Full-Arch Implant Rehabilitation Has Come a Long Way

The journey of dental implants began in the 1950s when Per-Ingvar Brånemark, MD, PhD, made a groundbreaking discovery: osseointegration.¹ This process — the direct attachment of bone to an inert, alloplastic material without any intervening fibrous connective tissue — became the foundational principle of modern implantology.² By the 1980s, Adell et al³ demonstrated that full-arch fixed implant prostheses were possible using six to eight implants, though this often required bone grafting. The field took a significant leap forward in 1998 when Paulo Malo, DDS, PhD, pioneered the All-on-4™ concept. This innovative approach allowed full-arch fixed prostheses to be supported by four strategically placed implants, with the posterior implants tilted up to 30° to maximize bone engagement while avoiding critical anatomical structures.

Numerous clinical studies have since validated the effectiveness of the All-on-4 technique in eliminating the need for bone grafting, reducing treatment time, and enabling immediate loading of provisional prostheses.^4-7 As practitioners gained experience, they began adapting this concept to create “All-on-X” variations, where “X” represents the specific number of implants needed for enhanced stability in high-load scenarios. Regardless of the variation, successful implementation requires a minimum of four implants with proper distribution across the dental arch.

Full-arch implant rehabilitation, particularly using All-on-X concepts, frequently incorporates immediate loading protocols that dramatically reduce treatment timelines while enhancing patient satisfaction. These protocols allow clinicians to place implants — whether straight or tilted — in positions that maximize available bone and achieve the primary stability necessary for immediate provisional restorations while achieving proper anterior-posterior relationship.^8,9

The ability to provide immediate provisional restorations has transformed the field of full-arch implant rehabilitation, offering patients immediate function and esthetics. This approach has gained widespread acceptance among patients due to several key advantages: reduced or eliminated need for bone grafting, significantly shorter treatment times, and markedly improved function and esthetics compared to traditional multi-stage surgical approaches that rely on removable interim prostheses.

References

1. Brånemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. experimental studies. Scand J Plast Reconstr Surg. 1969;3:81-100.
2. The glossary of prosthodontic terms: ninth edition. 2017;117:e1-e105.
3. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants.1990;5:347-359.
4. Papaspyridakos P, Chen CJ, Chuang SK, Weber HP. Implant loading protocols for edentulous patients with fixed prostheses: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014;29(Suppl):256-270.
5. Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res. 2012;23(Suppl 6):22-38.
6. Del Fabbro M, Ceresoli V. The fate of marginal bone around axial vs. tilted implants: a systematic review. Eur J Oral Implantol. 2014;7(Suppl 2):S171-189.
7. Del Fabbro M, Pozzi A, Romeo D, de Araújo Nobre M, Agliardi E. Outcomes of fixed full-arch rehabilitations supported by tilted and axially placed implants: a systematic review and meta-analysis. Int J Oral Maxillofac Implants.2022;37:1003-1025.
8. Seok WH, Yun PY, Chang NH, Kim YK. Tilted implants for implant-supported fixed hybrid prostheses: retrospective review. J Korean Assoc Oral Maxillofac Surg. 2023;49:278-286.
9. Kim YK. Prosthesis-implant arch area ratio (PIAAR) – a new geometric paradigm, replacing the current ‘a-p spread’ of a cantilever in full-arch implant prosthesis: a proof-of-concept experiment. J Prosthodont. 2023;32:227-233.

This originally appeared in Chang B. The evolution of full-arch implant rehabilitation. Decisions in Dentistry. 2025;11(3):10-15.