s used to be. After the placement, there is a period of bone integration, lasting between 3 and 6 months.
When smiling, it is difficult to distinguish ALL ON 6 and ALL ON 4 ceramic dental bridges from crowns on teeth, ie. Hollywood smile work
Removable and fixed temporary restorations
During the interim period, when the implants have been placed but not the final crowns, patients carry a temporary restoration, which can be removable or fixed. The removable option is a plain acrylic denture. This is the most common one used, since it is not extra charged.
However, some patients do not want a removable option. These can opt for a fixed temporary restoration, which involves fixing temporary plastic crowns onto the screws. The dental impression for the temporary crowns is taken straight after placing the implants and must be submitted within 48 to 72 hours after the placement, so that the implants do not lose any of their stability. The crowns are chained into a block in order to keep the implants together. The advantage of this approach is that the patient will spend only a day or two without teeth, after which they will immediately be provided with a temporary but fixed restoration. This also promotes proper shaping of gums and helps to simplify the process of making and the placement of final crowns. The fixed temporary option is applicable with the All-on-4 and All-on-6 systems, but not on full arch implant supported bridge.
The final arch placement
The final arch, made of ceramic crowns, is placed three to four months after, possibly a little later in exceptional cases. The crowns come in two compositions: metal ceramic or non-metal zirconium. In most cases, a 12 crown arch is planned, i.e. up to the 6s, but this can vary. Only All-on-6 features six implants and 12 crowns, since it is considered that 12 crowns is optimal for normal daily functions.
Since there is quite a lot of jaw bone defect associated with complete toothlessness, the pink hue ceramic is used as a camouflage, to make the shading between the gums and the crowns seem completely natural. The mounting of crowns onto implants is done using cement or screws, which has already been established from the initial analysis of the CBCT. The mounting using screws is more complex, but their future maintenance will be easier.
After the placement, patients must maintain scrupulous hygiene around the implant. If they live a healthy lifestyle and keep a good hygiene, a gradual regeneration of bone tissue can be expected. The cost of All-on-6 depends on the type of implants and crowns, and it is paid in two installments – you are charged for implants and temporary fixtures first, and later the final crowns are paid for.