The All-on-4 treatment concept is a technique used to totally rehabilitate the edentulous. It’s considered a prosthetic and surgical procedure. During the 1990s, this treatment concept was first developed, systematically analyzed and institutionalized.

A number of studies on the concept were funded by Nobel Biocare. The technique completely rehabilitates the edentulous maxilla and mandible. The technique uses a fixed prosthesis to accomplish this goal. A total of four implants are installed into the anterior maxilla, which is where bone density is highest.


The fixed prosthesis is supported by the four implants, and the prosthesis has anywhere from 12 to 14 teeth. Patients receive the prosthesis on the same day that the surgery is performed. The All-on-4 concept is Nobel Biocare’s registered trademark. With the All-in-4 technique, patients are given a screw-retained lower or upper set of teeth.

It’s an ideal procedure for patients who have major tooth loss. It can also be used for patients who don’t have enough bone mass for dental implants. One of the problems with tooth loss is that it’s almost always accompanied by a loss in jaw bone. For this procedure to be successful, bone must be transplanted from another part of the body.

Two locations where bone is frequently transplanted from are the skull and iliac crest. The transplanted bone is added to the area where the prosthesis will be deployed. The transplantation of the bone graft can take up to six months. Once the implant is in place, a further two to three months is needed before the fixed prosthesis can be placed.

The All-on-4 treatment is named after the nature of the technique itself because it involves the installation of a dental prosthesis that contains twelve teeth using four titanium implants. International patenting protect the specific pillars or implants used by Malo.

The process of bone grafting is frequently used for dental restorations. Some great examples are dental implants. It’s quite common for the success of restoration procedures to depend on the width, depth and height of the jawbone in the area where the implant is to be installed.

If the jawbone has sustained major damage or receded, it’s very unlikely that the bone will support one or more implants. To ensure the success of the restoration, bone grafting is the only solution.

Factors That Affect the Volume of Jaw Bone

Periodontal disease can have a major impact on jaw bone volume. Gum disease has been known to permanently damage the jaw bone, and the bone is the foundation that supports the teeth. Areas of the bone that are affected get progressively worse, and eventually, the teeth that are supported by the bone become unstable.

Tooth extraction is another factor that affects jaw bone volume. According to studies, patients lose jaw bone volume around the extraction site, and the volume loss occurs during the three years following the extraction. The bone loss is referred to as a bone defect.

Some other factors that affect jaw bone volume are infections and injuries. A major blow to the jaw can cause the bone to recede. Both physical and dental injuries can also have the same effect. There are even studies that show infections can cause receding of the jaw bone.

Oral Examination

To assess the overall condition of the gums and teeth, the doctor will thoroughly examine the affected areas. If the teeth adjacent to the area are in poor condition, the problem must be addressed. Periodontal disease must also be addressed.

The bone grafting procedure cannot begin until these issues have been addressed. It’s very likely that the doctor will order panoramic x-rays to measure the width and depth of existing bone. To determine the condition of the bone, the doctor might even order a CAT scan.

How Does Bone Grafting Work?

Bone grafts can be obtained from a number of different sources. An autogenous bone graft is used to harvest bone from the patient’s body. In this situation, the bone might be removed from the chin or lower jaw. An allograft bone graft involves the use of synthetic bone or cadaver.

A xenograft involves the use of cow bone. After a successful bone grafting procedure, the body can take up to six months to heal. In most cases, the bone is taken from the patient’s body.

However, it might also be taken from a bone bank. The transplanted bone must fuse with the existing bone, and once the process is complete, there will be enough bone mass to anchor implants.

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Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

When wisdom teeth are misaligned, they may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves.

Anatomy of the Teeth

The teeth are the hardest substances in the human body. Besides being essential for chewing, the teeth play an important role in speech. Parts of the teeth include:

  • Enamel: The hardest, white outer part of the tooth. Enamel is mostly made of calcium phosphate, a rock-hard mineral.
  • Dentin: A layer underlying the enamel. Dentin is made of living cells, which secrete a hard mineral substance.
  • Pulp: The softer, living inner structure of teeth. Blood vessels and nerves run through the pulp of the teeth.

Wisdom teeth also can be impacted — they are enclosed within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Partial eruption of the wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum diseas,e because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

How Do I Know if I Have Wisdom Teeth?

Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.

Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

How Are Wisdom Teeth Removed?

The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.

What Happens During Wisdom Teeth Removal?

Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic — the same type used to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as “laughing gas”), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.