Today All-on-4 represents an optimal treatment plan for many people who are not candidates for traditional dental implant procedures, but want to avoid the discomfort and inconvenience of loose dentures. But it’s been a long struggle to get here.
The Prehistory of Implants
There are a few examples of early implants placed by people who didn’t record their techniques or technology. Perhaps the earliest examples of true dental implants come from a recent discovery in La Chene, France, southeast of Paris. Dated to about 2300 years ago, researchers found the remains of a woman whose skull had been crushed. The remains included 31 teeth and an iron bar, which images taken at the site show was sitting in the place of the missing tooth. This is strong evidence, but it’s not conclusive. We don’t know for sure that the implant was placed in life.
The first definitive dental implants known is the use of shells implanted in place of lost teeth by the Maya around 600 AD. X-rays taken of the jaws that hold the implants show that the shells achieved osseointegration: they had been incorporated into the jawbone. We know these were implanted during life and stayed in place long enough for this healing to take place.
Implant Renaissance: High Hopes and Inflammation
During the Renaissance people tried to replace teeth with many different structures, most often tubes or screws that could serve as a tooth root. This implant was then topped with a cosmetic dental crown, similar in principle to modern dental implants. But the materials used for these implants (gold, platinum, chromium, molybdenum, and others) did not integrate well and often caused significant inflammation, leading to discomfort and implant failure.
Giving Up on Integration
The failure to achieve consistent osseointegration led to frustration among many researchers, and they began to look for other ways to secure replacement teeth. Subperiosteal and transosteal implants were developed.
Subperiosteal implants sit directly under the gums on top of the jawbone. A metal superstructure connects the implants together to secure a denture without actually attaching to the bone.
Transosteal implants operate like a mechanical bolt. The implant has two parts: one that fits under the jawbone and passes through the jawbone up to the top. Nuts secure the implant on the top and become anchor points for dental crowns.
Both of these types of implants could provide functional results, but they often resulted in high rates of complications and failure.
The Titanium Breakthrough
The problems with dental implants were overcome when Dr. Per-Ingvar Brånemark discovered in 1952 that titanium optical devices fused with the bones of rabbits in experiments. After this, he tested whether titanium would integrate with the bone in different contexts.
Then, in 1965, he performed the first modern dental implant procedure, placing four implants in the jaw of a patient to support a functional dental bridge.
This implant procedure is often considered to be the direct forefather of true All-on-4 deta implants, which would be developed about 30 years later.
The All-on-4 Innovation
The true development of All-on-4 begins with a dentist who was frustrated that he couldn’t provide his patients with good treatment options. Patients with little bone material wanted dental implants but they didn’t want a bone graft. To try to help these patients, Dr. Paulo Maló began experimenting with different implant configurations to try to optimize implant dentures.
In 1998, he performed the first All-on-4 procedure on a patient, achieving good success.
Then in 2000 he worked with Nobel Biocare to make the All-on-4 concept accessible to everyone.
One of the Most Researched Systems
Today, the All-on-4 is one of the most studied dental implant systems in use. There have been over 34 implant studies on All-on-4, covering more than 9000 implants in more than 2400 patients. With up to 10 years’ follow-up in the lower jaw and 5 years’ follow-up in the upper jaw, the success and satisfaction rates for these implant systems is amazing.
Take Part in History
Are you ready to become part of the All-on-4 history? Please call 914-526-2144 today for an appointment with a Westchester County implant dentist at Advanced Dentistry of Mohegan Lake.