The all-on-four treatment concept: Systematic review

Area of Science:

• Dentistry
• Oral Surgery
• Prosthodontics

Background:

• The All-on-4 treatment concept offers a viable alternative to traditional regenerative procedures for atrophic jaws.
• This approach aims to reduce morbidity and treatment costs associated with complex surgeries.

Purpose of the Study:

• To systematically review the literature on the All-on-4 treatment concept.
• Evaluate its indications, surgical techniques, prosthetic protocols, and complications after a minimum of three years in function.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE (PubMed), EMBASE, and the Cochrane Library.
• Grey literature was also screened using Open Grey from January 2005 to April 2016.

Main Results:

• Twenty-four articles met the inclusion criteria from an initial screening of 728.
• Methodological quality was often limited, with few studies reporting sample size calculations or adequate follow-up.
• A high survival rate of 99.8% for implants lasting over 24 months was reported.

Conclusions:

• The All-on-4 concept is a predictable treatment for atrophic jaws, especially for patients avoiding regenerative procedures.
• Despite high survival rates, evidence is limited by methodological quality and follow-up.
• Biological complications like peri-implantitis occur but require standardized success criteria due to high prevalence.