All-on-4 Treatment Concept
With just 4 implants, clinicians can achieve stable, immediately loaded full-arch restorations.
For nearly 2 decades, the All-on-4 treatment concept has been providing edentulous patients with an efficient and effective restoration using only 4 implants. Suitable for both mandibular and maxillary arches, All-on-4 involves placing 2 straight implants in the anterior and 2 angled implants in the posterior to create stable support for a provisional, fixed, and immediately loaded full-arch prosthesis. Nobel Biocare?s NobelSpeedy implant system has been widely documented for use with the All-on-4 protocol. However, all Nobel Biocare implant platforms with multi-unit abutments can be incorporated into the All-on-4 procedure. In addition to stabilizing bone levels from loss due to resorption under dentures, restoring chewing and speaking functionality, creating efficient treatment flow for shorter treatment time, and speeding recovery time (typically with very little discomfort or pain), All-on-4 offers clinicians and patients a wide range of benefits.
Stability and Reliability
The All-on-4 procedure utilizes tilted implants enabling both jaws to be treated without bone grafting and also without compromise in prosthesis support. Because the 2 posterior implants are tilted, longer implants can be used in minimum bone volume while relevant anatomical structures?particularly the maxillary sinus and mental nerve?are avoided. The tilted implants can be anchored in better quality anterior bone, reducing cantilevers and thus improving support of the prosthesis. Biomechanical measurements show that tilted implants, when splinted together as part of the prosthetic support, do not have a negative effect on the load distribution. The tilting of implants has been used as a sinus grafting alternative supporting fixed implant restorations for 20 years with results equivalent to straight implants.
With All-on-4 treatment, patients benefit from an immediate implant-supported restoration, as a provisional prosthesis is screwed onto the implants immediately after the implant placement surgery. Final solutions for All-on-4 treatments include fixed prostheses?such as NobelProcera Implant Bridge Titanium with acrylic veneering, or individual NobelProcera crowns cemented to the bridge framework?and removable solutions such as acrylic overdentures on a NobelProcera Implant Bar Overdenture. Guided Planning All-on-4 treatments can be planned and performed using NobelGuide Software, ensuring accurate prostheticdriven diagnostics, treatment planning, and guided-surgery implant placement. Powered by NobelClinician Software, NobelGuide provides detailed diagnostics such as 3-dimensional identification of available bone, virtual implant placement according to the anatomical situation and prosthetic needs, and ordering of an individualized surgical template. The software supports minimally invasive flapless techniques as well as surgical access through miniflaps and full flaps, while the surgical template ensures guided and exact implant placement.
All-on-4 was developed in the early 1990s by Dr. Paulo Malo (MALO CLINIC, Lisbon). According to Rutherford, NJ, oral and maxillofacial surgeon Dr. Steven Moss of MALO Dental Implants, All-on-4 protocols and components have been innovated to the point where the technique now provides success rates that rival conventional implant techniques. ?Tens of thousands of patients have had the All-on-4 procedure done,? Dr. Moss noted. ?Long-term studies done at the MALO CLINIC show continued success (over 98% implant survival) with 8 years (upper jaw) and 10 years (lower jaw) follow-up. I have performed this technique for a few years now and have experienced similar results.? ?Almost everyone is a candidate,? continued Dr. Moss. ?Esthetics are typically better than with conventional techniques, bone grafting is rarely necessary reducing the need for multiple surgical procedures, and the costs are typically lower than conventional techniques for full-arch implantsupported fixed bridges.?
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