The "All-on-4" protocol describes a treatment approach for fully edentulous patients using only 4 dental implants - 2 anterior implants and 2 tilted posterior implants. Key aspects include immediate loading with a temporary fixed bridge, avoiding posterior bone grafting, and achieving high success rates, esthetics, and function. The document presents a clinical case demonstrating the All-on-4 procedure for both the maxilla and mandible, showing imaging and prosthetic steps from initial surgery through 4-year follow up with good results.

1. Immediate loading
surgical protocol
for total rehabilitation
WHAT IS ALL-ON-4 ®?

2. Principles
Malo P, & al."All-on-Four" immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant
Dent Relat Res. 2003;5 Suppl 1:2-9.
Malo P, & al. “All-on-4” immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin
Implant Dent Relat Res. 2005;7 Suppl 1:S88-94.
• Only 4 implants for full maxillary
or mandibular rehabilitation
• Avoid implants in posterior regions
• 30°/45º tilting of the posterior
implants
WHAT IS ALL-ON-4 ®?

3. • Use of cantilever if needed
• Immediate function
• Immediate fixed low-cost
bridge (acrylic)
• Flap or flapless approach
Principles
Malo P, & al."All-on-Four" immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant
Dent Relat Res. 2003;5 Suppl 1:2-9.
Malo P, & al. “All-on-4” immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin
Implant Dent Relat Res. 2005;7 Suppl 1:S88-94.
WHAT IS ALL-ON-4 ®?

4. Malo P, & al."All-on-Four" immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant
Dent Relat Res. 2003;5 Suppl 1:2-9.
Malo P, & al. “All-on-4” immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin
Implant Dent Relat Res. 2005;7 Suppl 1:S88-94.
Total Rehabilitation Goals
• Avoid bone graft
• high success rate
• high esthetic
• high function
WHAT IS ALL-ON-4 ®?

5. Malo P, & al."All-on-Four" immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant
Dent Relat Res. 2003;5 Suppl 1:2-9.
Malo P, & al. “All-on-4” immediate-function concept with Branemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin
Implant Dent Relat Res. 2005;7 Suppl 1:S88-94.
Total Rehabilitation Goals
• High hygiene maintenance
capability
• Allow the patient
to immediately have teeth
• Low cost for the patient
• High profit for the professional
• Simple surgical and prosthetic
procedure
WHAT IS ALL-ON-4 ®?

6. All-on-4®
Maxilla & Mandible
c l i n i c a l C a s e s

7. All-on-4®
Maxilla & Mandible
c l i n i c a l C a s e

8. frontal views
Failing prosthesis Failing dentitionFailing Esthetic
c l i n i c a l C a s e

9. All-on-4®
Maxilla
& Mandible
upper & lower occlusal view
c l i n i c a l C a s e

10. upper & lower surgical phases
c l i n i c a l C a s e

11. upper & lower surgical phases
FLAP REFLECTION AND
RIDGE REGULARIZATION
c l i n i c a l C a s e

12. upper & lower surgical phases
TILTED IMPLANTS
INSERTION
Sinus wall cortical anchorage
high primary stability avoiding critical structures (Sinus and Mental nerve)
c l i n i c a l C a s e

13. upper & lower surgical phases
Angulated and straight abutments seated
c l i n i c a l C a s e

14. upper & lower surgical phases
c l i n i c a l C a s e

15. PROVISIONAL PROSTHESIS
post-op opg
c l i n i c a l C a s e

16. final prosthetic phases
Facebow and articulator set the basis for a correct final
esthetic and functional result
c l i n i c a l C a s e

17. final rehabilitation
procera implant bridge & composite teeth
c l i n i c a l C a s e

18. 4 YEARS FOLLOW UP
c l i n i c a l C a s e