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Clin Implant Dent Relat Res. 2017 Apr;19(2):233-244. doi: 10.1111/cid.12456. Epub 2016 Oct 18.

The NobelGuide® All-on-4® Treatment Concept for Rehabilitation of Edentulous Jaws: A Retrospective Report on the 7-Years Clinical and 5-Years Radiographic Outcomes.

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Department of Oral Surgery, Maló Clinic, Private practice, Lisbon, Portugal.
Private practice, Research and Development, Maló Clinic, Lisbon, Portugal.
Oral Surgery and Implant Dentistry Department, School of Dentistry, University of Granada, Spain.



There is a necessity of studies documenting the long-term outcome of full-arch flapless rehabilitations.


To evaluate the 7 years implant and prosthesis survival rate and 5-years marginal bone loss of full-arch fixed prosthetic rehabilitations supported by implants in immediate function with the All-on-4® treatment concept using a computer guided surgical protocol (NobelGuide® , Nobel Biocare).


This retrospective clinical study included 111 edentulous patients (n = 53 bruxers; n = 21 smokers; n = 59 systemically compromised), rehabilitated between February 2005 and November 2010 with 532 implants with the All-on-4® treatment concept using NobelGuide® . Outcome measures were implant and prosthesis survival, marginal bone loss at 5-years and the incidence of mechanical and biological complications. Survival was calculated using life-table analysis. Inferential analysis was performed to compare the difference in marginal bone loss between axial and tilted implants.


Sixteen patients were lost to follow-up. The implant cumulative survival rate was 94.5% at 7 years. Prosthetic survival was 97.8% (n = 3 prosthetic failures). The average (standard deviation) marginal bone loss at 5 years was 1.3 mm (1.06 mm) overall, 1.27 mm (1.02 mm) for tilted implants and 1.34 mm (1.1 mm) for axial implants (p < .001). Ninety-one patients experienced complications in the provisional prostheses (n = 47 patients who were bruxers; n = 25 patients with implant-supported rehabilitation as opposing dentition) ranging from prosthetic fracture (n = 66 patients) to abutment or prosthetic screw loosening (n = 74 patients). Thirty-three patients experienced complications in the definitive prostheses (all exclusive to patients who were bruxers or had implant-supported rehabilitations as opposing dentition) ranging from acrylic-resin prosthetic/crown fracture (n = 23 patients) to abutment or prosthetic screw loosening (n = 10 patients). Twenty-five patients (22%) registered peri-implant pathology.


Within the limitations of this study, it is possible to conclude that this treatment modality for completely edentulous jaws is possible with high long-term survival outcomes. Bruxing and smoking habits had a negative impact on implant failure, mechanical, and biological complications.


clinical research; computer assisted; edentulous mandible; edentulous maxilla; flapless implant surgery; immediate function

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