All-on-4® treatment concept

A minimally invasive solution with a fixed full-arch restoration for high patient satisfaction

 

In 1998 Dr. Paulo Malo successfully treated the first patient with the All-on-4® treatment concept. Since then hundreds of thousands of patients have been treated with this concept using Nobel Biocare implants.

The All-on-4® treatment concept is the best solution for full-arch treatment using tilted implants. But only when Nobel Biocare products are combined. Many have tried to mirror this groundbreaking concept, but only we have the scientifically documented success to back it up. 

What is the 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. 

Characteristics include:

  • Full-arch rehabilitation with only four implants 
    Two straight anterior implants and two implants tilted up to 45º in the posterior
  • Immediate Function (fixed provisional bridge)
    For patients meeting criteria for immediate loading of implants
  • Graftless procedure
    Bone grafting is avoided by tilting the posterior implants, utilizing available bone

► Download e-book: How you can start with the All-on-4® treatment concept

All-on-4® treatment concept with NobelParallel Conical Connection implants

Why 98% of patients would recommend the All-on-4® treatment concept1

all-on-4 treatment concept - Why 98% of patients would recommend it

Rapid improvement in quality of life

A fixed full-arch prosthesis on the day of
surgery quickly leads to improved patient satisfaction – with regards to function,
esthetics, sense, speech and self-esteem.2,3

Shorter treatment times

Tilting of the posterior implants avoids the
need for time-consuming bone grafting procedures, while immediate loading
shortens time-to-teeth.4

Lower costs

The concept is the least costly in comparison with conventional implant treatment modalities of the edentulous and soon-to-be edentulous jaw.4

Indications

Patients with terminal dentition

A significant number of cases treated with the All-on-4® treatment concept are patients with failing dentition.

Example of a patient with terminal dentition eligible for the All-on-4® treatment concept

Example of a patient with terminal dentition eligible for the All-on-4® treatment concept.

“Two thirds of patients we treat in our practice with full-arch restorations are soon-to-be edentulous patients.”
Dr. Wolfgang Bolz, Germany

Patients with edentulism are also often eligible for the All-on-4® treatment concept. A thorough evaluation of any patient is necessary in order to choose the right treatment and to establish a predictable treatment outcome. In our new e-book you will find four steps to help you identify the right patient and recommendations for treatment planning.

Download e-book: How you can start with the All-on-4® treatment concept

Clinical cases

Dr. Steven Bongard, Canada – All-on-4® treatment concept in the maxilla

Situation: Edentulous maxilla
Solution: Full-arch reconstruction with immediate provisionalization using the All-on-4® treatment concept and NobelParallel Conical Connection implants.

Surgical procedure

Denture conversion

Dr. Armando Lopes – All-on-4® treatment concept in the maxilla

Situation: Edentulous maxilla
Solution: Full-arch reconstruction with immediate provisionalization using the All-on-4® treatment concept and NobelParallel Conical Connection implants.

Discover detailed treatment plan

All-on-4 treatment concept in the maxilla


More clinical cases

Discover more freehand and fully guided, flap and flapless treatments with the All-on-4® treatment concept in our digital library.

Milestones

  • 1998 Dr. Paulo Malo treats the first patient using the All-on-4® treatment concept
  • 2004 Nobel Biocare launches the All-on-4® treatment concept
  • 2011 10 years follow-up in the mandible6
  • 2012 5 years follow-up in the maxilla5
  • 2015 34 clinical studies with 2000 patients
  • 2016 More than 100 000 patients were treated with the All-on-4® treatment concept
 

Science

All-on-4® treatment concept - proven solution with high survival rates
All-on-4® treatment concept - favorable bone and soft tissue parameters

Proven long-term solution with high survival rates

The All-on-4® treatment concept is a proven long-term solution with
up to 10 years follow-up in the mandible and 5 years in the maxilla.5,6

  • Cumulative survival rates are high in both the edentulous
    maxilla and mandible.2,3,5,6,7,8,9,10
  • Mid-term 3–4 years: 96.3–100%3,9,10
  • Long-term 5–10 years: 94.8–98.0%5,6

Favorable bone and soft tissue parameters

Stable marginal bone levels2,3,9,10 and healthy soft tissue10 both for
tilted and axial implants. The graph shows results for the mandible, but results for the maxilla are similar.7

      

All-on-4® treatment concept - high patient satisfaction
All-on-4® treatment concept - scientifically proven

