Key takeaways
- The 2003 paper reported 44 lower jaws, 176 immediately loaded implants, and an acrylic bridge delivered within two hours.
- The back implants were tilted so the bridge could reach about 12 teeth with a short cantilever.
- Prosthesis survival in that series was 100%. Implant survival was 96.7% and 98.2% in the two groups.
- All-on-4 is one full-arch technique. Six implants, a snap-on denture, and single implants are other plans.
| Piece of the protocol | What the paper reports |
|---|---|
| Who | 44 patients in one private clinic in Lisbon, April 1998 to June 2002. Lower jaws only. |
| Implants loaded that day | 176 Brånemark implants, placed in front of the foramina. Forty-five of them, in 12 patients, went into fresh extraction sites. |
| Teeth that day | An acrylic bridge reinforced with a metal strip, delivered within 2 hours, with at least 10 teeth. |
| Tilt | Posterior implants were tilted so a later bridge could hold as many as 12 teeth with a short cantilever of one molar. |
| Survival in that series | Implants 96.7% in the development group and 98.2% in the routine group. Prostheses 100%. |
- Prosthesis survival in the 2003 mandibular series. Implant survival was 96.7% and 98.2% in the two groups, in one clinic's lower jaws.
- 100%
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See whether four implants is the questionWhat did the original protocol actually do?
Maló, Rangert, and Nobre published a retrospective series of immediately loaded complete-arch prostheses in edentulous mandibles, or mandibles with hopeless teeth. Inclusion was consecutive among people who accepted the treatment. The acrylic bridge, reinforced by a metal strip, was delivered within two hours. Screw-access holes for the back implants usually sat around the second premolar.[1]
The first 30 patients were a development group. Twenty-four of them also received 62 rescue implants, in front of and behind the nerve openings. Those extra implants were not part of the provisional bridge. The authors later decided they were not needed. The last third of the patients received only the four immediately loaded implants. When an immediately loaded implant was lost, the provisional bridge survived on the remaining three until a replacement was added.[1]
Life tables show four immediately loaded implants lost before six months in the development group and one in the routine group. Cumulative implant survival was 96.7% and 98.2%. Prosthesis survival was 100%.[1]
Is All-on-4 the same thing as any full arch?
A full arch means a bridge that replaces a whole row. All-on-4 is one way to support that row: four implants, with the back ones tilted, loaded early. How four implants compared with six in later reviews is a separate question, and the reviews do not treat the count as interchangeable for every jaw. Full arch treatment versus individual implants is a different comparison again. People deciding whether the idea fits a life in dentures can read why people look at All-on-4.
The 2003 paper is a lower jaw. It is one clinic. It is not a personal success rate, and it is not a price.
Why does Renew describe it as one technique?
The All-on-4 dental implants page describes a full set of teeth fixed to four implants, planned from a 3D scan at a free consultation. The same site says some upper jaws are planned with six or more implants. That is a clinical choice after the scan, which is why this page keeps the 2003 definition tight.[2]
The implant surgeon places the implants. Tom Szarski, DD, is the denturist who designs and fits the teeth with the on-site lab. The paper's acrylic bridge, delivered within two hours, is the historical protocol. How this clinic stages temporary teeth and a later bridge is a separate article from the definition.
Sources
- "All-on-Four" immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study — Clinical Implant Dentistry and Related Research
- All-on-4 dental implants — Renew Implant Centre
Frequently asked questions
What is All-on-4 in the original paper?
Maló, Rangert, and Nobre described four implants in the lower jaw, in front of the nerve openings, loaded the same day with a fixed acrylic bridge. The series ran from April 1998 to June 2002 in a private clinic in Lisbon: 44 patients and 176 immediately loaded implants.
Does All-on-4 mean any full set of implant teeth?
No. It is a specific four-implant immediate-function concept. A full arch can also be built on six or more implants, and a snap-on denture is removable. Those are different plans.
Did everyone in that first series get extra rescue implants?
No. Twenty-four of the first 30 patients had 62 extra implants that were kept out of the temporary bridge. The authors later stopped placing them. The last third of the patients received only the four immediately loaded implants.
