When Nobel Biocare organised a seminar on the innovative All-on-4 treatment concept, at the company's UK head office in Uxbridge near London, I went to find out more.
The presenter was Ken Parrish, owner of the Advanced Implant and Perio Centre in Louisville, Kentucky, US; a highly experienced clinician and international lecturer. Ken shared his knowledge and techniques for using the All-on-4 concept, an advanced solution for the edentulous patient that requires a minimum of four implants per jaw.
I really enjoyed this presentation. It had the right content, was in the right environment and had the right number of people in attendance. I attend many implant events all over the world and they are frequently held in large auditoriums that hold thousands of people, making the experience quite impersonal. At these events only a handful of people get to question the presenter and usually this is at the end of the session. In this instance, the day was set in a much smaller setting, in a conference room where everyone had the opportunity to ask questions at any point during the presentation. This offered a greatly improved learning environment for me, as we were able to discuss issues as they arose.
As a prelude to the main topic for the day, Ken introduced the NobelActive implant. This is a very useful implant that produces excellent primary stability and is designed for immediate placement and restoration. He showed its uses in a number of cases, which I found very informative and much better than just reading about the implant. Ken is a practising dentist so his observations and recommendations have a relevance to all the dentists present that they could take back to their practices for use on their patients. He demonstrated exactly when to use this implant and what its limitations were. This was very useful as I plan to add these implants to my practice.
All-on-4 was the main topic of the seminar and Ken showed many cases; demonstrating each stage from planning, to placement, to the restoration. The technique is ideal for taking an edentulous patient and immediately restoring them with a fixed solution in one visit. The concept proposes that in certain individuals, where bone grafting is not employed but where the bone is limited, a minimum of four implants are placed. These are located between the mental foramina in the mandible and/or between the maxillary sinuses. The implants are angulated in such a way as to spread out the load to the maximum, thus enabling provision of a screw-retained solution. With careful planning, the Nobel Biocare implants are placed with attention to achieving primary stability.
With the assistance of a dental technician the patient's own full denture can then be adapted to provide a fixed restoration in the same appointment. The implants are then left to integrate as usual and a definitive restoration fabricated. This is cost effective and very satisfying for the patient.
I was present with my laboratory technician, Martin Docking of Precision Dental in Cornwall. He has experience of the technical side of the system so it was really good for him to see the clinical aspects. This really is a system that we feel will benefit some of our patients enormously.
Ken showed a wide variety of case studies from his obvious wealth of experience with All-on-4. He estimated he places 25-30 cases a month in his practice in Kentucky and is aware of many such practices across the US that are seeing a similar number of people and drastically improving their quality of life. The main benefit is that in the past, people with compromised bone would have had to undergo bone grafting procedures to generate sufficient bone quantity to support enough implants for a fixed restoration. This is a lengthy, sometimes uncomfortable and, by comparison, expensive treatment.
Now, All-on-4 offers a very attractive alternative for some of those patients. It is estimated that in the UK there are in excess of 4m edentulous people. Many of them, as we know, are very dissatisfied with their dentures. For some of them this concept can change their lives for the better.
The seminar gave another treatment choice I can take to my patients. For those who suffer the discomfort, inconvenience and to a certain extent stigma of wearing dentures, the idea of fixed teeth at less expense in terms of cost and time will be very attractive.
Ken had obvious enthusiasm for what he does and it was impossible not to feel the same. He was very approachable and fielded questions about all aspects of the All-on-4 concept with ease. He clearly demonstrated he is a very skilled clinician and it was a pleasure to attend the day's seminar. The day's format was ideal and it was a very enjoyable learning experience. I certainly gained a thorough understanding of the procedure and came away very excited to bring this to my patients as soon as possible.
In addition, I was very impressed with Nobel Biocare. They have undergone something of a change in their personnel over recent times and during the lunch break their new world CEO introduced himself and asked what we were looking for from the company. They are keen to offer a great customer experience and it was refreshing to see this. All in all it was a very successful day.