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Video Details
A Treatment For The Prevention of Mandibular Edentulism: All On Four For The Mandible

Description:
Mandibular edentulous patients can be some of the most difficult prosthetic patients to treat successfully. Tongue and vestibular movements during function can dislodge the denture, arch forms may demonstrate poor anterior/posterior spreads, and severe resorption of the mandible can lead to mental nerve involvements with unstable denture bases for effective chewing patterns. Fixed dental prosthesis stabilized by osseointerated implants are an effective treatment option for patients who have lost their mandibular teeth. Treatment options for the mandibular arch range from two implants and an overdenture to multiple implants with full arch fixed style prosthesis. This webinar will focus specifically on the diagnostic, surgical, and prosthetic procedures utilizing four implants and a screw retained fixed prosthesis in the mandible, the All On Four technique. In this webinar, Dr. Duello will build upon the material provided in previous presentations on DentalXP with detailed guidance on clinical procedures for the All On Four in the mandible.

Date Added:
4/15/2014

Author(s):

George V. Duello, DDS, MS George V. Duello, DDS, MS
George V. Duello, DDS, MS has been in private practice in St. Louis since 1983 after serving as Chief of Periodontics, MacDill AFB, Tampa, Florida. Dr. Duello was born in St....
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Online Videos / Surgery / Implant / A Treatment For The Prevention of Mandibular Edentulism: All On Four For The Mandible




Questions & Comments
Maurice Salama - (12/18/2013 10:32 AM)

George; This technique continues to pick up a lot of interest but can often be performed incorrectly or considered over treatment for many cases. Thanks for clarifying things. Maurice

yosef kowalsky - (11/27/2013 3:57 AM)

Thank for your answer. In the case you presented the implants wound up quite lingual to the teeth. This creates a buccal cantilever on one hand, but also puts the screw holes away from occlusion. What is "Montrael metal lingual"? Efrat Israel is far from Canada !

George Duello - (11/25/2013 2:57 PM)

Yosef, This is an excellent question. We too see breakage on a few case but they are in the minority. If we see breakage in the conversion denture, then we might use a Montreal metal lingual bar design for more strength and hopefully less breakage. The amount of horizontal and vertical overlap of the teeth needs to be considered in these cases. We use Pala Mondial i teeth from Heraeus that seem to work well. It is also my opinion that patient should have permissive occlusal guards especially in patients with horizontal envelopes of function. I hope this helps with your question. George

yosef kowalsky - (11/15/2013 5:55 AM)

Hi, excellent presentation. I have issues with acrylic breakage. What is your recommendation regarding teeth for the Acrylic screwed in (hybrid) bridges ? (I never refer to them as dentures, dentures are removable) Thanks

George Duello - (11/12/2013 1:17 PM)

Steve, We initially seal the holes with Fremit and then with Flowable composite after we have assured that everything is stable. George

steven wolfson - (10/30/2013 11:03 AM)

Do you recommend anything to seal the screw holes in the multiunit abutments? They fill with food and can smell really bad.

George Duello - (10/28/2013 8:33 PM)

Danish, 1. The straight multi-unit abutments have larger screw and can physically take more torque. Due to engineering of the angled multi-unit abutment to pass the screw thorough the angled abutment a smaller screw was engineered. Because it is physically smaller it can only accept fifteen ncm torque. 2. The small prosthetic screws that hold the prosthesis to the multi-unit abutments are again smaller in mass and can take a smaller torque value. 3. It is also my opinion that the smaller screws can act as a fuse to take pressures and loads off the implants. 4. Screw loosing is very uncommon but screw heads breaking if over torqued is common. I would follow the recommendations of the manufacturer-torque small screws to 15ncm. George

Danish Qadri - (10/28/2013 10:40 AM)

Any particular reason to minimize the torque on the prosthetic screws? What is the incidence of prosthetic or abutment screw loosening?

George Duello - (10/28/2013 7:59 AM)

Farhan, Yes, I do recommend a temporary cylinder on the multiunit unit to affix it to the temporary conversion denture. I am unsure of components from Astra that match the NobelBiocare temporary cylinder but I would assume they also would have one. George

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