What’s the All-on-4 Treatment Concept?

This summary is based on the article published in the Clinical Implant Dentistry and Related Research: The All-on-Four Treatment Concept: A Systematic Review (December 2014)

Sebastian B. M. Patzelt, DMD, Dr med dent; Oded Bahat, BDS, MSD, FACD; Mark A. Reynolds, DDS, PhD; Joerg R. Strub, DMD, PhD, Dr med dent habil, Dr. h.c.

Context

• Severe atrophy of the alveolar ridge often develops following tooth loss, with increasing severity over time in the edentulous jaw.
• Several prosthetic treatment options exist for this particular situation: complete dentures, removable implant-retained prostheses, or fixed implant-supported prostheses.¹
• However, implant retained or fixed implant-supported prostheses provide a higher degree of patient satisfaction than removable prostheses.^{2, 3}
• To avoid grafting procedures and to utilize pre-existing bone in the most effective way, angled implants (tilting of implants) is a well-documented alternative, with no apparent clinically significant difference in success rates compared with axially placed implants.⁷
• One particular treatment option is marketed as the All-on-4™ concept (Nobel Biocare, Goteborg, Sweden).
  • The principle of the all-on-four concept is to use four implants in the anterior part of complete edentulous jaws to support a provisional, fixed, and immediately loaded prosthesis.
  • The two most anterior implants are placed axially, whereas the two posterior implants are placed distally angled to minimize the cantilever length and to allow the application of prostheses with up to 12 teeth.^10–12
  • Final prosthetic solutions can either be fixed (FDP) or removable dental prostheses.¹²

Purpose of the Review

To evaluate the all-on-four treatment concept with regard to survival rates (SRs) of oral implants, applied fixed dental prostheses (FDPs) and temporal changes in proximal bone levels.

Key Findings

• The all-on-four treatment concept seems to be an approach for edentulous jaws according to the common demand of:
  • A cost-effective treatment concept,
  • Decreased treatment times with a lower patient morbidity, and
  • A higher patient quality of life as compared with extended surgical approaches and removable prostheses, respectively.
• Current evidence is limited by the quality of available studies and the paucity of data on long-term clinical outcomes of 5 years or greater.

References

List of references included in the review (PDF)