In our recent survey, we took a deep dive into the world of digital dentistry and the latest innovations in All-on-X therapy. We conducted thorough market research and an online survey aimed at dental practitioners. Our goal with this document is to present the results of the survey analysis in order to explore how our findings reflect the current and projected trends in this fascinating area of dentistry. In doing so, we hope to draw an accurate picture of the current state of All-on-X treatment method and extrapolate what the future holds for it.

Historical Background

Back in the day, the word “dentures” used to mean one thing and one thing only; that is “removable dentures”. Remember those bulky, artificial-looking teeth submerged in a glass of water on your grandparents’ bedside table? Humans have been donning various forms of makeshift dentures for hundreds of years. You might be familiar with the famous myth about George Washington’s wooden teeth set. While not exactly fashioned out of wood, the first US President did, in fact, sport ugly and pain-inducing dentures made out of ivory and human teeth!

Admittedly, the vast majority of modern dentures do not look so bad that they get mistaken for wooden teeth. We’ve come a long way since then. However, they do come with their fair share of disadvantages for denture wearers because they:

• Have to be taken out before bed.
• Look and feel artificial; unnatural.
• Can be unstable; either too big or too tight-fitting.
• Are not suitable for chewing certain foods. 
• Can cause soft tissue damage, gum disease and bone resorption.
• Break under excessive occlusal loads.
• Induce loss of facial muscle support.
• Often require denture adhesives and creams.
• Need to be remade (or relined) and replaced periodically.

Why All-on-X Treatment Is A Win-Win Situation?

Following the discovery of osseointegration and titanium biocompatibility by Swedish professor Per-Ingvar Brånemar, the first dental implant in the world was successfully placed in 1965. This groundbreaking achievement significantly improved tooth replacement techniques, and as a result, the field of dentistry was never the same again.

During the nineties of the last century, Portuguese professor Paulo Maló was making progress based on Brånemar’s work. He managed to come up with a simple but revolutionary concept in which four dental implants placed in the posterior region of the mandible or maxilla, and tilted at a 45° angle, could be placed on the same day of surgery without the need for bone grafting. The first instance of a patient receiving treatment with this innovative technique was in 1998. This is how the world-famous All-on-4® treatment modality came to be; the rest was history. 

In All-on-X, the “All” refers to the full-arch fixed hybrid prosthesis, and the “X” is the number of dental implants that provide support to it. Soon after, more stable options were gradually introduced such as the All-on-6 and the All-on-8 concepts. The number of implants can be as many as each individual case requires for proper support, stability and esthetics. The versatility of this modality makes it a win-win situation for both the patient and the dentist.

Win for the Patient

All-on-X can be life changing for completely edentulous individuals or those with failing (i.e. terminal) dentition. It dramatically improves the way they go about their everyday lives in terms of oral and overall health, masticatory function, diet, esthetics, social activity and even mental health. Here are some of the benefits:

• Cost effective: usually there’s no need for bone grafts which can be an added cost.
• Durable: it lasts for life with proper maintenance; one-and-done procedure.
• Quick: from extraction to implant placement, everything is done in 3-4 hours.
• Conservative: can be less invasive than other alternatives.
• Comfortable: more compatible than removable dentures.
• Customizable: digital planning and smile design provide an ideal bite for every case.
• Natural esthetics: lifelike restorative options are available (e.g. FP1, FP2 & FP3).

Win for the Dentist

Clinicians who dabble in implant dentistry as well as seasoned specialists can adopt and master All-on-X digital workflow in a relatively short period of time. It’s been reported that first-timers start to feel quite comfortable with the procedure after as little as 10-15 full-arch cases. Those who do, stand to reap the following benefits of All-on-X:

• Simplicity: once you master it, the procedure is always the same.
• Efficiency: pre-planned, same-day, step-by-step process.
• Predictability: you can expect the same results every time.
• Reproducibility: consistent treatment outcomes with each case.
• Immediacy: immediate loading of implants and prosthesis in just a few hours.
• Convenience: completed in one visit, saves your time and the patient’s.
• Profitability: you get to do more cases in less overall time.
• High success rate: implant failure is rare with proper protocols.

Common All-on-X Problems

However, in order to get the full picture, we must also be wary of some of the problems associated with All-on-X therapy. Some of those issues are due to the quality of the devices themselves, however, most of them can be a result of inadequate care and treatment prior to the procedure. The restorative dentist needs to be deeply involved in the process from planning to installation. Otherwise, All-on-X treatment may be unsuccessful because of device failure, tissue damage, and unnecessary expense for the patient. 

