All on Four® fixed implant support rehabilitation: a masticatory function study

Clin Implant Dent Relat Res. 2014 Aug;16(4):594-600. doi: 10.1111/cid.12031. Epub 2013 Jan 10.


Background: Fixed implant-supported prostheses according to All-on-Four® (Nobel Biocare, Goteborg, Sweden) principles have become an accepted treatment modality in totally edentulous patients, whereas the functional effect of this therapy is limited.

Purpose: The purpose of this study was to evaluate the muscular function of patients totally rehabilitated with All-on-Four.

Materials and methods: This study evaluated 63 patients. Twenty-one patients were successfully rehabilitated with maxillary and mandibular All-on-Four (no dropout implants, satisfactory aesthetic and function demands prosthesis), 21 patients were dentate, and 21 were rehabilitated with double complete dentures. Electromyography was carried out during clenching, nonhabitual and habitual chewing, and rest. All values were standardized as percentage of a maximum voluntary contraction. Data were analyzed by ANOVA to compare groups and paired t-test was used for comparison between sides within each group.

Results: All groups presented symmetric muscular activity. The All-on-Four and dentate groups had a similar muscles surface electromyography (sEMG) contraction pattern, that is, a higher sEMG activity of masseter than temporalis muscles, differing (p ≤ .05) from those of denture group. Not one statistical difference was found between All-on-Four and dentate groups.

Conclusion: The muscular function similarity of All-on-Four and dentate patients shows that this treatment concept may be considered as a good option for oral rehabilitation in edentulous patients.

Keywords: All-on-Four®; electromyography; fixed implant prosthesis; implant; masticatory muscles.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Dental Implants*
  • Dental Prosthesis, Implant-Supported*
  • Denture, Complete*
  • Electromyography
  • Esthetics, Dental
  • Female
  • Humans
  • Immediate Dental Implant Loading*
  • Jaw, Edentulous / rehabilitation
  • Jaw, Edentulous, Partially / rehabilitation
  • Male
  • Masseter Muscle / physiology*
  • Mastication / physiology*
  • Middle Aged
  • Radiography, Panoramic


  • Dental Implants