The creator of this unique and revolutionary concept is a Portuguese dentist Paulo Malo.
When we lose teeth, we not only lose teeth themselves but also the bone that supports them. Over time, the bone becomes thinner, and there may not be enough bone volume to support dental implants.
Various surgical methods are used to address this issue, such as bone grafting with artificial materials. In the upper jaw, especially in the molar region, sinus lift procedures are often necessary to create enough bone volume for implant placement. These procedures are costly, uncomfortable for patients, and time-consuming. It’s important to note that sinus lifts and bone augmentation prolong the implant loading period to 6-8 months.
The All-on-4 technique was developed to avoid these costly procedures, particularly in the upper jaw. In this technique, two implants are placed straight in the frontal segment, typically in the positions of incisors or canines, where bone loss is minimal. The other two implants are angled at 30 degrees in the area of premolars or molars, using a special template. When placed in the premolar area, the final prosthesis has two attachments, with the last tooth being smaller in size. When the last implant is placed in the molar area, the final prosthesis has one normal-sized tooth attachment.
For patients with complete or partial edentulism, the procedure is completed in one day. Teeth are extracted, the gums are prepared, the ridge is leveled, and a template is placed for implant placement in the front and at an angle in the premolar or molar region. After implant placement, an impression is taken for a temporary acrylic prosthesis, which is ready the same day.
The patient wears the temporary prosthesis for four months before the definitive prosthesis is made. The same process applies to the lower jaw, where at least four implants are placed. After implantation, the patient wears a temporary acrylic prosthesis fixed to the four implants, and after 3-4 months, the definitive prosthesis is made.
The definitive prosthesis is made of metal-ceramic, titanium, or zirconia.
The All-on-4 method avoids sinus lifting and bone augmentation, using four implants in both the upper and lower jaws, most of which can be immediately loaded with a temporary prosthesis. This method is relatively cost-effective and less emotionally painful for the patient.
