Mandible all-on-4 with Bond Apatite grafting

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Posted on By José Ferreira In Full Arch & Dentures

A female patient, 65 years old, heady, that wants to do a mandible rehabilitation with fixed teeth because she don't want to use removable prosthesis any more.
We decided to extract all the mandible teeth and go ahead with a all-on-four technique with immediate load and bone stabilization with Augma Bond Apatite.

initial aspect / planning
regularization of bone platform

insertion of parallel implants
insertion of angled implants

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Clean surgery. Have you considered Dentin Grafting in these cases? Dr. Salama


Thank you for the question and the comment Dr. Salama.

Well, I have tried the Dentin Grafting, and its true that it works but, at least for me, its a bit time consuming (the bone cement takes 10 sec. to apply) and at the end its not much cheaper than for example a 1cc of Bond Apatite.
But the main characteristics that makes me choose the Calcium Sulfate for immediate implants and big rehabilitations its:
1-the fact that being a salt, it helps to prevent implant infections and the graft himself never but never gets infected;
2-The Calcium Sulfate acts on stem cells derived from the peripheral blood, inducing the osteogenesis.
(J. Osteol Biomat 2010; 1:55-60)
3- At the end of +- 4 month the Calcium Sulfate its completely absorbed living only new formed bone in its place.


Wonderful surgery, thank you for sharing. Are these 3.5 NP Active implants? Any concerns regarding the strength of these implants long term compared to the 4.3 RP implants?


Thank you for your attention and for the nice comment Dr Xavier.

You are absolutely right! They are 3.5mm Nobel Active implants.

Regarding the 3,5 vs 4,3, in my clinical experience, I use the 3.5 more and more as time goes by because they leave more bone width around the implants preventing bone absorption in the long term. Also, to compensate the narrow width of the implants I always use longer implants (if possible) to achieve a better primary stability in the immediate load and to augment the implant surface in the bone to create more load resistance in the long term.
To protect and all the rest) the 3,5 conical platform I also use the multi-units abutments. For last, this 3,5 cc from Nobel are able to support a torque of 180 Ncm before breaking. Now a days for me less its more (-;

bone width with 3,5
bone width with 4,3