First Time In Vietnam
‘All-On-4’ Solution With Advanced Surgical Guide
Exclusively At Dr Hung & Associates Dental Center
Mrs T.T.H, 55 years old, has lost all her teeth in the lower arch and had been using removable denture for the past 10 years. However, since the unfit denture resulted in discomfort and poor aesthetics, she came to us to look for another solution.

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After making careful analysis of the patient’s case, we decided to co-operate with associated dental specialists from the US to perform the ‘All-On-4’ solution with advanced surgical guides. This is the most advanced system which has never been implemented in Vietnam before.
All-On-4 is a technique in which only 4 implants are required to be placed on one complete edentulous arch, and then a restoration will be placed on these implants. This technique is optimal for cases where there is severe bone deficiency in posterior teeth (to the side of the molars), does not require bone grafting and is more economical for patients.

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Our dental surgeons, prosthodontists and dental technicians at Dr. Hung & Associates Dental Center had been working online with the associate dental specialists in the US to design the surgical guides including 3 guides, which ensured the procedure was performed speedy and accurately. Right after the surgery, patient was applied immediate temporary restoration on implant. At the moment, Mrs. T.T.H is very satisfied with her new teeth.

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Following is the complete procedure of the ‘All-On-4’ surgery with surgical guides performed at Dr Hung & Associates Dental Center:

Before the surgery
– Physical examination.
Patient: T.T.H, 55 years old
History:
+ Upper arch: partial removable denture, for 5 years.
+ Lower arch: complete removable denture, for 5 years.
Diagnosis: lower arch’s denture was loose and unstable due to Residual ridge resorption

Taking CT Cone Beam X-Ray image

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After performing physical examination and basing on the patient’s case, the suggested treatment was an ‘All-On-4’ with surgical guides (place 4 implants in these following teeth: 32, 35, 42, 45 and apply immediate temporary on implant).
– Take CTCB with Denture
– Using data from the CT Cone Beam and Nobel Clinician software to develop the treatment plan.
However, our teams noticed that aveolar ridge at teeth position 32, 35, 42, 45 was sharp, small and unlevelled.
Therefore, we decided to whittle the Aveolar ridge of the lower arch to expand the diameter of implants and to facilitate restoration
Working online with dental specialists in the US, we agreed on the treatment plan and the design of surgical guides.
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Using data from the CT Cone Beam and Nobel Clinician software to make the treatment plan.
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After discussions, we decided that surgical guides include 3 guides:
– The first guide simulated the patient’s denture, fitted her upper arch and was responsible for determinding positions needed to be whittled.
– The second guide was to check the jawbone ridge after whittled , in order to ensure the arch was flattened and facilitated to place the implants.
– The third guide indicated the positions of implants. Provisional restoration on implants was designed by CAD/CAM system to apply immediately after implantation.
Transfer the treatment plan and necessary information to the Laboratory to produce the surgical guides and Provisional restoration on implants
Final discussion among surgeons about the surgery.
During the surgery
Preparation for patient and surgery room.
Patient had a general examination and the surgery was performed with pre-anesthesia and local anesthesia.
Surgery procedure
Place the first guide then specify 3 positions to fix guides and mark the whittle point.
Whittle as marked, place the second guide with fixed pin to check the whittled arch.

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Place the third guide to implant: 4 holes were drilled and 4 implants were placed at the exact position according to the surgical guide.
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Finally, immediate loading on implant was applied.
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After the surgery
Result:

Surgery duration: 1 hour 45 minutes.
Minimum invading.
Surgery was performed precisely according to the treatment plan.
Immediate loading on implant produced by CAD/CAM system was applied promptly and accurately after the surgery.
The patient’s overall health condition was good and stable.
The patient and doctors are both satisfied with the treatment result.
Patient is scheduled to have regular dental examination to check the healing status. After 10 days, the wound had completely healed and stitches were removed. Loading on implants functioned properly and aesthetically guaranteed.
After 6 months, permanent prosthesis will be placed.

Conclusion
Treatment using the CAD/CAM system has made the process faster, less invading and more accurate.

sample case 22Implementing restoration with guided implantation surgery in oder to ensure aesthetics and functions of restoration.
At Dr Hung & Associates Dental Center, with the team work performing and tightly co-operation between all surgeons, prosthodontists and Lab-in-house techinicians, along with the most advanced technologies and equipments, we proudly provide our patients with only best qualified treatments, completely comparable with countries who has developed dental systems around the world.

Patient’s details:
Male, 55 years old

Consultation and treatment plan:
Overall examination

Overall condition: Good

Heart related diseases: No

Diabetes: No

Intra-oral examination:
The patient has lost both 2 jaws for more than 20 years. There was major bone deterioration, and the denture after years has been loosened and cannot be used anymore.
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CT X-Rays was taken at Dr Hung & Associates Dental Center to analyse and evaluate the overall jaw and soft tissue conditions.
all on 4 3.jpg The patients CT Cone Beam X-Rays

As the patient has lost teeth for a long period of time, bone has deteriorated a lot in both the upper and lower jaw. Bone has deteriorated to some important surgical areas or lower jaw nerves.
Setting treatment plan:
The patient did not want to have traditional denture anymore and has chosen implant placement instead.
After discussion with the patient, we have decided to apply All-On-4 implant placement for the patient in this case.
Treatment plan:
Upper jaw: 4 implant placement by Implant Nobel CC using All-On-4 techniques
Lower jaw: 4 implant placement by Implant Nobel Active using All-On-4 techniques
Bone examination and digital implant placement using Nobel Clinician software
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Making Surgical guide
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Surgical guide after designed on computer will be produced using CAD/CAM techniques

Implant placement procedure:
Because the patient has lost teeth for a long period of time (20 years), there has been major bone deterioration, especially in the back teeth where bone has deteriorated close to the nerves of the lower back teeth, so we have decided to install the implants as followed:
Front teeth: 2 implants placed straight at the 2 central incisors
Back teeth: 2 implants placed tilted at the 2 first premolars
The patient had been notified about the conditions and position for implant placement prior to the surgery.
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Implant placement surgery using Surgical guide

With the support of our anesthetist, our doctors and assistants finished placing 8 implants after 2 hours 46 minutes
After the surgery, all the implants will be re-checked on Panorama X-Rays again to avoid problems that may occur.
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Panorama image of the All-On-4 implants

Temporary prosthesis
Temporary prosthesis was carried out using the patient’s old denture. Using the patient’s old denture allow them to adapt better and feel more comfortable than making a new one.
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Old denture was used as temporary crown

Post-surgery
Doctors will check and clean the wound within a week after the surgery.
Eighth day: Remove stitches
Tenth day: Final check-up
Permanent prosthesis
Approximately 6 months after the surgery when the implants have combined with the bone, permanent prosthesis will be carried out.
CT X-Rays will be taken to identify the level of bone integration
Remove temporary prosthesis, take impression for study cast to make permanent prosthesis
Dental crowns were made of zirconia materials on a titanium frame 910 crowns/jaw) in our Lab in-house within 3 days.
Permanent prosthesis was placed on the fourth day
Chewing testing took place in few days while the patient was on holiday in Hoi An City.
The patient returned for final check-up on the eighth day. The patient was completely comfortable and satisfied with the new teeth.
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Dentists’ comments after the treatment was been complete:
The patient’s overall health condition was good.
Implants combined well with the jaw bone and worked well under pressure.
Crowns on implants matched well with each other, the color and size of which also matched the patient’s skin tone and face structure.
The patient was satisfied with the aesthetic factors as well as functionality of the results.