The document describes the "All-on-4" treatment concept for completely edentulous mandibles involving placement of 4 dental implants. Developed in 1993, it involves inserting 4 implants, at least 10mm long and 3.75/4mm wide, for anchorage with angled abutments to increase spread and reduce cantilever forces. The case report then describes using this technique with 4 Noble Active implants to fully restore an edentulous mandible. Advantages include high success rates, reduced bone grafts and costs, while disadvantages include unsuitability for large bone defects and technical sensitivity.

1. UNIQUE ID – S791
Conflict of Interest – there are no conflict of interests

2. “ALL-ON-FOUR” – A COMPLETE
PROSTHETIC RESTORATION OF SEVERELY
RESORBED RIDGE– A CASE REPORT.

3. INTRODUCTION
•Dr. Paulo Malo gave the treatment concept of “All-on-4” in
the year 1993.
•.
Maló Paulo et. al. “All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A
Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Volume 5, Supplement 1, 2003. Pg 2 – 9.

4. • “All-on-4” is a graftless implant placement procedure.
• Less strain to crestal bone by increasing A-P spread.
Maló Paulo et. al. “All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A
Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Volume 5, Supplement 1, 2003. Pg 2 – 9.

5. • Full arch conventional dental implant procedure - 6-8
implants.
• All-on-4 – 4 implants of minimum length 10mm and of
width at least 3.75 / 4mm.
• Cortical anchorage.
• Reduced bone density not an issue.
• Shorter rehabilitation process.
• Less time taking (2 hours).
• Cost effective.
Maló Paulo et. al. “All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A
Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Volume 5, Supplement 1, 2003. Pg 2 – 9.

6. CASE REPORT

7. PATIENT DETAIL
A 70 year old patient came to the department with a complaint of
completely edentulous mandibular arch and wanted to get it
restored.

8. TREATMENT PLANNING

9. Intra- oral examination of the patient.
OPG taken and implant size decided.

10. IMPLANT USED
4 Noble Active implants of the Noble Biocare system was used
for the procedure.
Dimensions of anterior and posterior implant used – 4.3 x 15mm.
Two 00 and two 300 angulated multiunit abutment were used.

11. Full thickness mucoperiosteal flap was raised and a All-on-4 guide
was placed.

12. Osteotomy site for implant placement was
prepared with All-on-4 guide.
Abutment with temporary cylinders
Anterior 00 and Posterior 300 angulated multiunit
abutment

13. Provisional prosthesis.
OPG after implant placement.

14. AFTER 6 MONTHS

15. Impression posts were splinted together using
pattern resin and 19 gauge wire.

16. Abutment level open tray impression made
Impression with gingival mask

17. Titanium framework
Try-in of titanium framework

18. Screw retained final prosthesis.

19. Post – operative view

20. DISCUSSION
ADVANTAGES:
1.The success rate of this concept is very high. (9 years of follow-up, 96.2%
survival)
2. Angled implant increases A-P spread and reduces posterior cantilever.
3. Implants well-spaced, good biomechanics, easier to clean
4. No need of nerve repositioning and sinus lift.
5. Immediate function and aesthetics
6. Economical. (less number of implants and in most cases eliminates bone
grafts)
Maló Paulo et. al. “All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A
Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Volume 5, Supplement 1, 2003. Pg 2 – 9.
Malo Paulo, et al. All-on-4® immediate function concept for completely edentulous maxillae. A clinical report on the medium and long term 5

21. DISADVANTAGES:
1.Cannot be performed in patients presenting with large osseous defects in
the anterior region.
2. Very technique sensitive .
LIMITATIONS:
1. Patients must have good general health and acceptable oral hygiene.
2. Sufficient bone availability of the patient with at least 10mm of residual
bone.
3. Immediate loading can only be done with sufficient primary stability of
the implant. ( min. 40N)
Maló Paulo et. al. “All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A
Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Volume 5, Supplement 1, 2003. Pg 2 – 9.

22. CONCLUSION
The long term results of the “All-on-4” technique and the
numerous advantages of immediate loading, the reduced
morbidity, the high patient satisfaction and relatively low costs
should be taken into account when a decision among the
alternative treatment options for an edentulous jaw has to be
made. Long – term maintenance and regular follow – up visits to
the dental clinic are required for the long term success of the
prosthesis as well as implants.
Taruna M et. al. Prosthodontic Perspective to All-On-4® Concept for Dental Implants Journal of Clinical and Diagnostic Research. 2014 Oct,
Maló Paulo et. al. “All-on-Four” Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A
Retrospective Clinical Study. Clinical Implant Dentistry and Related Research, Volume 5, Supplement 1, 2003. Pg 2 – 9.