All-on-4 protocol: High-tech dental implant surgery in clinics in Turkey
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Tooth loss not only affects the aesthetic aspect, but also has a significant impact on the patient's quality of life. Professional dental prosthetics can help in this complex clinical situation. Removable dentures, although they are an inexpensive solution, have significant disadvantages: they do not provide sufficient chewing function, cause a noticeable discomfort when used, often look unnatural and, most importantly, do not prevent progressive jaw bone atrophy. Dental implant surgery is considered the optimal method for treating adentia. Developed based on advanced biomechanical research, the modern All-on-4 protocol allows a full row of teeth to be restored with only four dental implants. Leading dental clinics in Turkey offer this procedure using state-of-the-art equipment and premium materials. In this article you will find information about the All-on-4 protocol, the stages of dental implant surgery, treatment results, and the benefits of the technology.
Content
- What is the All-on-4 protocol?
- Main indications for the use of this approach
- Benefits over conventional implantation methods
- Stages of the All-on-4 implant procedure
- Benefits of dental implants in Turkey
- Prices for All-on-4 implants
What is the All-on-4 protocol?
Dental implants are artificial tooth roots. They can have different shapes, but usually look like oblong screws that are screwed into the bone. Dental implant surgery is the best method of prosthetics because it provides a natural look of teeth with full restoration of chewing function. The implant grows completely into the bone in 3-6 months, provides adequate chewing load, and prevents bone atrophy, which is inevitable with other types of prosthesis placement.
In standard cases, a single crown is attached to a single implant. This works well if you need to restore one lost tooth or several teeth in different locations. However, if you need to restore all the teeth in your jaw, this approach is too traumatic and expensive. Too many dental implants will be needed to provide normal chewing function and natural-looking teeth.
For this reason, dentists have created a system in which all the artificial teeth are attached to only four dental implants. The protocol has received the corresponding name, All-on-4, which reflects the essence of this prosthetic option. The All-on-4 technology was developed in 1998 by a team of Portuguese dentists led by Paulo Malo. It is now a popular dental implant protocol used to replace the dentition of one or more jaws.
Main indications for the use of this approach
The All-on-4 protocol is used in cases of total adentia or when the patient has single teeth remaining. Reasons may include:
- Age-related tooth loss
- Congenital anomalies where teeth are missing
- Severe dental diseases, such as generalized periodontitis, which can cause the loss and extraction of almost all teeth even at a young age
The majority of patients are those with a hereditary predisposition to periodontitis and elderly people who have gradually lost their natural teeth over many years. Most of them have some degree of bone atrophy in their jaws, which are not adequately loaded for mastication (the widely used dental bridges and removable dentures do not provide adequate loading despite the preserved masticatory function).
Previously, bone augmentation with sinus lift surgery or bone block grafting was always required in cases of atrophy. In other words, a rather traumatic surgery was required before dental implants could be placed. With the All-on-4 protocol, patients rarely require a sinus lift because the requirements for alveolar bone width and thickness are reduced. Implants can be placed with a bone width of 5 mm and a height in the area of the anterior teeth of 10 mm above and 8 mm below.
The All-on-4 technology also has other benefits, which we will discuss below.
Benefits over conventional implantation methods
- The price of dental prosthetics is significantly lower because the patient only needs four dental implants.
- With fewer implants, the procedure is less traumatic, faster, and less uncomfortable after surgery.
- All-on-4 is a one-stage protocol. This means that the patient does not have to undergo two surgical procedures several months apart. The next day, the doctor will place temporary crowns on the dental implants and replace them with permanent ones in the second stage of treatment.
- The protocol can be used in both the upper and lower jaw. If necessary, eight implants can be placed in a single procedure (four on each side).
- By reducing the number of implants used, the risk of complications is significantly reduced: the placement locations of the artificial roots are chosen so that they cannot damage the mandibular canals and maxillary sinus. The mandibular nerve is not damaged when implants are placed in the lower jaw.
Stages of the All-on-4 implant procedure
If there are no indications for sinus lift surgery, the dental implant procedure is performed in 2 stages:
- Surgery to place dental implants and temporary prostheses
- Placement of permanent dentures
Stage 1: Surgery to place dental implants and temporary prostheses
In standard cases, a one-stage procedure is performed. This means that after the implant is placed, the dentist will not suture the gum tightly and wait for the implant to grow into the bone. The day after the implant is placed, the dentist will place a temporary denture. For the success of the one-stage prosthetics, all dental implants must be securely fixed in the bone. After their placement, the doctor checks the reliability of the fixation with a special key. In most cases, the implants are well fixed, so the procedure is completed according to the one-stage protocol.
The duration of this stage is 5-7 days.
Preparation (1-2 days)
The doctor examines and sanitizes the oral cavity. Before surgery, the patient undergoes standard laboratory tests such as general clinical tests, infection tests, and a coagulogram. A CT scan will also be performed to plan the dental implant procedure. Patients are trained in the care of orthopedic structures.
If there are teeth left in the mouth, they will be extracted. This procedure does not need to be done separately. The remaining teeth can be extracted on the day of the implantation, just before the artificial roots are placed.
Surgery (1 day, 2 hours for each jaw)
Dental implant surgery is performed under local anesthesia or intravenous anesthesia. Doctors may also use mild sedation, in which the person's consciousness is reduced, but there is still contact with the doctor. Sedation is supplemented by infiltration anesthesia in the upper jaw and conduction anesthesia in the lower jaw. In the first case, the doctor injects local anesthetics into the affected tissues, and in the second case, the specialist blocks a major nerve that conducts pain impulses.