Common problems include:

• Inadequate planning: regardless of the device quality, not enough consultation between the restorative dentist and the oral surgeon can compromise implant placement.
• Improper implant placement: inaccurately placed implants can break or cause bone loss especially in patients with bruxism.
• Poor communication with dental labs.

All-on-X is on the Rise

Our survey showed that more than ⅔ of clinicians have been seeing more All-on-X patients over the past 5 years. This is significant because almost 60% of them reported that their patients are specifically asking for this treatment. Since more and more people are eligible and can afford All-on-X prostheses, an increasing number of doctors are also case-selecting for this particular procedure (e.g. 27% of our survey correspondents). 

At first glance, we may assume that because life expectancy is getting higher, it’s mostly senior citizens (i.e. above 60 years old) who are getting implant-supported hybrid dentures. Surprisingly, according to our findings, dentists report that around 82% of their All-on-X patients are aged 60 or younger. All signs point to an even bigger surge in this population, which means we’re going to see more eligible All-on-X cases from varying age groups. 

This will result in an increasing patient in-flow. More cases require more time, so it’s safe to say that dental practitioners are not only interested in the quality of such restorations but also the speed at which the procedure can be done. The faster and more efficient the workflow, the more patients they’re able to see and the more time they can dedicate to each case. Time, in this case, is literally money!

Takeaways from the Survey Report

In 2020, the dental market in the US hit $15.57 billion. The growth is expected to reach $30.59 billion by 2027, that’s a compound annual growth rate of 10.13% in just 7 years. The dental industry has proven itself to be virtually recession-proof and even pandemic-proof. This projected growth is due to increased demand which in turn is caused by the following factors:

• Aging population 
• Poor oral hygiene 
• Smoking habits
• Diabetes
• Preventive and prosthetic dentistry
• Oral and cosmetic surgery
• Advanced dental technology
• Advanced dental procedures

Nowadays, more than ever, patients know what they want. Information is readily available and patients are aware that implants are a safe long-term solution for single tooth replacement as well as full-arch restoration. On average, US dentists provide one All-on-X treatment per week. All-on-X has been the fastest growing overdenture treatment option since 2017. That said, various treatment options are required to be tailored to every patient’s unique needs, including their budget. 

Immediate placement and loading protocols are growing twice as fast as classic delayed implant procedures. Patients prefer shorter overall treatment times and less invasive treatments. New protocols offer lower postoperative complications, and a quicker path to the final restoration, while cutting down on chair time. When it comes to All-on-X, clinicians who take these trends into consideration stand to gain a significantly higher inflow of new patients.

Since most patients are keen on moving directly from failing dentition to a new fixed implant-supported restoration, dental practices actively compete in offering low-cost All-on-X surgeries. Digital workflows enable the standardization of cases and the use of a wider variety of prosthetic materials. Digital dentistry is a majorly significant megatrend that enables more dentists to provide more dental implant services by flattening the learning curve. Booming guided surgery solutions and intraoral scanners within practices facilitate processes and ensure confidence, reliability and precision even for the less trained practitioners. In the very near future, the precise and predictable fully digital workflow will become a standard of care for edentulous patients.

With a steady rise in the number of general practitioners placing implants, the use of guided surgery is experiencing double-digit growth. Practitioners who are willing to embrace integrated treatment planning workflows benefit from higher predictability, more efficient surgical procedures, and maximization of treatment outcomes through a fully digital collaborative approach.

We’re now able to break new grounds when it comes to esthetics with the advent of new materials. Novel PMMA materials provide more natural appearance in All-on-X temporary restorations, which makes it possible for the patients to wear them for longer periods of time if required. Final 3D-printed All-on-X zirconia prostheses are able to compete with conventional restorations in both form and function. 3D printing technology decreases chair time and costs as it’s becoming increasingly popular and affordable

The field of full-arch rehabilitation is undergoing massive and rapid progress. Dental practitioners have to contend with new informed patient behavior, scientific findings, and evolving technological solutions. While the overarching megatrend of digitalization is revolutionizing all aspects and steps in the dental treatment workflow, the focus now should be on opening up new venues for further development of clinical skills, increasing efficacy and realizing the full potential of the entire dental team. Being a competent practitioner these days involves not only a high level of clinical skill but also the ability to keep up with the latest technologies and digital trends.