Introduction

Case Report
A ____ year old man reported to the department with the chief complaint of _________. The
patient was a denture ________. The patient presented a non-relevant medical history. An
orthopantogram was recorded to determine the bone height and presence of any root stumps or
radiographic pathology. The case was discussed with the oral and maxillofacial surgeon
associated with the faculty and an all-on-four treatment was planned for.
Discussion
Introduced by Paula Malo, all-on-four treatment concept has been widely accepted in the recent
past for the treatment of completely edentulous atrophic jaws to enable successful implant-based
rehabilitation. Placing the distal implants at an angulation enables the use of longer dimensions
implants without the need of performing complex surgical procedures like bone grafting and
nerve transposition, thereby increasing the treatment acceptance by the patient.(1) As the name
suggests, four dental implants are placed, two in anterior segment which are straight and two in
distal jaw, one on each side which are angulated at 45⁰. Angulation of the implants enables
placement of longer length along with avoiding the infringement of vital structures like the
inferior alveolar nerve and floor of maxillary sinus in mandible and maxilla, respectively.
Despite the wide advantages presented, a lack of uniformity in terms of methodology and long
follow-ups provide with a high risk of bias thereby providing a low level of scientific evidence.
This has been highlighted in the systematic review by Soto-Penaloza et al in 2017 who found
only 24 articles which fulfilled their inclusion criteria of immediate loading of the placed
implants. After 24 months of treatment, thy reported a survival rate of 99.8%.(2)
Chowdhary et al proposed a ‘simpli5y’ concept wherein five dental implants (2 in maxilla and 2
in mandible) were used for edentulous arches rehabilitation. A total of 30 patients were equally
divided into two groups were an average insertion torque (IT) of 45Ncm with delayed implant
loading was seen in one while IT of over 65Ncm and immediate loading was possible in the
other.
References
1. 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;8(10):ZE16–9.
2. 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;9(3):e474–88.