The “all-on-four” treatment as a solution in dental implants
Keywords:
All-on-Four, Tilted Implants, Dental Prostheses, Immediate Loading, Edentulous Mandible, Edentulous MaxillaAbstract
The present report is intended to reach an idea about the “All-On-Four” treatment, about the simple of the clinical procedure and the pro and cons that they give to do; focusing mainly on the indications of treatment, surgical procedures and prosthetic protocols, and secondly on the mechanical and biological complications involved. A search was executed in Pubmed and Cochrane, with the descriptors ("All-on-Four"), ("Dental Implants"), ("Complication of All-On-Four"), ("Management of All-On-Four") and ("Techniques "), Where the research works evidenced by the prosthetic and surgical approach of the "All-On-Four" implants, as well as their consequences, was analyzed. The “All-On-Four” treatment objective is to evaluate the survival rate of the implants to rehabilitate maxillary and completely edentulum jaw.
Downloads
References
Zincir ÖÖ, Parlar A. Comparison of stresses in monoblock tilted implants and conventional angled multiunit abutment-implant connection systems in the all-on-four procedure. BMC Oral Health. 2021 Dec 16;21(1):646. doi: 10.1186/s12903-021-02023-y.
Taruna M, Chittaranjan B, Sudheer N, Tella S, Abusaad M. Prosthodontic perspective to all-on-4® concept for dental implants. J Clin Diagn Res. 2014 Oct;8(10):ZE16-9. doi: 10.7860/JCDR/2014/9648.5020.
Durkan R, Oyar P, Deste G. Maxillary and mandibular all-on-four implant designs: A review. Niger J Clin Pract. 2019 Aug;22(8):1033-1040. doi: 10.4103/njcp.njcp_273_18.
Soni R, Yadav H, Pathak A, Bhatnagar A, Kumar V. Comparative evaluation of biting force and chewing efficiency of all-on-four treatment concept with other treatment modalities in completely edentulous individuals. J Indian Prosthodont Soc. 2020 Jul-Sep;20(3):312-320. doi: 10.4103/jips.jips_464_19.
Pan Y, Heng C, Wu ZJ, Tam J, Hsung RT, Pow EH, Lam WY. Comparison of the virtual techniques in registering single implant position with a universal-coordinate system: An in vitro study. J Dent. 2022 Feb;117:103925. doi: 10.1016/j.jdent.2021.103925.
Türker N, Büyükkaplan US, Sadowsky SJ, Özarslan MM. Finite Element Stress Analysis of Applied Forces to Implants and Supporting Tissues Using the "All-on-Four" Concept with Different Occlusal Schemes. J Prosthodont. 2019 Feb;28(2):185-194. doi: 10.1111/jopr.13004.
Fernández-Ruiz JA, Sánchez-Siles M, Guerrero-Sánchez Y, Pato-Mourelo J, Camacho-Alonso F. Evaluation of Quality of Life and Satisfaction in Patients with Fixed Prostheses on Zygomatic Implants Compared with the All-on-Four Concept: A Prospective Randomized Clinical Study. Int J Environ Res Public Health. 2021 Mar 25;18(7):3426. doi: 10.3390/ijerph18073426
de Araújo Nobre M, Maló P, Gonçalves I. Evaluation of Clinical Soft Tissue Parameters for Extramaxillary Zygomatic Implants and Conventional Implants in All-on-4 Hybrid Rehabilitations: Short-Term Outcome and Proposal of Clinical Recommendations for Intervention in Recall Appointments. Implant Dent. 2015 Jun;24(3):267-74. doi: 10.1097/ID.0000000000000253.
Shankar SD, Doddamani S. To evaluate and compare the accuracy of definitive casts using various splinting methods on implant level impressions in All-on-Four treatment: An in vitro study. J Indian Prosthodont Soc. 2020 Apr-Jun;20(2):193-201. doi: 10.4103/jips.jips_210_19. Epub 2020 Apr 7.
Siadat H, Alikhasi M, Beyabanaki E, Rahimian S. Comparison of Different Impression Techniques When Using the All-on-Four Implant Treatment Protocol. Int J Prosthodont. 2016 May-Jun;29(3):265-70. doi: 10.11607/ijp.4341.
Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. A retrospective analysis of 800 Brånemark System implants following the All-on-Four™ protocol. J Prosthodont. 2014 Feb;23(2):83-8. doi: 10.1111/jopr.12089.
Gaonkar SH, Aras MA, Chitre V, Mascarenhas K, Amin B, Rajagopal P. Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four™ concept: A systematic review. J Indian Prosthodont Soc. 2021 Jan-Mar;21(1):3-10. doi: 10.4103/jips.jips_100_20.
Zhao R, Yang R, Cooper PR, Khurshid Z, Shavandi A, Ratnayake J. Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments. Molecules. 2021 May 18;26(10):3007. doi: 10.3390/molecules26103007.
Dewi AH, Ana ID. The use of hydroxyapatite bone substitute grafting for alveolar ridge preservation, sinus augmentation, and periodontal bone defect: A systematic review. Heliyon. 2018 Nov 2;4(10):e00884. doi: 10.1016/j.heliyon.2018.e00884.
Maló P, Araújo Nobre MD, Lopes A, Rodrigues R. Double Full-Arch Versus Single Full-Arch, Four Implant-Supported Rehabilitations: A Retrospective, 5-Year Cohort Study. J Prosthodont. 2015 Jun;24(4):263-70. doi: 10.1111/jopr.12228.
Gaonkar SH, Aras MA, Chitre V, Mascarenhas K, Amin B, Rajagopal P. Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four™ concept: A systematic review. J Indian Prosthodont Soc. 2021 Jan-Mar;21(1):3-10. doi: 10.4103/jips.jips_100_20.
Sun X, Cheng K, Liu Y, Ke S, Zhang W, Wang L, Yang F. Biomechanical comparison of all-on-4 and all-on-5 implant-supported prostheses with alteration of anterior-posterior spread: a three-dimensional finite element analysis. Front Bioeng Biotechnol. 2023 Jun 16;11:1187504. doi: 10.3389/fbioe.2023.1187504.
Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I. All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e531-41. doi: 10.1111/cid.12282.
Maló P, de Araújo Nobre M, Lopes A, Ferro A, Botto J. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res. 2019 Aug;21(4):565-577. doi: 10.1111/cid.12769.
de Araújo Nobre M, Maló P, Gonçalves I. Evaluation of Clinical Soft Tissue Parameters for Extramaxillary Zygomatic Implants and Conventional Implants in All-on-4 Hybrid Rehabilitations: Short-Term Outcome and Proposal of Clinical Recommendations for Intervention in Recall Appointments. Implant Dent. 2015 Jun;24(3):267-74. doi: 10.1097/ID.0000000000000253.
Gönül O, Çicek A, Afat İM, Akdoğan ET, Atalı O. Biomechanical Comparison of Asymmetric Implant Configurations for All-on-Four Treatment Using Three-Dimensional Finite Element Analysis. Life (Basel). 2022 Nov 23;12(12):1963. doi: 10.3390/life12121963.
Cattoni F, Chirico L, Merlone A, Manacorda M, Vinci R, Gherlone EF. Digital Smile Designed Computer-Aided Surgery versus Traditional Workflow in "All on Four" Rehabilitations: A Randomized Clinical Trial with 4-Years Follow-Up. Int J Environ Res Public Health. 2021 Mar 26;18(7):3449. doi: 10.3390/ijerph18073449.
Maló P, de Araújo Nobre M, Lopes A, Moss S. Posterior maxillary implants inserted with bicortical anchorage and placed in immediate function for partial or complete edentulous rehabilitations. A retrospective clinical study with a median follow-up of 7 years. Oral Maxillofac Surg. 2015 Mar;19(1):19-27. doi: 10.1007/s10006-014-0444-7. Epub 2014 Feb 28.
Szabó ÁL, Nagy ÁL, Lászlófy C, Gajdács M, Bencsik P, Kárpáti K, Baráth Z. Distally Tilted Implants According to the All-on-Four® Treatment Concept for the Rehabilitation of Complete Edentulism: A 3.5-Year Retrospective Radiographic Study of Clinical Outcomes and Marginal Bone Level Changes. Dent J (Basel). 2022 May 11;10(5):82. doi: 10.3390/dj10050082.
