Zirconia All-on-4 fixed prosthesis before / after

The Diagnosis: When Saving Teeth is No Longer an Option

Many people postpone dental treatment because they fear drastic procedures or the thought of total tooth loss. Our patient’s story began with a classic yet highly educational situation: due to extensive periodontal disease (periodontitis) and advanced decay, the 23 teeth remaining in the oral cavity unfortunately had to be declared unsalvageable.

During the diagnostic phase (CBCT and physical examination), we faced the following conditions:

• Bone loss in the posterior region: The patient had lost their back molars years ago, leading to significant bone resorption (atrophy) in those areas.
• Adequate bone in the anterior region, around the remaining teeth: Fortunately, there was sufficient and high-quality bone in the front region to ensure the stable anchoring of implants.

Using traditional methods, this condition would have required multiple rounds of bone grafting, sinus lifts, and up to 12–14 months of waiting. However, we chose a faster and gentler path.

Initial state: missing teeth, periodontal disease, and decay

The Solution: All-on-4 Fixed Prosthesis and Nobel Biocare Technology

The essence of the All-on-4® concept is that only 4 specially placed implants per jaw support a full, fixed dental arch. The rear implants are inserted at a 45-degree angle, allowing for maximum utilization of the existing bone stock while bypassing areas that would otherwise require bone grafting.

For the procedure, we chose Nobel Biocare Parallel CC implants, which are among the world leaders in the field. Why?

• Immediate Loadability: Their design provides extraordinary primary stability.
• Parallel-walled design: An ideal choice for this type of complex rehabilitation.
• Lifetime Warranty: The manufacturer’s globally recognized quality provides peace of mind for the patient.

Surgery Day: Towards a New Life in Just 1.5 Hours

It’s hard to believe, but the removal of 23 unsalvageable teeth and the placement of a total of 8 implants into the upper and lower jaws took only 90 minutes. The surgery was performed under local anesthesia and, based on the patient’s feedback, was completely painless.

Digital Planning: The Key to Precision

Prior to the surgery, we created 3D digital plans. This allowed the procedure to be so efficient, as the position, angle, and depth of every single implant were determined on the computer beforehand. Immediately after the surgery, precision impressions were taken so our dental laboratory could begin manufacturing the temporary fixed prosthesis right away.

Recovery Beyond Expectations

A common fear is that a procedure of this volume will be followed by days of intense pain. We prepared our patient for post-operative discomfort, but the report at the next day’s check-up was surprising.

The patient took only a single Cataflam tablet on the evening of the surgery and required no further painkillers afterward. This excellent result is thanks to the minimally invasive surgical technique and the precise, tension-free placement of the implants.

72 Hours Later: The First Real Smile

The biggest advantage of All-on-4® is that the patient does not have to live without teeth or with a removable denture for months. Seventy-two hours after surgery, we secured the temporary fixed bridges. Although these were not yet made of the final material, the aesthetic change was already immense. The patient could speak, smile boldly, and—with certain restrictions—eat again.

All-on-4 temporary fixed prosthesis on multi-unit abutments screwed onto implants

The Final Result: Zirconia All-on-4 Fixed Prosthesis with Smile Design

During the 4-month healing period, the implants fully integrated with the bone (osseointegration). Then came the “artistic” part of the process.

Digital Smile Design and Mock-up

We didn’t just create teeth; we created harmony. We took the patient’s facial characteristics and lip line into account. Before the final prosthesis, we created a 3D printed plastic trial (mock-up) to check the bite and aesthetics. We only proceeded to final production once everything was perfect.

Monolithic Zirconia and Custom Ceramic Gum

The material for the final bridge was monolithic zirconia, currently one of the most durable and aesthetic dental materials available. For a natural effect, we complemented the restoration with custom ceramic artificial gums, which restored the fullness of the face and masked the signs of previous bone loss.

Monolithic zirconia All-on-4 prosthesis with custom ceramic artificial gum

Comparison: Why was the All-on-4 Fixed Prosthesis the Better Choice?

Summary: The Start of a New Life

This case study perfectly illustrates how modern technology and professional expertise can bridge even the most hopeless-looking situations. After the removal of 23 unsalvageable teeth, our patient received not just a new set of teeth, but a fuller, more confident life.

Zirconia All-on-4 fixed restoration

Are you struggling with a similar problem? Don’t wait until the bone stock is completely gone. A consultation is the first step toward a smile you can be proud of again.

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