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 replacement option that is fixed (doesn’t come out).
The All-on-4 corrective technique involves our surgeon placing 4 dental implants into the jaw, and then the general dentist (in conjunction with a laboratory technician) fabricates and screws into place a modified form of a dental bridge called a hybrid prosthesis. This bridge is temporary and placed so that the patient has their smile, although the patient cannot chew on it as the metal implants go through the process of bonding with the Jaw bone (generally for a period of 8-12 weeks). After that time, new impressions are taken in the patient’s mouth and a new definitive set of teeth are fabricated and delivered.
While the goal is to provide this type of corrective 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 are not uncommon, a conventional “back up” denture is made just in case and delivered to the patient instead.
Once these situations allow 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 and the patient cannot floss between them. The hybrid prosthesis can only be definitively cleaned when the patient visits their dentist, who must remove the prosthesis in the office to do so.
How the CONUS technique can meet many patients’ needs
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, and provides all of the function and appearance of the All-on-4 technique but with other advantages in certain cases. The CONUS technique 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 time 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 temporary conventional denture, fitted to be very comfortable and adjusted as needed by the dentist. After the 8-12 weeks, the final teeth are delivered. And, 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 prosthesis, 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, namely for cleaning. 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. 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 very earliest doctors to have offered the CONUS option to patients.