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Video Details
A Treatment For The Prevention of Maxillary Edentulism: All On Four For The Maxilla

Description:
Since the advent of osseointegration, the patient who is edentulous or soon to be edentulated has many options to prevent wearing complete removable prosthesis. In the maxillary arch there are anatomical features that may preclude patients successfully utilizing an implant prosthesis. Some of these include alveolar resorptive changes after extractions, pnuematized sinuses, hard and soft tissue palatal vault configurations, and bone exostosis with associated undercuts. Psychological, many patients suffer after the loss of teeth with loss of self-esteem and avoidance behaviors. One of the prosthetics protocols to threat the maxilla of edentulous patient is the All On Four technique that provided the patient with a fixed prosthesis on four osseointregrated implants. This program will focus specifically on the diagnostic, surgical, and prosthetic procedures of the All On Four patient. 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 maxilla.

Date Added:
3/5/2014

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 Maxillary Edentulism: All On Four For The Maxilla




Questions & Comments
Michael Dahm - (3/15/2017 10:29 AM)

excellent

yosef kowalsky - (3/22/2014 1:45 PM)

The mandibular case had an unnecessary cantilever . you could have added anothr implant on each side or tilted your distal implant ,

George Duello - (3/16/2014 10:25 AM)

Thanks for comments. My thoughts on your question are: 1. The decision on many implants is based on prosthetic needs and design, the individual patient's envelope of function-horizontal vs. vertical chewing patterns, anatomy of the maxilla and the degree of pnuematization of the sinuses, referral or patient preferences, and cost. In my opinion the minimum to provide a fixed restoration is 4 but sometime 8 maybe necessary depending on the above. My goal is generally to provide a fixed solution for the patient vs. a removable prosthesis on bar with attachments. 2. Bone density in Hounsfield unit is not completely accurate in dental CBCT vs medical CBCT because different areas int the scan appear with different grayscale values therefore some objective and subjective judgement need to be made as to the bone density in the maxilla arch which transitionally has less dense bone. 3. Yes I have planned cases with a guided surgical approach and still found the bone quality or torque value of the implants to below the minimum recommended standards for immediate loading--in those case cases we just follow a conventional two-stage loading protocol which is still within the guidelines for successful osseointegration and long term prosthetic stability. Undersizing implant osteotomy during the drilling sequence can help sometimes with creating torque values but even that surgical technique can not always guarantee primary stability for immediate loading. Great questions and thanks for your support on DentalXP for this Wednesday Webinar.

Maurice Salama - (3/11/2014 3:11 PM)

George; Great job and very timely. Can you give me an idea of how and when you decide on "All on Four" over 5,6,7 or 8 implants and a conventional prosthesis? How do properly evaluate Bone Density on pre-planning? Just Houndsfield units? Is that accurate enough? Have you ever planned a case as immediate with this technique and found the bone quality poor or initial implant stability too LOW to pursue? If so, what then? Especially in the Maxilla? Thanks for sharing. Maurcie

George Duello - (3/5/2014 10:21 AM)

Thank you for your kind remarks. I agree a bone reduction guide fabricated by the laboratory is an excellent suggestion and I use them as well as the duplicate denture. I also concur that an acrylic lab reduction guide works better in my hands. As stated in the webinar, 15mm is the minimum but in this case 18mm would have been acceptable as well. However, I caution clinicians to be mindful of how much alveoloplasty is performed because I have seen excessive reduction as well and then the length of the implants is compromised on the other side and the final prosthesis is very large and very thick. We need be responsible in our diagnosis and treatment to remove the appropriate amount of bone based on the individual case. I appreciate your remarks.

Joel Benk - (3/5/2014 6:10 AM)

Great presentation! I am so glad to have the opportunity to see a presentation that is not only professionally done but also shows mistakes that we make and presents solutions. True learning and I applaud you for that. When I have done the all on four surgeries bone reduction has been the hardest thing for me to embrace yet with this, very prothetic driven procedure, bone reduction is vital to a successful outcome as you have so eloquently shown. I have done these using both software designed guides and lab provided bone reduction guides that really help me with this surgery. I used the same scanning protocol you have shown with the nobel guide yet am finding the lab generated guides appear more predictable in my hands. Can you speak to this. Additionally I shoot for the incisal edge to the apical aspect of the transition zone to be 18mm for that dimension. Do you think that is too much? Thanks again. Best Joel

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Since the advent of osseointegration, the patient who is edentulous or soon to be edentulated has many options to prevent wearing complete removable prosthesis. In the maxillary arch there are anatomical features that may preclude patients successfully utilizing an implant prosthesis. Some of these include alveolar resorptive changes after extractions, pnuematized sinuses, hard and soft tissue palatal vault configurations, and bone exostosis with associated undercuts. Psychological, many patients suffer after the loss of teeth with loss of self-esteem and avoidance behaviors. This program will focus specifically on the diagnostic, surgical, and prosthetic procedures of the All On Four patient. 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 maxilla.

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