Grandi T, Signorini L. Rehabilitation of the Completely Edentulous Mandible by All-on-Four Treatment Concept: A Retrospective Cohort Study with Up to 10 Years Follow-Up. Medicina (Kaunas). 2021 Dec 22;58(1):10. doi: 10.3390/medicina58010010.
Wang Q, Zhang ZZ, Bai SZ, Zhang SF. Biomechanical analysis of stress around the tilted implants with different cantilever lengths in all-on-4 concept. BMC Oral Health. 2022 Nov 5;22(1):469. doi: 10.1186/s12903-022-02520-8.
Pandey A, Durrani F, Rai SK, Singh NK, Singh P, Verma R, Kumar J. Comparison between all-on-four and all-on-six treatment concepts on stress distribution for full-mouth rehabilitation using three-dimensional finite element analysis: A biomechanical study. J Indian Soc Periodontol. 2023 Mar-Apr;27(2):180-188. doi: 10.4103/jisp.jisp_278_22.
Okuhama Y, Nagata K, Kim H, Tsuruoka H, Atsumi M, Kawana H. Validation of an implant stability measurement device using the percussion response: a clinical research study. BMC Oral Health. 2022 Jul 14;22(1):286. doi: 10.1186/s12903-022-02320-0.
Sivrikaya EC, Yilmaz O. Comparison of Extramaxillary Anchored Implants, Tilted Implants, or Sinus Elevation Concepts on Stress Distribution in Atrophic Maxilla: A Finite Element Analysis. Int J Oral Maxillofac Implants. 2022 May-Jun;37(3):563-570. doi: 10.11607/jomi.9631.
Shankar SD, Doddamani S. To evaluate and compare the accuracy of definitive casts using various splinting methods on implant level impressions in All-on-Four treatment: An in vitro study. J Indian Prosthodont Soc. 2020 Apr-Jun;20(2):193-201. doi: 10.4103/jips.jips_210_19.
Toledano M, Osorio MT, Vallecillo-Rivas M, Toledano-Osorio M, Rodríguez-Archilla A, Toledano R, Osorio R. Efficacy of local antibiotic therapy in the treatment of peri-implantitis: A systematic review and meta-analysis. J Dent. 2021 Oct;113:103790. doi: 10.1016/j.jdent.2021.103790. Epub 2021 Aug 27.
Deste G, Durkan R. Effects of all-on-four implant designs in mandible on implants and the surrounding bone: A 3-D finite element analysis. Niger J Clin Pract. 2020 Apr;23(4):456-463. doi: 10.4103/njcp.njcp_471_19.
Murugaian J, Ganesan L, Shankar MSS, Annapoorni H. A comparative evaluation of stress distribution between an All-on-Four implant-supported prosthesis and the Trefoil implant-supported prosthesis: A three-dimensional finite element analysis study. J Indian Prosthodont Soc. 2022 Jan-Mar;22(1):56-64. doi: 10.4103/jips.jips_203_21.
Soto-Penaloza D, Zaragozí-Alonso R, Penarrocha-Diago M, Penarrocha-Diago M. The all-on-four treatment concept: Systematic review. J Clin Exp Dent. 2017 Mar 1;9(3):e474-e488. doi: 10.4317/jced.53613.
Durkan R, Oyar P, Deste G. Maxillary and mandibular all-on-four implant designs: A review. Niger J Clin Pract. 2019 Aug;22(8):1033-1040. doi: 10.4103/njcp.njcp_273_18.
Galindo-Moreno P, Fernández-Jiménez A, Avila-Ortiz G, Silvestre FJ, Hernández-Cortés P, Wang HL. Marginal bone loss around implants placed in maxillary native bone or grafted sinuses: a retrospective cohort study. Clin Oral Implants Res. 2014 Mar;25(3):378-384. doi: 10.1111/clr.12122. Epub 2013 Feb 20.
Bozyel D, Taşar Faruk S. Biomechanical Behavior of All-on-4 and M-4 Configurations in an Atrophic Maxilla: A 3D Finite Element Method. Med Sci Monit. 2021 Mar 28;27:e929908. doi: 10.12659/MSM.929908.
Downloads
Published
Issue
Section
License
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) posterior al proceso de aprobación del manuscrito, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada.












