All-on-4® treatment concept –efficient and reliable full-arch restorations
Science FirstThe All-on-4® treatment concept provides edentulous andsoon-to-be edentulous patients with an efficient andeffective restoration using four implants to support an
immediately delivered full-arch prosthesis.

either extremely satisfied (74%) or satisfied (21%) with
their new teeth, and 98% said they would definitely
recommend (88%) or consider recommending (10%) similar
treatment to friends and colleagues.9

Proven long-term solution
Up to 10 years follow-up in the mandible and 5 years in
the maxilla.1,2

Shorter treatment times
Two key elements of the All-on-4® treatment concept
significantly reduce treatment complexity, the number ofsurgeries, and the overall treatment time: tilting of theposterior implants avoids the need for time-consumingbone grafting procedures and reduces prosthetic cantilevers, while immediate loading shortens time to teeth.

High survival rates
High cumulative survival rates (CSR) in both edentulous
maxilla and mandible.1–8
Mid-term 3–4 years
96.3–100% 4–6
Long-term 5–10 years 94.8–98.0% 1,2Favorable bone and soft tissue parameters
Stable marginal bone levels4–8 and healthy soft tissue5
both for tilted and axial implants.
Rapid improvement in quality of life
Immediate implant loading with a fixed provisional
prosthesis quickly leads to improved patient satisfaction– with regards to function, esthetics, sense, speech, andself-esteem.7,8 In an OHIP (oral health impact profile)study, 95% of 250 patients described themselves as being

Stable bone levels around axial and tilted implants
Axial implants

Marginalbonebone level
level change(mm)Marginalchange(mm)

0Lower costs
The All-on-4® treatment concept is not only the least
time-consuming treatment option in comparison withconventional implant treatment modalities of theedentulous and soon-to-be edentulous jaw, but also theleast costly.10
For healed and extraction sites
The All-on-4® treatment concept is successful in healedand extraction sites,8 also in combination with thetreatment concept NobelGuide with guided drilling andimplant insertion.12,13

TiUnite implants are the implants of choice for theAll-on-4® treatment conceptAll TiUnite implants

91.2%

Tilted implants

-0.2

51.3%

– NobelSpeedy

-0.4
-0.6

25.2%

– Brånemark System-0.8

14.7%– NobelActive

-1.0
-1.2
-1.4
-1.6
-1.8
-2.0

06

1218

24

30

36

42

48

54

60

66

Time
implantation(months)
Time after
after implantation(months)
Axial implants

Implants
immediately loaded with radiographic baseline set at time of insertion.
Tilted implants
Therefore all bone remodeling is reported. Graph shows results for mandible,
but results for maxilla are similar.4

Outlink®
(Sweden & Martina)

3.7%

NanoTite™
(Biomet 3i®)

3.1%

OsseoTite®
(Biomet 3i®)

2.0%
01000

2000

3000

4000

5000

Number of placed implants

Systematic review of clinical studies on All-on-4® treatment concept until August 3,
2012 (13 of 487 initially identified papers met the inclusion criteria). Nobel Biocare
implants with TiUnite surface are predominantly used for this type of full-archrestoration (adapted from Patzelt et al. 2013).11

Clinical evidence supporting the All-on-4®
treatment concept
Published clinical studies evaluate the use of approximately 10,000 implants (NobelSpeedy Groovy, Brånemark System,NobelActive) in 2500 patients in both edentulous mandible and maxilla, with follow-up times of up to 10 years.
References
1 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 10years of follow-up. J Am Dent Assoc
2011;142:310-20
2 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 theMedium (3 Years) and Long-Term(5 Years) Outcomes. Clin Implant Dent
Relat Res 2012;14 Suppl 1:e139-50
3 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
4 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
5 Agliardi E, Panigatti S, Clericò M,
Villa C, Malò P. Immediate rehabilitation of the edentulous jaws with full
fixed prostheses supported by fourimplants: interim results of a single
cohort prospective study. Clin Oral
Implants Res 2010;21:459-65

6 Balshi TJ, Wolfinger GJ, Slauch RW,Balshi SF. A retrospective analysis of800 Brånemark System implants
following the All-on-Four™ protocol.
J Prosthodont 2014;23:83-8

11 Patzelt SB, Bahat O, Reynolds MA,Strub JR. The All-on-Four Treatment
Concept: A Systematic Review. Clin
Implant Dent Relat Res 2013 [epubahead of print]

7 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

12 Pomares C. A retrospective studyof edentulous patients rehabilitatedaccording to the ‘all-on-four’ or the‘all-on-six’ immediate function concept
using flapless computer-guided
implant surgery. Eur J Oral Implantol
2010;3:155-63

8 Mozzati M, Arata V, Gallesio G,
Mussano F, Carossa S. Immediate
Postextractive Dental Implant
Placement with Immediate Loading
on Four Implants for Mandibular-FullArch Rehabilitation: A RetrospectiveAnalysis. Clin Implant Dent Relat Res
2013;15:332-40

13 Malo P, de Araujo Nobre M, Lopes
A. The use of computer-guided flapless
implant surgery and four implants
placed in immediate function tosupport a fixed denture: preliminary
results after a mean follow-up periodof thirteen months. J Prosthet Dent
2007;97(6 Suppl):26-34

9 Babbush CA. Posttreatment
quantification of patient experienceswith full-arch implant treatment usinga modification of the OHIP-14
questionnaire. J Oral Implantol
2012;38:251-60
10 Babbush CA, Kanawati A, Kotsakis
GA, Hinrichs JE. Patient-Related andFinancial Outcomes Analysis ofConventional Full-Arch Rehabilitation
Versus the All-on-4 Concept: A Cohort
Study. Implant Dent 2014;23:218-24

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