“All-on-4® treatment concept”


The “All-on-4® treatment concept” Procedure is a surgical technique that was developed by a Dr. Paolo Malo from Portugal along with Nobel Biocare in the early 1990s. This is the technique advertised by major clinics stating teeth in a day. The concept works due to cross bracing and cross stabilization of the implants the day of surgery.

In this technique, 4 implants are placed in the anterior region of the upper or lower jaw. The anterior regions of the jaws have the most dense bone and allow implant placement avoiding critical structures. This allows for a high success rate in allowing the fitting of a fixed prosthesis with 12 to 14 teeth IMMEDIATELY on the day of surgery. Through this technique, we can restore esthetics and function. We can load these immediately due to cross bracing of multiple implants.

The “All-on-4® treatment concept” technique allows doctors to place implants in patients with poor bone levels, who would normally require a bone graft prior to traditional implant placement. These implants are often placed simultaneously with removal of the teeth and the teeth are inserted that same day. This procedure is graftless. These teeth are FIXED in the mouth and NOT REMOVEABLE. Cleaning and hygiene is done with small brushes and floss threaders to get under denture and around the implants.

This procedure permits the patient to achieve the immediate functioning of the mandible and the maxilla. This procedure is in two phases.

1st Phase

Surgical : This phase usually takes 3 to 4 hours and during this time the patient will undergo surgery where the remaining teeth are removed, implants are placed, and a temporary full acrylic prosthesis will be applied to the maxilla or mandible. This temporary full acrylic prosthesis is meant to be in place 6-12 months.

2nd Phase

Prosthesis : This 2nd phase usually takes place 4 to 6 months after the 1st phase is finished and the goal is to install the final prosthesis. This final prosthesis is placed on a titanium bar that is tied to the implants placed above. The denture prosthesis can be made of ceramic or titanium/acrylic based on amount of bone/tissue support needed and esthetics.


The majority of dental implants can be performed under local anesthesia (numbing of the areas); local anesthesia with oral premedication; or local anesthesia with IV anesthesia (intravenous general anesthesia). This is based on your medical history and desires.


The “All-on-4® treatment concept” technique has been developed to maximize the use of the available bone. From the surgical perspective, it is a predictable procedure and it permits the patient to get the same teeth function as they would have with their natural teeth.

Risks, Complications and Side Effects

The “All-on-4® treatment concept” surgical technique has the same risks as any other oral surgery and these will be gone over with you at your consultation.

Some side effects associated with this procedure are bruising and swelling which will disappear after 5 to 10 days depending on the patients health condition.  Temporary numbness may occur in some cases.

Peri-operative medications will be given to you at your preoperative consultation along with oral hygiene instructions and a maintenance protocol.

The goal of All-on-4® treatment concept is to place teeth the day of surgery. While this happens in most scenarios, it sometimes is not possible. For this technique to be successful, the implants placed need to have a certain stability or torque value. If this cant be obtained due to the quantity or quality of the bone, the implants are still placed but NOT loaded for 4-6 months. This allows the implants to osseo integrate or fuse to the bone.

Recovery time

Depending on the patients general health condition, recovery time for an “All-on-4® treatment concept” surgery varies from 5 to 10 days. Esthetically, because bruising and swelling may appear, the full recovery period ranges can be a little more prolonged. Most patients have esthetically recovered within 14 days after surgery.