Key takeaways
- The 2003 series delivered a metal-reinforced acrylic bridge within two hours of lower-jaw surgery.
- Nine of those early acrylic bridges, 30% of the development group, had a repairable fracture.
- After the acrylic was made thicker, the routine group in that series had no fractures during the study.
- A 2014 review named fracture of the all-acrylic bridge as the main prosthetic complication.
| Fact | Source limit |
|---|---|
| Acrylic bridge with a metal strip, delivered within 2 hours, at least 10 teeth | Lower jaws in one Lisbon clinic, 44 patients |
| Repairable fractures in 9 of the development-group acrylic bridges (30%) | The authors then thickened the acrylic and used higher curing pressure |
| No fractures in the routine group during the study | That group mostly kept the reinforced acrylic for the follow-up they reported |
| Fracture of the all-acrylic fixed bridge was the major prosthetic complication in a 2014 review | 13 papers, short follow-up for many of them, not a personal forecast |
- Development-group acrylic bridges with a repairable fracture in the 2003 series (9 prostheses). The later routine group had none during the study.
- 30%
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See how temporary teeth fit your planWhat were the first teeth in the original series?
Maló, Rangert, and Nobre delivered an acrylic prosthesis, reinforced by a metal strip, within two hours after the four lower implants were placed. It was designed to hold a minimum of 10 teeth, because the tilted back implants moved the screw holes forward, usually to about the second premolar. Prosthesis survival in the series was 100%.[1]
Patzelt, Bahat, Reynolds, and Strub reviewed 13 papers and 4,804 implants, of which 74 failed, 74% of those failures inside the first 12 months. They counted 1,201 prostheses incorporated within 48 hours. Mean cumulative survival at 36 months was 99.0% for implants (standard deviation 1.0) and 99.9% for prostheses (standard deviation 0.3). Mean bone loss was 1.3 mm (standard deviation 0.4). They found no significant difference between upper and lower jaws, or between straight and tilted implants. They also wrote that the evidence was limited, that studies of five years or more were scarce, and that randomized trials were needed. The complication they single out is fracture of the all-acrylic bridge.[2]
The day-one visit itself, including what "same day" does and does not include, is in same-day implants and new teeth in one day. The sore-mouth weeks that follow are in the first weeks after All-on-4.
Why did some of those acrylic teeth fracture?
Nine acrylic prostheses in the development group, 30%, had repairable fractures. Screw fracture or loosening sometimes came with those breaks. The routine-group bridges were then made with more material thickness, and the acrylic was cured under higher pressure. That group had no fractures in the reported follow-up. The authors wrote that a reinforced acrylic prosthesis might be used as a lower-cost final in that protocol. They also built metal or milled titanium finals for the development group, which is a different object from the two-hour acrylic.[1]
A fracture of the plastic teeth in that series did not, by itself, mean the bridge was lost. The implants were scored on their own life table. When one immediately loaded implant failed, the provisional survived on the other three.[1]
Why does Renew call the day-one teeth temporary?
The All-on-4 dental implants page says most patients receive implants and a full set of temporary teeth in a single visit, and that the permanent bridge is placed within a few months, after the implants integrate. People leave with teeth on day one. The whole treatment is still staged.[3] When that later bridge is made is covered in when the final teeth are made after All-on-4.
The implant surgeon places the implants. Tom Szarski, DD, is the denturist who plans the teeth with the on-site lab. Calling the first set temporary is how this clinic separates the day-one acrylic-style bridge from the bridge made after integration. It is not a promise about how either set will feel in a particular mouth.
Sources
- "All-on-Four" immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study — Clinical Implant Dentistry and Related Research
- The all-on-four treatment concept: a systematic review — Clinical Implant Dentistry and Related Research
- All-on-4 dental implants — Renew Implant Centre
Frequently asked questions
Are the teeth you leave with on surgery day the final bridge?
At this clinic, no. The All-on-4 page says most people receive implants and temporary teeth in one visit, and that the permanent bridge is placed a few months later. The 2003 series also started with acrylic, then made a different prosthesis for its first 30 patients.
Why did the early acrylic bridges break?
Maló and colleagues reported repairable fractures in nine of the development-group acrylic prostheses, 30%. They then thickened the acrylic and cured it under higher pressure. The routine group had no fractures during the study. A 2014 review still names all-acrylic fracture as the main prosthetic complication of the concept.
Did a fracture mean the implants had failed?
In the 2003 series, prosthesis survival was 100% even when an acrylic bridge needed repair. Implant losses were counted separately. A repairable fracture of the plastic teeth is a prosthetic event.
