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How the All-on-4® revolution began

by: Michael Stuart

Dr. Paulo Malo successfully treated the first patient with the All-on-4® treatment concept back in 1998. Since then, people around the globe have benefited from this innovative treatment method. But what led to the creation of this revolutionary concept?


Even decades after dental implant placement became an established method for restoring quality of life, many of those most in need of help were unable to benefit.

As late as the 1980s, some thirty years after the original discovery of osseointegration, clinicians faced obstacles when it came to treating many edentulous and soon-to-be edentulous patients.

With many such patients suffering from moderate to severe bone resorption, finding adequate bone to place implants was a challenge. There were financial considerations too, as placing enough implants to restore a whole jaw made costs prohibitive for many patients. A new solution was needed. 

The start of a treatment transformation

In the 1990s, we worked with Dr. Paulo Malo from the MALO Clinic in Portugal to revolutionize implant treatment for edentulous and soon-to-be edentulous patients. A new concept was devised that would overcome the common barriers to success.

Following extensive research and development, Dr. Malo treated his first patient with this new treatment concept in 1998.

Fast-forward seventeen years and the concept is an established treatment method for edentulous and soon-to-be edentulous patients, offering immediate improvements in function, esthetics and speech. Today, you know it as the All-on-4® treatment concept.

The All-on-4® treatment concept offers an alternative to complex grafting procedures and provides prosthetic support with just four implants. This can increase the likelihood of treatment acceptance and reduce costs. 

Four reasons to offer your patients All-on-4®

From concept idea to concrete proof

Today, the All-on-4® treatment concept is backed by a wealth of clinical evidence. Follow-up data show high survival rates over a period of 10 years in the mandible and 5 years in the maxilla.1,2

As the research backing the concept continues to grow, so too does the number of people seeking the treatment. This is largely thanks to word-of-mouth endorsement from the many satisfied patients who are already experiencing improved quality of life as a result of the concept.

Dr. Paulo Malo, who conducted the first All-on-4 treatment

Dr. Malo (pictured left) describes his role in developing the All-on-4® treatment concept as “the challenge of a lifetime”, but one that has brought hugely rewarding results, both for him personally, and for his patients. A genuine feat of dentistry, engineering and ingenuity, many who previously criticized the concept are now advocates. 

Today, a wealth of research demonstrates the success of the All-on-4® treatment concept, but only when Nobel Biocare products are combined. Many have tried to mirror this revolutionary concept, but only we have the scientifically documented success to back it up.

Experience the impact for yourself

If you’d like to extend your skills with the All-on-4® treatment concept, we can help. Our global course catalog offers a range of training opportunities, whether you’re starting out with the protocol or looking to refine your technique.

According to Dr. Antony Carbery from Canada, the investment in training is well worth it: “All-on-4® has helped me increase my patient base substantially.

“I can offer a life-changing and cost-effective method that allows more patients to have proper implant treatment.”

More to explore


Malo P, de Araujo Nobre M,Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc 2011;142:310-20

Malo P, de Araujo Nobre M,Lopes A, Francischone C, Rigolizzo M. “All-on-4” Immediate-Function Concept for Completely Edentulous Maxillae: A Clinical Report on the Medium (3 Years) and Long-Term (5 Years) Outcomes. Clin Implant DentRelat Res 2012;14 Suppl 1:e139-50