NMDA Journal Summer 2020

New Mexico Dental Journal, Summer 2020 10 Musings The All on Four By Burt Melton, DDS “All on Four,” sometimes expressed as “AO4,” is dental slang that has become a term used for a fixed dental prosthesis for edentulous patients, supported by four (sometimes more) dental implants placed in a dental arch. The prosthesis can be maxillary, mandibular, or both dental arches opposing each other. The term “All on Four” was coined by Dr. Palo Maló of Lisbon, Portugal after taking the classic “Branemark” implant supported restoration to new heights and dimension. He was seeking a “lesser but adequate res- toration” for people needing dental implant reconstruction but could not afford the tra- ditional, more costly approach to free patients from poor fitting removable den- tures. AO4 is a stripped down approach that could minimally qualify as a “dental success” at a greatly reduced cost. Subsequently, an international dental implant company took his concept and term and used it to create a marketing buzz that has become an everyday dental treat- ment modality. The company’s goal (and that of Dr. Maló) is to create a way to pro- vide, sell, and market more dental implants through dental practitioners to treat the greater public. Almost anyone who has few or no remaining teeth is disgusted with, or not wanting complete or partial dentures may possibly afford this new solution. In many dental circles, dentists are not clini- cally fulfilled until they can say they have “done one” almost like announcing they have lost their “dental implant virginity.” Dr. Maló then found himself in a race in the international and United States dental market with companies like Clear Choice to gain and control market share to own, franchise and/or teach practitioners around the world. His concept to eliminate edentulism today, practiced by many oral surgeons, prosthodontists and restoring dentists to treat the greater public really caught on. However, the concept has become heavily controlled by dental laboratory technicians who make clinical calls they have not been