All-On-4 and CONUS
Many people have heard of a concept called “All-on-4”, often referred to as “Teeth in a Day”. This technique is an option for patients who have lost all of the teeth in one or both of their jaws or who require the removal of their remaining teeth and desire a dental implant tooth replacement option that is fixed (doesn’t come out). The technique involves the surgeon placing 4 dental implants into the jaw and then the general dentist, (in conjunction with a laboratory technician) fabricating and screwing into place a modified form of a dental bridge called a hybrid prosthesis. This bridge is temporary, placed so that the patient has their smile, although the patient cannot chew on it, as the implants go through the process of bonding with the patient’s Jaw bone, generally for a period of 8-12 weeks. At that time, new impressions are taken in the patient’s mouth and a new definitive set of teeth fabricated and delivered. While the goal is to provide this type of restoration on the day of surgery, it is not always possible, as the bone may be too soft to screw the teeth onto the implants or there may be bone missing, requiring bone grafting and later placement of the affected implants. In these situations, which can occur with some frequency, a conventional “back up” denture is made “just in case” and delivered to the patient instead. Once the situation allows for implants to be placed and loaded, the bridge-like set of teeth is secured to the implants with mini screws. One of the downsides of having teeth that the patient can’t remove, however, is that since these teeth are all connected together, the patient cannot floss between them, and the hybrid prosthesis can only be definitively cleaned when the patient visits their dentist, who must remove it in the office to do so.
A more recent and innovative option is called the CONUS technique. This is a solution for the same patients that would be candidates for All-on-4, providing all of the function and appearance of the All-on-4 technique while also in many situations having some advantages over that technique. It involves the same pattern of placement of 4 implants, but rather than go through the uncertainties as to whether or not the hybrid can be placed or if the patient must wear a denture for a time, the implants are placed and allowed to integrate to the patient’s bone for 8-12 weeks before a final set of teeth is made. During this time the patient wears a conventional denture, fitted to be very comfortable and adjusted as needed by the dentist to maintain its comfort. After that period of time, the final teeth are delivered, but rather than being screwed in, they are seated firmly and secured by a tight friction fit to 4 small parallel posts, one on each implant, each mated to a female housing within the hybrid prosthesis itself. This, just like All-on-4, is worn 24/7, but it has the distinct advantage of the patient being able to remove it whenever they feel it necessary to clean it well. This gives the patient all of the advantages of teeth that are fixed while providing the patient the ability to remove the prosthesis periodically to clean it themselves, thus optimizing the health and longevity of the implants themselves. Finally, maintenance on CONUS prostheses is generally much less expensive than dental maintenance on All-on-4.
Doctors Nail and Dombrowski are very comfortable with and have performed numerous All-on-4 and CONUS procedures and were among the earliest doctors to have offered the CONUS option to patients.