Should you pursue the All-on-4® treatment concept?

Dr. Paul O’Reilly explains how, and why

A past president of the Irish Society of Periodontology, and a faculty member at the Dublin Dental School, Dr. Paul O’Reilly is a periodontist performing full-arch rehabilitation at the Burlington Dental Clinic and the Hermitage Medical Clinic in Dublin, Ireland.

Dr.Paul O’Reilly

Just over ten years ago, the All-on-4® treatment concept was introduced to his practice, and in this interview, he shares his experience with the concept, and gives advice to clinicians considering this treatment as a next step in professional or practice development.

Dr. O’Reilly, can you please speak a little bit about how you were introduced to the All-on-4® treatment concept?

“The All-on-4® treatment concept was starting to gain real traction in implant dentistry in the mid-2000s, and at that time, we were following conventional implant procedures for full arch cases. Six implants in the maxilla, for example, sometimes with immediate restorations. However this could require a lot of bone grafting before the implants and additional complicated procedures.

“What especially appealed to me about the All-on-4® treatment concept was that it would enable us to treat patients with reduced bone volumes and offer them a fast, predictable solution. We started out conducting a few straightforward cases ourselves, following the published protocol. But after we decided to get more training in 2010, that’s when things really kicked off. We visited the MALO CLINIC in Lisbon: a great training center, and the protocol was so well honed there, with people who were very skilled in teaching and giving advice.

“When we came back to our practice, we started doing it their way: we saw the patient in the morning, the lab work was done during the day, and the prosthesis was fitted that evening.”

How often do you perform these procedures now?

“We’ve gone from one every so often to about 50 a year, and the plan is to keep growing it.”

Why should a clinician consider starting the All-on-4® treatment concept at their practice?

“Offering this treatment can set you apart from other practices – being able to provide patients an implant-retained, same-day restorative option, which is cost-efficient, and simpler than many other grafting procedures.

“We’re seeing more and more edentulous patients moving away from treatment with prolonged grafting procedures and toward the All-on-4® treatment concept. They’re drawn by the immediacy of the result that we can deliver – a new smile within 24 hours.

What advice would you give clinicians thinking about starting the All-on-4® treatment concept?

“First and foremost, you need experience in implant dentistry – it’s not a beginner treatment modality. It can range from fairly straightforward treatment of edentulous patients through to complicated cases with compromised bone volumes or terminal dentition, so it helps to have a lot of implant surgeries under your belt.

“You should also spend as much time as you can in training courses, and keep in contact with the experts once you’ve gotten started. It’s not a procedure where you can just look at the brochure, watch the video, and begin – it really benefits to invest time and gain the confidence to deal with any issues that pop up during treatment. Keep within your comfort zone and have an experienced practitioner at your side when doing it for the first time.”

So support groups and mentorships are important?

“If you don’t have a support network, you’re going to repeat the same mistakes again and again, even without knowing you’re making a mistake. That’s why proper training, peer support and commercial support from Nobel Biocare are all so important.

“In general, if you’re looking for either a formal or informal mentoring system, you should get in touch with your local Nobel Biocare sales representative. They’ll be able to put you in touch with a mentoring program designed to help you out at the beginning by providing access to colleagues who have more experience. Personally, I needed this help when I was first starting out with All-on-4® treatment concept, and I’m more than happy to help make this journey as easy and stress-free as possible for newer clinicians.”

All on 4 treatment concept

The All-on-4® treatment concept is a cost-efficient, graftless solution that provides patients with a fixed full-arch prosthesis on the day of surgery.

Learn more about the All-on-4® treatment concept on this webinar with Dr. Ana Ferro