Paulo Malo: Full-arch rehabilitation of edentulous patients with the All-on-4® treatment concept

Dr Malo presents an overview over the principles of the All-on-4® treatment concept with a focus on the prosthetic options and design characteristics. The All-on-4® treatment main principles comprise: 4 implants for full arch rehabiliation, avoid implants in the (maxillary) posterior region due to amount and soft quality of bone, posterior implants tilted up to 45 degrees, bone reduction to avoid the transition zone, immediate function with fixed, screw-retained acrylic bridge, with prosthetic gingiva, and if needed, cantilever. Bone grafting is usually avoided and only done in rare, e.g. trauma cases. Depending on available bone, treatment options range from 4 regular size implant cases to hybrid or full quad constructions with 2 or 4 Zygomatic or other extramaxillary implants. Like a skyscraper, for stability the bridge needs to have some flexibilty, and therefore contains an infrastructure in titanium, rather than with e.g. CoCr steel being too rigid and increasing risk of fracture. CAD/CAM construction offers many advantages over cast, such as passive fit, no welding zones and excellent esthetics.