All-on-4®
The All-on-4® Concept is considered a breakthrough in Implant Dentistry. It is a rehabilitation concept for edentulous jaws that provides immediate function (insertion of implants, abutments and connection of the prosthesis on the same day of surgery). Since 1998, when the first patient was included in the first scientific study to validate this concept,1 the All-on-4® has allowed thousands of patients to be rehabilitated and enjoy a functional dentition throughout their lives independently of the age. Today, with more than 100 scientific studies published on this subject and over 20 years of follow-up, the All-on-4® concept is regarded as a landmark in modern Implant Dentistry.
The Rehabilitation of edentulous jaws is a challenge, since tooth loss is accompanied by bone loss, inducing the resorption of both maxilla and mandible, and making it difficult to insert dental implants for prosthetic support without the use of complex bone grafting or nerve transposition procedures. Especially autogenous bone grafting constitutes a surgically complex procedure for reconstruction of the severely atrophic jaw with bone harvested from the patient’s donor site (frequently the iliac crest) to provide enough support for the insertion of standard dental implants, in a total time elapsed between the inception and finalization of the rehabilitation process that can ascend to one year or more. The All-on-4® concept was scientifically introduced in 20031 with the publication of the first study documenting the surgical, prosthetic and maintenance procedures – the MALO CLINIC Protocol – in the mandible, followed by the publication of the same concept in the maxilla two years later.2 The All-on-4 concept® is based on the premise that four implants are inserted in the edentulous jaw as cornerstones: two implants inserted in the anterior region of the jaw in an axial position or slightly tilted anteriorly; and two implants (one implant in each segment bilaterally) inserted in the posterior regions of the jaw (anterior to the mental nerve in the mandible; anterior to the sinus wall in the maxilla) and tilted distally, to provide support for an immediate prosthesis with 10 teeth on the same day of surgery that will provide immediate function during the functional osseointegration period. Once the osseointegration is achieved, a definitive prosthesis with 12 teeth is manufactured and connected for long term performance. The All-on-4® concept allows virtually rehabilitating any patient without the need of bone grafting procedures and thus reducing the total time of rehabilitation without compromising the long-term success, as indicated by the more than 90% cumulative implant survival rate in a follow-up of up to 18 years.3,4
Since the dawn of the All-on-4® concept, MALO CLINIC always provided Educational support for performing the All-on-4® concept the right way, providing the opportunity of treating more patients with superior quality for over 9000 Dentists and Oral Surgeons around the world. We provide this training in all aspects of the All-on-4® Concept MALO CLINIC Protocol: Surgical, Prosthodontic and Maintenance in both on-site and online courses. Every year the protocols are updated introducing new technologies, products, procedures that further strengthen the All-on-4 concept, safeguarding our alumni of applying the latest version of the protocol that makes a difference in both the clinician and the patient’s lives. Find out all about it at www.maloeducation.com or reach out through the e-mail education@maloclinics.com!
References:
1. Maló P, Rangert B, Nobre M. “All-on-Four” immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003;5 Suppl 1:2-9. doi: 10.1111/j.1708-8208.2003.tb00010.x.
2. Maló P, Rangert B, Nobre M. All-on-4 immediate-function concept with Brånemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S88-94. doi: 10.1111/j.1708-8208.2005.tb00080.x.
3. Maló P, de Araújo Nobre M, Lopes A, Ferro A, Botto J. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res. 2019 Aug;21(4):565-577. doi: 10.1111/cid.12769. Epub 2019 Mar 28.
4. Maló P, de Araújo Nobre M, Lopes A, Ferro A, Nunes M. The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: A longitudinal study with 5-13 years of follow-up. Clin Implant Dent Relat Res. 2019 Aug;21(4):538-549. doi: 10.1111/cid.12771. Epub 2019 Mar 28.
