All-on-X Treatment: A Full-Arch Dental Implant Option for Suitable Patients

Dr Eugene Woo,  Associate Consultant, Department of Oral and Maxillofacial Surgery,National Dental Centre Singapore

Dr Charles Tan,  Registrar, Department of Prosthodontics, National Dental Centre Singapore

All-on-X treatment is a fixed, implant-supported solution for patients missing most or all of theirteeth. Combining dental implants, digital planning and multidisciplinary expertise, it restores function,aesthetics and quality of life while minimising the need for extensive bone grafting.

INTRODUCTION

The All-on-X (AOX) treatment is a revolutionary, multidisciplinary approach for patients who are missing most or all of their teeth. It involves using several dental implants (typically 4-6) to support a fixed full-arch prosthesis that cannot be removed.

As it is directly anchored to the jawbone via the implants, it does not dislodge (unlike a set of dentures). This enables the patient to achieve a stronger bite force and tolerate firmer foods. It also improves speech and reduces social embarrassment for the patient.

The most common variant is the All-on-4 protocol, which uses two vertical anterior implants and two posteriorly tilted implants to support a fixed prosthesis. This design overcomes anatomic limitations to minimise the need for bone grafting procedures, which are often associated with increased treatment morbidity, costs and treatment duration.

INDICATIONS

• Completely edentulous patients or those with terminal dentition
• Patients who opt for a fixed prosthetic restoration (i.e. they are not keen on removable dentures)
• Patients who have a loose and unstable set of dentures

CONTRAINDICATIONS

• Poorly controlled systemic diseases (e.g., poorly controlled diabetes or active malignancy)
• Ongoing or history of antiresorptive therapy (case dependent)
• History of head and neck radiotherapy
• Heavy smokers

TREATMENT PROCESS

1. INITIAL ASSESSMENT AND EXAMINATION

On initial presentation, patients will receive combined input from various dental specialists (Prosthodontics, Oral and Maxillofacial Surgery and Periodontics) to assess their suitability.

A clinical examination is performed to assess the patient’s facial profile, occlusal relationship, as well as any remaining teeth that may be present.

2. CLINICAL RECORDS

An intra-oral scan is performed to obtain a digital record of the patient’s dentition. This facilitates the planning ofthe future prostheses and implant positions.

A Cone-Beam Computed Tomography (CBCT) scan is taken to assess the native bone as well as identify various anatomical landmarks.

3. DIGITAL PLANNING

Planning of the implant positions and dental prosthesis is performed using digital planning software (Image 1). This will be used to fabricate guides that are used during surgery. The guides ensure that the implants are position edoptimally (Image 2).

4. SURGICAL PHASE

At this stage, the dental implants are inserted using the patient-specific guides. If necessary, bone and gum augmentation may also be performed simultaneously. This process may be performed under local or general anaesthesia, depending on the patient’s comfort and the case complexity (Image 3).

If the implants are sufficiently stable, the restorative phase can be initiated immediately postoperatively, and a temporary fixed prosthesis can be delivered on the same day. Otherwise, the implants are left to osseointegrate (3-6 months) before moving on to the restorative phase. The postoperative recovery period takes about 1 week. Mild facial swelling and oedema are to be expected during the recovery (Image 4).

5. RESTORATIVE PHASE

The prosthodontist will design and fabricate the new prosthesis, which will be seated and secured to the dental implants. This consists of a few appointments to ensure an accurate bite and ideal aesthetics for the patient (Images 5, 6 and 7).

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6. MAINTENANCE PHASE

Upon completion of treatment, the patient will require routine follow-ups for maintenance of the dental implants.

TECHNOLOGICAL ADVANCEMENTS

Recent advances in 3D imaging, Computer-aided Design and Computer-aided Manufacturing (CAD/CAM) technology have revolutionised the way implant treatment is performed. At the National Dental Centre Singapore, our in-house 3D printing facilities allow the use of custom-made surgical guides for implant therapy. This enhances the precision and accuracy of the implant placement, facilitating the restorative process and minimising surgical risks.

CONCLUSION

AOX treatment is an excellent treatment option for replacingmultiple missing teeth. With multidisciplinary carefrom various dental specialties, it can significantly improve a patient’s function, appearance and quality of life.

Dr Eugene Woo is an Oral and Maxillofacial Surgeon at the National Dental Centre Singapore. He has clinical experience in dental implant therapy, orthognathic surgery, oral pathology, maxillofacial trauma and temporomandibular joint disorders.

Dr Charles Tan is a Registrar in the Prosthodontics Department at the National Dental Centre Singapore. He has clinical experience in dental implant therapy, full mouth rehabilitations, fixed and removable prostheses and aesthetic dentistry.

GP Appointment Hotline: 6324 8798.