Dental implant treatment for patients with complete edentulism

Total edentulism refers to the loss of all teeth in both jaws and is caused, primarily, by untreated dental conditions and systemic diseases that lead to the complete loss of teeth in both dental arches.  

The most common causes of total edentulism are:

• periodontal disease;
• severe tooth decay;  
• trauma;
• general and systemic diseases: diabetes, osteoporosis, immune disorders, which affect blood circulation and the quality of the jawbone
• lifestyle factors: smoking, poor oral hygiene and a diet low in nutrients significantly increase the risk of tooth loss.

Total edentulism has a profound impact on quality of life, affecting essential functions such as chewing and speaking, as well as physical appearance.

Impact on chewing

As far as chewing is concerned, the absence of teeth reduces the ability to break down and fragment food. For this reason, people may end up avoiding solid, fibrous or hard foods (meat, raw vegetables, fruit).

Furthermore, swallowing food that has not been chewed properly puts a strain on the stomach and disrupts digestion.

Impact on speech

The absence of teeth also affects speech (phonation), as it prevents the tongue and lips from being positioned correctly.

Pronouncing labiodental (F, V) and linguodental (T, D, S) consonants becomes extremely difficult, and the uncontrolled flow of air through the oral cavity produces a hissing sound whilst speaking.

Aged appearance

In terms of facial appearance, missing teeth lead to resorption of the jawbone, sagging of the lips and a prematurely aged appearance of the face. 

Treatment options for complete edentulism fall into two main categories, depending on the method of attachment:  

• fixed implant-supported solutions (the ideal method)  
• removable or adjustable solutions (more affordable, but with many drawbacks)

Removable dentures

Traditional full removable dentures, commonly known as ‘denture plates’, are removable medical devices made entirely of acrylic, used to replace all the teeth in one arch. They are held in place by suction and can be removed and cleaned by the patient every evening.

Fixed implant-supported prostheses  

Fixed implant-supported prostheses are permanent prosthetic solutions, either screw-retained or cement-retained, on a support consisting of several dental implants (usually between 4 and 6 implants per arch). They completely replace the missing teeth. The restoration is firmly fixed in the dental surgery and can only be removed by the dentist for regular professional cleaning.

Modern dental implant systems offer a fixed solution for replacing all the teeth in an arch. Depending on the clinical situation, the dentist may recommend treatments such as All-on-4® or All-on-6®, tailored to each patient’s needs.

The All-on-4 implant system

The modern All-on-4 system is a surgical technique that enables the complete restoration of an edentulous arch using just four dental implants.  

Two implants are placed vertically in the front, whilst the other two are inserted at an angle (up to 45 degrees) in the side areas. This strategic angulation makes the most of the strong natural bone and avoids sensitive anatomical structures (such as the maxillary sinuses or the alveolar nerve).  

The system allows a temporary fixed denture to be fitted within just 24–48 hours of surgery.

Advantages of All-on-4:

• Fixed dentures in 24 hours: The patient leaves the clinic the very next day with a functional and aesthetically pleasing fixed denture (temporary restoration), without spending a single day without teeth.
• Avoids the need for bone grafts: As the implants are placed at an angle in areas of maximum bone density, complex and costly bone augmentation or sinus lift procedures are avoided in most cases.
• More cost-effective than conventional systems: As it uses fewer implants and eliminates the need for bone augmentation, the total cost is lower compared to a traditional restoration using 6–8 straight implants.

Disadvantages of All-on-4:

• The All-on-4 implant system is not recommended for patients who suffer from bruxism or have very soft bone in the upper jaw.  

Dental implant treatment is planned in stages, from the initial assessment through to the fitting of the final restoration. Each stage is designed to ensure the integration of the implant and a long-term functional and aesthetic outcome.

Consultation and CBCT (Computed Tomography)

Before deciding whether dental implant treatment is suitable for you, a clinical assessment is required. The dentist examines the condition of your gums, oral mucosa and remaining teeth (if any), as well as your medical history (chronic conditions, medication).

In the next stage, radiological investigations are recommended:

Three-dimensional digital radiography (CBCT), a mandatory examination, which provides accurate images of the jawbone, measuring its length, width and density.

CBCT allows for the precise localisation of the maxillary sinuses and the inferior alveolar nerve to avoid damaging them during surgery.

Digital planning

Using specialised dental software, the dentist uploads the computed tomography (CBCT) scan and the digital scan of the dental arches.

Based on this data, a surgical guide is created – a plastic template produced using 3D printing. This is placed on the patient’s gum during the operation and guides the insertion of the implant exactly into the position simulated on the computer, eliminating human error.

Implant placement

Dental implant placement is carried out via surgery under local anaesthesia. After preparing the bone, the dentist inserts the implant into the position determined during the digital planning stage.  

Depending on the complexity of the case, the procedure can take between 30 and 90 minutes.

Temporary prosthesis

In certain situations, where immediate loading is recommended, the patient may receive a temporary restoration immediately after the implant is placed.  

This serves both an aesthetic and functional purpose during the osseointegration period, allowing the patient to smile and carry out their daily activities with greater comfort.

Final prosthesis

Once the osseointegration process is complete, the implant is ready to support the final restoration.  

The crown or final prosthetic restoration, in the case of treatment with the All-on-4 implant system, is custom-made to blend harmoniously with the rest of the dentition and ensure optimal long-term functionality.

Adaptation period

After the final restoration has been fitted, a settling-in period is required during which the patient gets used to the new dental restoration. Regular check-ups and following the dentist’s advice help to maintain the health of the implant and ensure the long-term success of the treatment.