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All On Four Implants: Bone Loss Treatment Choice

Gold Standard Full arch reconstruction for one or both jaws has the greatest appeal for patients who have lost the majority of their teeth that is often complicated with bone loss issues.

The largest patient group, in terms of sheer numbers, are denture wearers or patients with denture partials.

Worn Out Adult Teeth New Jersey
Worn Out Teeth + Partials
Partials, like dentures, will cause some degree of bone loss. The removal of teeth ceases stimulation of bone. How much bone is lost with the use of partials is very different for each patient.

Some patients are fitted with precision partials and have excellent dental function and bite. Others who have had poor performance and fit of a denture partial will oftentimes keep using a poor fitting partial because of frustration and or cost issues.

Loose, rocking, pinching or otherwise uncomfortable partials can accelerate the loss of bone.

Old Denture Partials
Upper Jaw Implant Guide
The sequence of photos shown in this treatment example are of a "30 something" female who sustained considerable loss of dental function and loss of posterior bone in the upper and lower jaws.

An unusual bite eventually developed, mimicking s severe orthodontic underbite issue, as seen in the adjacent photo.

Frustrated with multiple experiences of cosmetic and functional dental failure, this young woman elected to use the Nobel Biocare treatment protocols that would recreate what she once had.... with premium grades of implants, surgical procedures and prosthetics.

Partials Cause Posterior Bone Loss
Bone Loss Degradation in 4 Quadrants
Long Term Use of Partials
The All On Four protocol (see video) assures patients of precision implant placements that take the best advantage possible of healthy bone, generating a computerized design of a prosthetic that rebuilds the dental function of a given arch with a normalization of lost bite height (vertical dimension) that typically accompanies long term denture use.

For this patient, her All On Four treatment plan enabled Dr. Kristin and Dr. Carmen to minimize the need for bone block grafting in the deficient areas. Specific sizes of implants (diameter and height) were used to form a rock solid foundation in both the maxilla and mandible for a bite strength she hasn't enjoyed since her early adult years.

TeethInAnHour Mandible Implants
Lower - Upper Jaw Implants
The calculated distribution of her renewed biting forces assures that all supporting bone structures will be healthfully maintained with little concern for overloading a particular implant.

Implant Placements

The adjacent photo reflects the placement of 4 mandibular implants (alignment guide pins showing) and 4 maxillary implants. Selective use of tissue grafting products are used to fortify each implant site along with the need to "plump up" gum tissues on an as-needed basis.

Upper Arch Close Up
Upper Arch Close Up View
Periodontal Suturing - Four Implants
The next photo is a closeup view of the upper arch, showing locations of each implant site and periodontal surgeries that will heal into a nicely formed upper ridge of bone.

Bite Height - Cosmetic Face Lift

The loss of bone that normally occurs with long term use of denture products creates what we all recognize as "granny mouth." The mouth over-closes... creating an effect where the chin appears to get closer and closer to the nose. The removal of upper and lower dentures in a denture patient over dramatizes this effect.

Understandably a collapsed bite is associated with aging. All On Four dentistry reverses the aging effect of a collapsed bite.

All On 4 Success Outcome
New Teeth - Bite - Function
Collapsed Bite Correction
The design and fabrication of the upper and lower prosthetics incorporate numerical values necessary for recreating the patient's original and "normal" bite height, given her facial characteristics.

CTScans: Planning and Fabrication

The advantage of CAD/CAM 3 Dimensional scanning and treatment planning creates a system of prosthetic attachment and aesthetic design that is, for practical purposes, unsurpassed in reconstructive dentistry.

The adjacent, over-retracted picture of the patient's new teeth provides a view of how prosthetic teeth and gingival areas are created that provides the confidence that the patient's "new smile" will reveal nothing but teeth and gum tissue that looks and feels as natural as Mother Nature's own handiwork.

South Jersey Cosmetic and Implant Dentistry
Kristin B. Petulla, D.D.S.
Jennifer L. Kazemi, D.M.D.
43 East Main Street
Marlton NJ 08053



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tooth replacement procedures are technique sensitive and can incorporate different degrees of predictability for implant success dependent upon the skills and technologies used by the local surgeon periodontist specialist or local implant dentist diagnosis of occlusal function and restoration procedure

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