Edmond Bedrossian: Management of complications in the graftless concept

The All-on-4 treatment concept has an impressive track record. Described by Branemark et al. in 1971, a 10 year follow up in 1975 reported no statistical differences in success rates between a 4 or 6 implant restoration. Dr Bedrossian presents a comprehensive recent literature review of implant based fixed restorations in the maxilla using different surgical tretament options, comparing the graftless approach with straight, tilted and Zygomatic implants and the grafting approach with sinus floor elevation or LeFort 1 osteotomy with interpositional grafts. The graftless approach shows higher success rates and offers the advantage of immediate loading protocol. Dr Bedrossian discusses the main typical complications such as inadequate initial stability, early failure of tilted posterior implants, failure of Zygoma implants, lack of premaxillary bone, and reviews a possible complication management algorithm, ranging from delayed implant replacement over inserting longer or wider implants, to ultimately placing Zygomatic or double Zygomatic implants. Dr Bedrossian summarizes that it is important to understand the patient's needs and demands, to apply adequate, simplified vs optimal procedures, and that surgeons and prosthodontists follow an interdisciplinary approach and understand the limitations of the case in order to provide predicable and evidence based treatments.