While I have successfully done, surgery portion only as a member of the comprehensive dental team, many of these All on X cases I am not a big fan and I think the trend will pass soon. Too many of the cases, presumably because the “CE courses” teach it that way, are set up to be a one trick pony with the extreme angulation of the fixtures. I understand and have angled many posterior fixtures to accommodate these cases and feel bad every time. I fear that the angled fixtures are fine as long as the prosthesis remains fully intact but are worthless in the event that the final prosthesis needs to be modified. It is always my preference to place the fixtures in a more traditional parallel fashion, when possible of course, primarily to facilitate any future complication or change in final restorative plan. After 20+ years of replacing “permanent” teeth with these so called “permanent” implants I have learned to allow a little wiggle room for the possible failure of this “permanent” solution and angled fixtures just do not allow ant freedom to drift from this trendy path…
So you think the so-called benefit of an AOX in avoiding sinus lift procedured
is not really relevant.??
This is a great question for discussion. I can appreciate your point of view. Dr. Malo seems to have shown long term success of 10-18 years follow up which is definitely impressive (see article here: https://doi.org/10.1111/cid.12769).
I am more interested in the specific case you show. In your case, there is no need for employing angulated implants to increase posterior spread. There is enough bone all the way back to support parallel implants spread out over the arch. I don’t think anyone would suggest All on 4 angulated implants in the case you are showing. If I am missing something please let me know.
Thanks for your post!
I just think that many folks take the concept too far and place angled fixtures as a matter of “Protocol”. In my experience a sinus lift has demonstrated itself to be a technically easy procedure and not one that I would consider a game changer but again I just think we are too quick to pull the trigger and move a patient into a hybrid. IMHO without better planning I think in the near future there are going to be a lot of people running around with partially failed All on X and some nonrestorable angled fixtures in their heads…
I agree with you on everything except that I do think some people, most likely as a result of aggressive marketing, would still opt to place angled fixtures simply as a matter of protocol. While angled fixtures certainly have their place I believe that our profession has developed a seriously unhealthy obsession with full arch implant treatment and when necessary we should avoid robotic protocol driven treatment and most important plan for future potential modifications.
There are alot of people running around with problems from All on x in my practice. Too often the fixture is slightly tilted toward buccal and recession occurs. A PITA to fix.
I am excited by the Nexus system that Keystone sells. Allows for 1/2 bone reduction or none, which is much kinder for cleanability, stays away from muscle attachments, less disruption of KG, still uses Titanium bar w zirconia Monolythic on top of the bar yet can be made like crown and bridge thickness buccal lingually…much easier hygiene.