98% of patients would recommend this treatment

In one study, 95% of 250 patients were satisfied with their new teeth.
88% said they would definitely recommend similar treatment to friends
and colleagues and 10% would consider recommending it.1

The scientifically proven concept

  • 34 clinical studies (clinical case reports excluded) with 2000 patients
  • > 9200 TiUnite implants
  • Up to 10 years follow-up in the mandible and 5 years in the maxilla

Testimonials

What patients say

All-on-4 patient, Pat Farrell

"I always had problems with my teeth and oral health in general. My dentist was a real life-saver. My teeth feel like my own—so secure,
that I know I never have to worry about them ever again. Getting
implants is the best decision I have ever made!"
Pat Farrell, US

All-on-4 patient, Carole Lane

"For much of my life, I suffered from gum disease, bone loss and unstable teeth. I was very self-conscious about my situation and thought that there was no solution to my problem. I cannot believe the difference All-on-4 has made in my life."
Carole Lane, UK

What users say

Clinician testimonial - Prof. Paulo Malo

"The use of four implants reduces treatment complexity, which yields many benefits. Costs for both the doctor and the patient are reduced because less surgical time and products are used. The lab technician
can profit from reduced intricacy in the fabrication of the prosthesis – leading directly to more predictable workflow patterns. And simplified hygiene bodes well for improved long-term oral health all around."
Prof. Paulo Malo, Portugal

Clinician testimonial - Dr. Larry Benge

“Thanks to All-on-4, I can avoid lengthy and unpredictable bone grafting procedures. Patients with removable dentures tend to have a certain age. It makes a world of difference to them whether they get fully functioning teeth on the day of surgery or a year later.”
Dr. Larry Benge, Australia

Clinician testimonial - Dr. Antony Carbery

“All-on-4 has helped me increase my patient base substantially. I can
offer a life-changing and cost-effective method that allows more patients
to have proper implant treatment.”
Dr. Antony Carbery, Canada

Clinician testimonial - Dr. Enrico Agliardi

“With no other procedure that I offer is the increase in quality of life as apparent as with All-on-4. The patients enter my practice with misfitting and often painful removable dentures and leave the same day with a fixed implant-based provisional restoration that looks and feels like a full set of natural teeth.”
Dr. Enrico Agliardi, Italy

References

Babbush CA. Posttreatment quantification of patient experiences with full-arch implant treatment using a modification of the OHIP-14 questionnaire. J Oral Implantol 2012;38:251-60

Mozzati M, Arata V, Gallesio G, Mussano F, Carossa S. Immediate postextractive dental implant placement with immediate loading on four implants for mandibular full-arch rehabilitation: a retrospective analysis. Clin Implant Dent Relat Res 2013;15:332-40

Read on PubMed 

Weinstein R, Agliardi E, Fabbro MD, Romeo D, Francetti L. Immediate rehabilitation of the extremely atrophic mandible with fixed full-prosthesis supported by four implants. Clin Implant Dent Relat Res 2012;14:434-41

Read on PubMed 

Babbush CA, Kanawati A, Kotsakis GA, Hinrichs JE. Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: A cohort study. Implant Dent 2014;23:218–24

Read on PubMed

5 Malo P, de Araujo Nobre M, Lopes A, Francischone C, Rigolizzo M. "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and long-term (5 years) outcomes. Clin Implant Dent Relat Res 2012;14 Suppl 1:e139-50

Read on PubMed

6 Malo P, de Araujo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc 2011;142:310-20

Read on PubMed

7 Francetti L, Romeo D, Corbella S, Taschieri S, Del Fabbro M. Bone level changes around axial and tilted implants in full-arch fixed immediate restorations. Interim results of a prospective study. Clin Implant Dent Relat Res 2012;14:646-54

Read on PubMed 

Babbush C, Kutsko G, Brokloff J. The All-on-Four immediate function treatment concept with NobelActive implants: a retrospective study. J Oral Implantol 2011;37:431-45

Read on PubMed

9 Agliardi EL, Pozzi A, Stappert CF, Benzi R, Romeo D, Gherlone E. Immediate fixed rehabilitation of the edentulous maxilla: a prospective clinical and radiological study after 3 years of loading. Clin Implant Dent Relat Res 2014;16(2):292-302

Read on PubMed

10 Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. A retrospective analysis of 800 Brånemark System implants following the All-on-Four™ protocol. J Prosthodont. 2014 23:83-8

Read on PubMed