The history of All-on-4 dental implants

The ability to replace an entire arch of teeth using just 4 titanium rods is a marvel of modern dentistry.

This treatment, called “All-on-4”, did not happen overnight but rather evolved from several breakthroughs in dentistry.

The father of implants

The work of Per-Ingvar Brånemark, a Swedish physician and research professor, is generally credited for bringing the concept of implants to the forefront of the dental field.

Brånemark proved that osseointegration was possible—that bone could be fused with a non-organic element, notably, titanium. Brånemark’s titanium screw is the foundation from which all future implant work was built.

Early implant trials

You would think that early implant experiments would focus on single tooth applications, but most initial trials in the 1970s and 1980s actually attempted full-arch implants.

There are two key reasons why:

  1. Risk-reward for patients: Patients missing an entire arch of teeth were more open to experimental procedures than those only needing one or two teeth replaced.
  2. Cross-arch support: Dividing bite pressure across multiple implant points provided greater stability compared to supporting a single tooth.

A series of improvements

Full-arch implants used to be attached to between 6 and 12 posts. Until an important discovery paved the way for installation on just 4 titanium rods.

It was believed in that past that “back-up” posts were necessary, in the event that 1 or 2 failed. But studies showed that implants more often failed from improper hygiene rather than screws releasing from the jawbone. A prosthesis installed on 4 posts was easier to care for, eliminating the need for additional rods in most cases.

The advent of implant angulation, or placing the back screws at an angle to the jawbone, is also cited as a breakthrough that led to the possibility of All-on-4 technology. Angled implants allow the oral surgeon to overcome anatomical restrictions related to mouth space and damaged bone. Implant angulation provided a way to avoid bone grafting.

A final piece of the puzzle

All-on-4 is unique in its immediate results. The prosthesis is loaded on the same day posts are installed. A full-arch implant used to take 4-6 months to complete, but now patients can now leave the office on the same day with a completely new set of teeth, including extraction.

Same day loading was first documented in 1990 when the first ever Nobel Biocare All-on-4 treatment was completed in 1998 by Dr. Paulo Malo.

Since then, hundreds of thousands of patients around the world have benefited from the ultimate solution for treating severe tooth loss.