Dental Asia January/February 2024

USER REPORT
All about the All-on-4
The All-on-4 (AO4) treatment concept enables 4-6 implant fixtures to be
placed into each jaw at one go, providing patients with a full set of teeth in
a day. Dental Asia speaks with Dr Samintharaj Kumar, CEO and founder of
Nuffield Dental where he teaches dentists on the procedure.
From 16-17 Dec 2023, Nuffield
Academy conducted a clinical live
residency for students to gain the
knowledge and competencies about
the AO4 treatment procedure. The
educational branch of Nuffield Dental,
the academy brought its students
through from the concept’s origins
to surgical techniques and hands-on
exercises to gain competencies in the
method.
First developed 26 years ago by Dr Paulo
Malo, the AO4 treatment aimed to transcend
conventional dentistry by offering full-arch
restoration for patients grappling with the
challenges of extensive tooth loss.
The implant technique uses four implants per
arch, where traditional implants use anywhere
from 6-8 implants in each arch. In the long run,
fewer implants would be more cost-efficient
as compared to single dental implants.
Moreover, its immediate restoration enables
the treatment to be performed in one single
surgery, providing an efficient and effective
way to replace a full arch of teeth overnight.
Dr Kumar was granted deep insights into
the methodology, having trained at the Malo
Clinic Lisbon in 2009 under Dr Malo himself.
“Learning from Dr Malo was not just about
acquiring technical skills; it was an immersive
experience into his visionary approach. This
training has been instrumental in shaping
my expertise and philosophy in dental
implantology,” said Dr Kumar.
Dr Kumar at Nuffield Academy teaching students
about the AO4 treatment concept
jawbone. The fusing of the implant into the
jawbone also results in a more convenient
and longer-lasting impact for patients. Instead
of having to remove dentures, AO4 implants
function like a natural set of teeth that requires
no sticky dental adhesive. In addition, AO4
requires no bone grafting for many patients,
which is common in traditional implant
procedures.
On the first day of Nuffield Academy’s training,
students underwent lectures in basic surgical
and prosthetic principles. They witnessed
a live surgery for unimaxillary full-arch
rehabilitation with immediate loading which
covered the AO4 surgical in accordance with
protocols from Malo Dental.
As an affiliated clinic, the partnership
between Nuffield Dental and Malo Dental
has benefitted patient care by bringing
world-class methodologies to the forefront
of its treatments, where it has become a
cornerstone of Dr Kumar’s practice at Nuffield
Dental.
adept in both the science and art of
this procedure,” said Dr Kumar. “For
our students, this association is not
merely academic; it is an immersive
foundation into the highest standards
of dental excellence, providing them
with a travelator that will accelerate
their pace of developing their own
practices.”
Dr Kumar also believes that AO4
treatment is profound where the
emotional and psychological uplift patients
experience is as significant as the clinical
outcome, a sentiment echoed in patient
satisfaction studies.
“This full-arch restoration technique is not
merely a dental intervention; it is a catalyst
for renewed self-esteem and an enhanced
quality of life, as documented by Brånemark et
al. in their foundational work on the subject,”
he said. Shortly after his training, Dr Kumar
completed his first AO4 surgery on a family
member who to date has no clinical issues
and is enjoying eating what she was unable
to before.
The implants of the AO4 procedure are placed
at an angle providing for increased contact
by using the natural support of the patient’s
“By incorporating the AO4 into our educational
offerings at Nuffield Academy, we are
nurturing a cadre of dental professionals
Dr Kumar conducting a lecture
DENTAL ASIA JANUARY / FEBRUARY 2024 45