In any case, the procedure is performed without any significant discomfort. In Turkey, it is carefully monitored that the patients are satisfied with the services of the doctors, do not retain unpleasant memories, and are not afraid to seek dental care again.
During surgery, the doctor makes an incision in the gum, separates the mucoperiosteal flap, drills a hole in the bone, and screws the implant into it. The two anterior artificial roots are placed vertically and the two lateral roots are placed at an angle. In Turkey, the implants are placed with the help of surgical templates, which ensures perfect accuracy and increases the success rate of the procedure to 98-99%.
After the implant is placed, an abutment is placed to which the prosthesis will be attached. Once the procedure is complete, transfers are placed to take an impression of the implant level. Prostheses are made in the shortest possible time and usually placed in a few hours or the next day. The doctor puts the mucoperiosteal flap back in place and sutures.
Placement of temporary dentures
Implants are just artificial tooth roots and you cannot chew with them. Dentures are placed on the roots, which are made in a dental laboratory from impressions. The dentist makes impressions immediately after the implants are placed. These impressions are used to make temporary dentures. Temporary dentures are fitted 24 hours after the surgery, which requires only one visit to the clinic.
Even temporary implants are of good quality. They look good and allow you to chew food. Temporary dentures are usually made of acrylic.
Stage 2: Placement of permanent dentures
After an osseointegration period of 3-4 months, the temporary dentures are replaced with permanent ones. Permanent dentures can be made of various materials such as zirconium dioxide, ceramics, or metal ceramics.
This stage takes up to one week. The total treatment process from the first visit to the implantation of the permanent denture is about 4 months on average.
Benefits of dental implants in Turkey
Patients from all over the world, including developed countries, travel to Turkey to have implant dentures done. There is only one reason for this and that is the high quality of prosthetics combined with the low prices of dental services.
Turkey has extensive experience with the All-on-4 protocol developed by Nobel Biocare. Nobel Biocare produces an implant system that has been used worldwide for more than a quarter of a century. This system is well researched, reliable, continuously improved and offers high dental implant surgery success rates.
Because the All-on-4 implant system has become so popular, other companies have started producing it as well. The results are no worse. Here is a list of alternative brands of high-quality implants that Turkish dentists can use instead of the original system from Nobel Biocare:
- Straumann, Switzerland. These dental implants have a special SLActive coating for better osseointegration (the process of growing into the bone).
- Astra Tech, Sweden. These dental implants are among the TOP-3 best-selling implants in the world. OsseoSpeed technology provides more reliable fixation in the bone tissue, which is important for a one-stage prosthetic protocol where artificial teeth are loaded even before the artificial roots grow into the bone.
- Xive Ankylos, Germany. The company uses sandblasting and high-temperature treatment of the implant surface, which accelerates the process of osseointegration.
- Osstem, Korea. The company ranks first in the world in terms of number of implants, used in more than 80 countries. The company offers the widest range of dental implants.
All dental implants are of high enough quality to provide you with a full restoration of your chewing function. After a consultation, the dentist will choose the best option for you based on your clinical case and your wishes regarding the implant cost.
The price for the services of dentists is very different between Turkey and countries such as Germany, the USA, Japan, etc. That is why people go to Turkey first of all to save money on excellent medical services. This country welcomes medical tourists, and large clinics are mostly focused on foreign patients.
Prices for All-on-4 implants
The price for dental prosthetic surgery is made up of two factors. These are as follows:
- The price of the implants themselves. The price depends on the manufacturer of the implant system. In addition to the implants, you will need dentures and artificial tooth crowns, which are usually not included in the price of the All-on-4 implant system.
- The price of dental services. Dental clinic fees depend on the country, the level of the clinic, and the availability of insurance. If you are going to place dental implants in Turkey, the cost of treatment will not be high.
It is also worth considering that in some situations additional treatments may be required to achieve good results, such as bone augmentation procedures when there is not enough alveolar bone due to atrophy to reliably place four dental implants. These cases require additional dental care, which increases the overall price of dental services.
All-inclusive package for All-on-4 dental implant surgery in Turkey: what is included in the package?
A package deal means that you will receive a turnkey price for your dental implant surgery. This means that you do not have to pay separately for dental implants, abutments, dentures (temporary and permanent), instruments, medical products, dental consultations, preparatory procedures, surgery, first and second stage of implantation, diagnostic procedures, etc. You simply pay a fixed price and get the amount of dental services you need to achieve the results you want. Dentists in Turkey often use this approach, thereby saving patients from unnecessary anxiety.
"Depending on the type of implant and the level of the clinic, the price of the All-inclusive package will be between €3,500 and €6,800. In Germany or Switzerland, the same program would cost between €35,000 and €65,000."
You are welcome to use the Booking Health services if you want to place all dental implants on a turnkey basis in one of the best dental clinics in Turkey. On our website, you can find out prices, get information about procedures, and leading clinics and dentists in Turkey. Please leave your request on the website to get help in choosing a clinic. The team of specialists at Booking Health will help you choose a dental center in Turkey and a good dentist. They will make an appointment for your preferred dates and take care of your travel arrangements. You will receive high-quality dental services in Turkey. When you make an appointment through Booking Health, the cost of treatment for you will be lower as there are no additional fees for foreign patients.
Choose treatment abroad and you will for sure get the best results!
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.
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