All On 4 Two Years On And More: How Are Patients Feeling About It?

Mayan skulls dating to 600 AD have been unearthed with replacement teeth made of materials like seashell and jade, fused to the jawbone.

How to deal with the debilitation of missing teeth is far from a modern problem. It’s been a human consideration for thousands of years that began its reshaping in the 1940s.

It was then that researchers observed that titanium implants, placed in the bones of animals, were impossible to remove after a few weeks; an echo over two more decades before it was put to practical use.

Swedish physician and researcher Per-Ingvar Brånemark had both a degree and a PhD in medicine, but no dental accreditation. Yet it was he who permanently and resoundingly transformed dentistry.

Brånemark created the first titanium implant. He described this fusing of bone to precious metal as ‘osteointegration’ – the process by which it is known today.

And it happened during an experiment that was deemed a failure given this ‘disappointing’ result.

The test was originally designed to have the ability to cleanly remove the titanium pin – a hugely expensive material at the time and the reason for its reuse. Like those before him, Brånemark noticed the way in which bone had quickly integrated with the titanium tube; the difference being that he was the first to envisage its incredible potential.

The first recipient of Brånemark’s dental implants was 35-year-old Gösta Larsson: a patient with the complexities of acute chin deformity, a cleft palate, severe jaw misalignment and congenitally missing teeth.

The year was 1965.

The space race was in full swing, and February marked the assassination of Malcolm X. The war in Vietnam was escalating, and it was the year the Rolling Stones would complete their fourth European tour. It was a time of US race riots, and the passing of the Voting Rights Act. For the first time NASA’s Mariner 4 flew by Mars, and Muhammad Ali defeated Sonny Liston in one of the most controversial boxing matches to this day. It was a year of social and scientific breakthroughs; so ripe for the four mandible dental implants that Brånemark placed.

They were a success.

Even so, it was years before Brånemark’s work was accepted by the scientific, dental and medical communities.

Although he was Professor of Anatomy at the University of Gothenburg, it refused to fund his research, so Brånemark opened a private clinic in order to treat patients. In 1978 he formed a partnership with the Swedish company Nobel Biocare, and his dental implants were finally under manufacture.

It took until 1983, and a conference in Toronto for the importance and validity of his work to gain recognition.

Twenty-five years after his groundbreaking procedure, Larsson’s original implants helped him to overcome hearing loss with a bone-anchored hearing aid: an innovative application of osteointegration at the time.

The courage of Gösta Larsson in this pioneering procedure cannot be overlooked. And these life-changing implants served him for forty-one years, until his death in 2006.

Eventually, Professor Brånemark’s work awarded him many honours – including, in 1992, what it often referred to as the mini-Nobel Prize: the coveted Swedish Society of Medicine’s Soederberg Prize. He also received the Swedish Engineering Academy’s equally prestigious medal for technical innovation, along with the Harvard School of Dental Medicine Medal.

The tireless work and enduring change brougnt to dentistry by Professor Per-Ingvar Brånemark is illustrated by the more than 30 honorary positions he held throughout Europe and North America. They include the UK’s Honorary Fellowship of the Royal Society of Medicine; an honorary doctorate from the European University of Madrid; and in 2011 the European Inventor Lifetime Achievement Award.

Brånemark died in 2014 at the age of 85. Since then, his son Rickard, a Doctor of Orthopaedic Oncology Orthotics and Prosthetics has pioneered the use of titanium implants in artificial limbs.

Professor Per-Ingvar Brånemark’s greatest achievement of all is in the lives of millions of people who benefit from his research, ingenuity and dedication every day. It is because of him, that people all over the world are literally able to talk the talk, and walk the walk.

A 26-year-old had their top molars removed at age 20. It made chewing difficult and appearance personally embarrassing. After researching and budgeting, the procedure was done and this is what they have to say:

“The day of the surgery I didn’t really have any pain and the next day wasn’t that bad either – just a little swelling. On the third day, I experienced serious pain, so much so that I began regretting my decision to have the procedure performed. I called the office and they assured me the pain would go away, and fortunately they were right. There was an adjustment period to having All-on-4 placed, but two years later, the implants feel completely natural. I do have to use a waterpik after every meal, but aside from that, I have the best smile and oral health that I have ever had. The procedure is not without its drawbacks, but I can honestly say that having it done was the best decision I ever made.”

All On 4 has been available since 1998, after years of research by Portuguese dentist and entrepreneur Dr Paulo Malo.

For patients missing only one or two teeth, dental implants work well; for those missing many, or all their teeth, prior to Dr Malo’s innovation, dentures – that often cause gum irritation, a sore mouth and limited choice of foods – was their only choice.

After having suffered for 40 years with bad teeth, another recipient of All-On-4 says, “Another set of teeth to get used to, but a ton better than my old, rotten teeth! So happy I went through with it! No more fillings, root canals, abscesses, crowns, extractions, or pain! Just cleanings from now on!! If you’re thinking about doing this, do your research. It’s not quick and painless but it’s worth it in the end. 1000%.”

It was the combined technical skill of Nobel Biocare scientists and Dr Malo’s research that resulted in the most comfortable, aesthetically pleasing and healthiest way for multiple teeth to be replaced. All-On-4 has such advanced technique that it can be used for patients experiencing bone loss, with growth stimulated at the implant sites.

It is this, along with the positioning, the number of required fixtures, and a shortened healing time that mark the differences between All-On-4 and regular dental implants. Its origination allows dentists to implant at an angle, avoiding the sinus cavity and any low-density bone areas as insertion sites.

The most comprehensive study into the durability of the All On 4 was conducted between 2011 and 2021.

Almost 250 All-On-4 patients were tracked over this ten year period.

There are a number of reasons that all dental implants have the possibility of rejection or failure. They range from the age of the patient, to their use of tobacco, alcohol, or necessary pharmaceuticals as well as any chronic infection or inflammatory conditions. It is also dependent on the overall home oral hygiene, along with professional attention via regular dental appointments.

The study found that 98% of the implants remained stable and functional after five years; with 95% still functioning after ten.

Ninety-five percent of the monitored patients had experienced no implant failure at all.

It’s an outstanding success rate. Although it cannot be guaranteed for longer than a decade, the results also found that 99% of the attached crowns were still in good condition; however, eventually prosthetics often need replacing.

Naturally, there will be patients with unfortunate experiences of the All-On-4 technique that do not reflect these findings.

Nothing in the world is perfect. Results are also reliant on many factors, including the skill and precision of the clinician, as well as the appropriate, ongoing and quite diligent aftercare. Nonetheless, as a replacement for missing teeth and an alternative to full or partial dentures, investing in your better oral health with even the new option of All On 4 Plus is well worth discussions with your dentist.

From the father of modern implantology himself, Professor Per-Ingvar Brånemark, “No-one should die with their teeth sitting in a glass of water.”

Note: All content and media on the  Diggers Rest Dental House website and social media channels are created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.