title: An evidence-based protocol for immediate rehabilitation of the edentulous patient.
abstract: BACKGROUND
  A procedure using 4 dental fixtures with an immediate-loaded prosthesis for totally edentulous patients is the focus of an evidence-based analysis that uses modern methodologies to review an innovative clinical technique. The long-term outcomes for this surgical and prosthetic treatment for previously or newly edentulated patients by clinical teams worldwide, as well as the author's clinical personal data in a referral-based private practice, are reported in this investigation.
  
  
  METHODS
  An independent research dentist performed the literature review using terms that would identify articles commensurate with this article. The search years for keywords were limited to 2010 and 2011 because the purpose of the article was limited to current thinking and evidence on this specific technique. In this article, the author elected to restrict the literature search to journals that are commonly read and received in his clinical practice on a monthly basis. Because of the specific nature of this procedure, all historical references to the "all-on-4" procedure were also included in the database inquiries.
  
  
  RESULTS
  The literature search revealed that the investigated technique has been reported worldwide by multiple authors using retrospective clinical analyses. In the maxillary jaw, the range of implants placed was 27 to 980 fixtures with 1 to 7 years of follow-up, demonstrating a cumulative implant success rate range of 92.5% to 100%. The mandibular arch demonstrated cumulative success rates of 93.8% to 100% with 1 to 10 years of follow-up with a range of 18 to 980 fixtures being placed. The investigator's own personal clinical statistics compared favorably with other clinical teams, with a total of 120 fixtures being placed in both jaws with 6 years of follow-up with a cumulative survival implant success rate of 100%. Continuous stability of the definitive final prosthesis was above 99% in the largest reported review and 100% for this author's private practice.
  
  
  CONCLUSIONS
  Based on extensive reporting by multiple clinicians, the technique investigated is grounded in good bioengineering basic science, and demonstrates long-term clinical outcomes that can provide highly predictable long-term prosthetic stability for the edentulous patient. This highly focused critically appraised review of individual articles using 4 implants to support a fixed dental prosthesis provides clinicians and patients with a protocol that conservatively and immediately reduces the morbidity associated with the loss of teeth and removable prostheses traditional used to negate edentulism.
authors.affiliation: georgeduello@mac.com
authors.forename: George V
authors.initials: GV
authors.lastname: Duello
mesh_terms: D000543:Alveoloplasty / Q000379:methods*; D017267:Dental Prosthesis Design; D017268:Dental Prosthesis Retention / Q000706:statistics & numerical data; D019094:Dental Prosthesis, Implant-Supported / Q000379:methods*; D055094:Evidence-Based Dentistry; D006801:Humans; D008137:Longitudinal Studies; D009066:Mouth, Edentulous / Q000534:rehabilitation / Q000601:surgery*