The technique for total rehabilitation of the edentulous, known as the All-on-4® treatment concept, is a surgical and prosthetic medical procedure. The concept was developed, institutionalized and systematically analyzed in the 1990s through studies funded by Nobel Biocare in collaboration with a Portuguese dentist Paulo Maló. It consists of the rehabilitation of the edentulous maxilla and mandible with fixed prosthesis by placing four implants in the anterior maxilla, where bone density is higher, allowing the highest success rate. The four implants support a fixed prosthesis with 12 to 14 teeth and it is placed immediately on the day of surgery. All-on-4® is a registered trademark of Nobel Biocare.
Description of the procedure
The All-on-4 ® treatment concept provides a permanent, screw-retained, same-day replacement for the entire upper and / or lower set of teeth. The procedure is best for patients with significant tooth loss or decay and for people whose bone loss in the jaw area prevents them from getting dental implants. Often, tooth loss is accompanied by loss of the jaw bone which poses the problem of reconstruction of the jaw bone. For the implementation to be successful it is necessary to transplant bone from other parts of the body, for example, the iliac crest or the skull and apply it in the area where it is planned to deploy tooth or teeth. Transplantation of bone graft technique takes between three and six months so that the implants can be placed. After implant placement, it is necessary to wait two to three months, after which time it is possible the placement of the fixed prosthesis. The total rehabilitation time lasts about twelve months.
Many patients can not do the transplant of bone for general health reasons (diabetes and others). The rehabilitation of the teeth in this way (the transplantation of bone) due to health problems is impossible in 20% of patients.
The All-on-4® treatment concept, will address these drawbacks because it consists in establishing a fully customized denture (bridge) based only on four titanium implants. These implants act as "pillars" to the bridge that supports the prosthetic teeth. The invented process takes advantage of existing bone, even if scarce, avoiding having to use bone grafts.
The posterior implants are substantially angled at approximately 45 degrees to avoid compromising the sinus cavity in the upper jaw and the nerve canal in the jaw.
The All-on-4® treatment concept owes its name to the very nature of the method, which consists of applying a dental prosthesis with at least twelve teeth (bridge) fixed in the jaw, based only on four titanium implants.
The specific implants or pillars used by Malo are protected by international patenting. The All-on-4® treatment concept can be used successfully with alternative implants.
Patent claims for the dental implant fixation
According to the first claim accepted under the European patenting process, the implant (7) is characterized by having a form that allows an effective anchoring even in a jaw bone (1) with a combination of soft and hard bone portions or inlays (2, 3, 4, 5), which fixture can be applied in holes (6, 8) with diameters (D’, D’’) which are substantially smaller than a main diameter (D) of the fixture (7) so as to produce a clamping effect (10) on the fixture (7) from the soft bone portion (3) or portions, said fixture (7) comprising an outer surface, the main diameter (D), an end surface and a front portion (7b), which from the point of view of diameter grows very much narrower towards the end surface and which is arranged with both a cutting function (12, 13, 14, 15) and a threading function (11) and is thus able, upon contact with a hard bone portion (4, 5) or portions, to penetrate through these hard bone portions (4, 5) without causing any substantial tendency for displacement of the respective hard bone portion (4, 5), and a thread (11) which has one, two or more thread turns and extends along the greater part of the outer surface and also down along the front portion (7b) while substantially maintaining its thread profile, wherein the main diameter (D) is 4 mm, the diameter (d) of the end surface is 2 mm, and the front portion (7b) has a Height (H) which is substantially equal to the diameter (d) of the end surface.
Price of the treatment
The price may vary for each country or region, and normally it is divided in two phases
- The first phase involves removing any remaining teeth, and placing the four dental implants along with an immediate temporary bridge secured to the four implants. This phase may cost between $10000 to $15000, dependent on the above factors.
- Few months after the above phase, once complete healing and bonding of the implants to the bone has taken place, a final bridge is usually fabricated. This bridge typically consists of a metal framework, which strengthens the system, and often has a few more posterior teeth. This phase may cost between $10000 to $17500, dependent on the materials used and the type of teeth (porcelain or acrylic) developed.
The total price (if both superior and inferior arches are considered) could possibly reach $57000.
- Maló, Paulo; Rangert, Bo; Nobre, Miguel (2003). "'All-on-Four' Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Mandibles: A Retrospective Clinical Study". Clinical Implant Dentistry and Related Research 5: 2–9. doi:10.1111/j.1708-8208.2003.tb00010.x. PMID 12691645.
- Malo, Paulo; Rangert, Bo; Nobre, Miguel (2005). "All-on-4 Immediate-Function Concept with Brånemark System® Implants for Completely Edentulous Maxillae: A 1-Year Retrospective Clinical Study". Clinical Implant Dentistry and Related Research 7: S88–94. doi:10.1111/j.1708-8208.2005.tb00080.x. PMID 16137093.
- "Trademarks". Nobel Biocare. May 25, 2011.
- Maló, P; Nobre, M; Lopes, A (2011). "Short implants in posterior jaws. A prospective 1-year study". European journal of oral implantology 4 (1): 47–53. PMID 21594219.
- Maló, Paulo; De Araújo Nobre, Miguel (2011). "Implants (3.3 mm Diameter) for the Rehabilitation of Edentulous Posterior Regions: A Retrospective Clinical Study with Up to 11 Years of Follow-Up". Clinical Implant Dentistry and Related Research 13 (2): 95–103. doi:10.1111/j.1708-8208.2009.00188.x. PMID 19681926.
- Malo, Paulo; de Araújo Nobre, Miguel; Lopes, Armando; Moss, Steve M.; Molina, Guillermo J. (2011). "A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up". Journal of the American Dental Association 142 (3): 310–20. PMID 21357865.
- WO patent 2004091424, Carvalho, Paulo Malo, "Fixture for anchoring in jaw bone", issued October 28, 2004