All-on-4 treatment concept bridge with better resilience

In MaloClinic, if a MaloClinic ceramic bridge is used on upper jaw, then normally lower jaw will adapt acrylic bridge with titanium framework as a restorative choice. However, resin breakage became a major source of mechanical complications. So we try to combine IBO titanium framework, BioHpp and individaul Emax crowns, in an attempt to possess both rigidity and resilience in one system.
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Let’s see what Professor Malo has to say about MaloClinic bridge, which is All-on-4 bridge.

Malo:” The system needs flexibility, and the flexibility is given by the abutment, avoid connecting the bridge directly to the implant…”

“For him, who has already hundred of thousands of cases, it’s not a bad idea listening to their experience”

Malo:” You should try to go with titanium, because titanium is more flexible, which means that, the cantilever can flex if you have prematurity. It’s very important to have flexibility in the system, otherwise you will have more cracks, more breakage.”

I have been practicing All-on-4 for quite a few years. I think this is an innovation for those fully edentulous patients. However, I realise there is this one thing that is killing, which is…, right, mechanical complications.

This didn’t come very often, but it’s like a thorn in your side for me and my patients. From time to time, I had to arrange emergency repair appointment for them. So I really want to go back to the literature to see what’s going and how do I solve this problem, mechanical complications, is this problem just happen to my patients, or is it a generic one?

And then, I realised, most of the mechanical complications came from resin material, especially those fixed implant supported bridges made of either acrylic denture base material or composite resin teeth.

In fact, resin breaks, resin denture base cracks all the time, composite resin teeth break, too. So, in the past, we have to understand, these materials were used for removable dentures, which we all know that sustain not as much chewing force. But fixed restorations are very different. Many studies have shown us that, biting force on fixed restorations are simply much greater.

There is a trend of using monolithic zirconia framework opposing each other. The system is so rigid that many patients complained about it’s noisy clicking sound when teeth are colliding together.

So I am on a constant look for a material that is both rigid and, right, flexible.

On my right hand side, this is an IBO, a CAD/CAM titanium framework, representing rigidity. On my left hand side, this is a BioHpp, a material of polymer, full of resilience. Now, I am gonna fuse them together.

Viola, this is probably the world’s first IBE.
This is a denture made from a combination of three materials, a CAD/CAM titanium framework, a press-on high performance polymer, and individual Emax crowns.

This system features enamel-like strength on crowns, dampening effect that simulate periodontal ligament, and the strength from titanium framework.

The principle of IBE design involving three materials, including Procera IBO, BioHpp high performance polymer, and Emax lithium disilicate. My personal experience was that, conventional CAD/CAM technique of BioHpp could not be applied on IBE, it has to be press-on, which is technique sensitive. This frustrated me, sometimes.
But I want to say….hard works always pay off!

Right, hard work always pays off. This hard work was inspired by Professor Malo’s principle of resilience, and also the intention of long term maintenance for our All-on-4 patients, because, you know, individual Emax crowns can be easily replaced if there is any problem. Of course this combination needs to be put into test in the long run. I will keep you posted if there is any further information.

I hope this video brings you some insight, and if you have any question, please leave a comment below, and until next time, I hope to see you soon, Bye Bye.

Wow, look at the sky out there!

Видео All-on-4 treatment concept bridge with better resilience канала 鍾泰豐