Duration: 1 hour, 2 minutes, 41 seconds

Author: Dr. Saj Jivraj, Dr. Hooman Zarrinkelk

The All on 4 Concept Diagnosis to Delivery Part 3: Clinical Patient Presentations Surgical and Prosthetic Protocols for Fabrication of a Full Arch Immediate Load Prosthesis

When it comes to providing comprehensive dental care to patients, understanding different treatment approaches is crucial. In this article, we will delve into the all on 4 concept and explore the diagnosis to delivery process for full arch immediate load prosthesis. We will focus on clinical patient presentations and the surgical and prosthetic protocols involved in this innovative technique.

Dentate and Edentulous Patients: Two Different Cases

In the world of dentistry, every patient presents unique challenges and requirements. To discuss the all on 4 concept effectively, we will consider both dentate and edentulous patients.

1. Dentate Patient

A dentate patient refers to an individual who still has some natural teeth present. This scenario demands a more delicate approach as the treatment needs to be tailored to preserve the remaining teeth while providing a stable framework for the prosthesis.

2. Edentulous Patient

An edentulous patient, on the other hand, has lost all their natural teeth. This situation often requires a more extensive treatment plan, including extractions and implant placement.

Problems Identified through Panoramic Radiograph

Panoramic radiographs are essential diagnostic tools that provide an overview of a patient’s oral health. When analyzing this type of radiograph, dental professionals often come across several problems that need to be addressed. Common issues identified include neglect, periodontal disease, and bone loss.

Identifying Available Bone: Zone One and Two

Before proceeding with the all on 4 concept, it is crucial to assess the patient’s available bone. This assessment helps determine the feasibility of implant placement and the prosthetic outcomes. The available bone is typically categorized into two zones:

1. Zone One

Zone one refers to the anterior part of the mouth where the bone is denser, providing better stability for implant placement. This area is often considered ideal for immediate loading of implants.

2. Zone Two

Zone two, which includes the posterior region, may present some challenges due to decreased bone density. However, with proper planning and precise surgical techniques, implants can still be successfully placed in this area.

CT Scans: Assessing Bone Height for Implant Placement

For more accurate and detailed assessment of bone height, CT scans are often employed. These scans allow dental professionals to visualize the bone structure in three dimensions and determine if there is enough bone height for implant placement.

Immediate Loading: The Key to Same-Day Fixed Appliances

The all on 4 concept revolutionizes dental implant procedures by enabling immediate loading of implants. Immediate loading means that a fixed appliance can be attached to the implants on the same day as tooth extraction. This technique offers numerous benefits to patients, including reduced treatment time and faster restoration of oral function.

The Surgical and Prosthetic Protocols

When it comes to fabricating a full arch immediate load prosthesis, several surgical and prosthetic protocols need to be followed. These protocols are carefully designed to ensure the success and longevity of the prosthesis. The steps involved may include:

1. Extraction of Remaining Teeth

For a dentate patient, any remaining teeth that are not salvageable need to be extracted to prepare the mouth for implant placement and prosthesis fabrication.

2. Implant Placement

Implants are strategically placed in the available bone zones, ensuring appropriate angulation and distribution for optimal support and stability of the prosthesis.

3. Immediate Loading

After implant placement, the prosthesis is attached to the implants, offering immediate restoration of the patient’s smile and oral function.

4. Follow-up Care

Regular follow-up appointments are crucial to monitor the healing process and make any necessary adjustments to the prosthesis.


Understanding the diagnosis to delivery process of the all on 4 concept is essential for dental professionals seeking to provide comprehensive care to patients. By considering the clinical patient presentations, panoramic radiographs, available bone zones, CT scans, and surgical and prosthetic protocols, dental practitioners can successfully fabricate full arch immediate load prostheses.


1. How long does it take to fabricate a full arch immediate load prosthesis?

The time required for fabricating a full arch immediate load prosthesis can vary depending on the individual case. However, with advancements in technology and streamlined protocols, it is possible to complete the process within a shorter timeframe compared to traditional implant procedures.

2. Are there any risks associated with immediate loading of implants?

Immediate loading of implants is generally considered a safe and effective technique. However, like any dental procedure, there are some risks involved, such as implant failure or complications during the healing process. These risks can be minimized through proper patient selection and adherence to surgical and prosthetic protocols.

3. Can the all on 4 concept be used for patients with severe bone loss?

The all on 4 concept is designed to address cases with varying degrees of bone loss. While severe bone loss may present challenges, the technique can still be utilized with proper planning, implant angulation, and the use of additional surgical procedures like bone grafting.

4. How long do full arch immediate load prostheses last?

The longevity of full arch immediate load prostheses depends on various factors such as oral hygiene, regular maintenance, and the patient’s overall health. With proper care and regular follow-up appointments, these prostheses can last for many years.

5. Are there any dietary restrictions after receiving a full arch immediate load prosthesis?

In the initial healing phase, patients may need to follow a soft food diet to avoid excessive force on the implants and prosthesis. However, as the healing progresses, most patients can gradually resume their regular diet.

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