Immediate implantation and immediate loading were initially met with skepticism by the dental community when they first came into use 25 years ago, and for quite some time after their introduction many dentists still argued against their use on the basis of a wide variety of factors, including a higher failure rate, greater bone loss, and aesthetic and function problems, which were often caused by quickly made and poorly fitting prostheses.

Nonetheless, the demand by patients for quality treatment in a significantly reduced timeframe has seen the steadily increased use of these techniques over the years. This has resulted in new approaches being developed step by step and their ongoing refinement and improvement. The requirement to contain costs has lead to a certain standardization of protocols, with the result that treatment approaches have become more uniform, which in turn has increased the practicality of using these techniques, even if some dentists can still have a certain degree of doubt in specific clinical contexts.   

All of these considerations have lead the author to develop new methods and concepts that obtain results that are always more predictable as well as being tailored for the individual characteristics and needs of every single patient; these techniques and concepts will be presented as we review the last 25 years of immediate implantation and loading.

Learning Objectives

• When it is correct to use immediate post extraction implantation, and when it isn’t
• The influence of implant and abutment designs on the final result
• The importance of primary stability for immediate loading and the correct ways to measure it

Dr Degidi graduated from the University of Bologna in 1981 and he is both MD and DDS. He is an Adjunct Professor, Postgraduate Master in Clinic Implantology, University of Bologna. Dr Degidi has extensively published (more than 137 articles on PubMed) on his fields of interest: immediate loading, implant aesthetics, biomaterials, primary stability. He is the inventor of the WeldOne Concept (intra oral welding) as well as of the Conometric Concept (cementless fixed restorations). Currently he is in private practice dedicated to implant surgery and prosthetics.

Qualifications: MD DDS

The loss of teeth is an early sign of aging, with an undeniable impact on the global population daily life and social interaction.

Through innovation, along with continuous clinical and scientific research, it has become possible to treat virtually every edentulous case with a highly functional and aesthetic fixed solution, increasing the quality of life for these patients. The MALO CLINIC protocol for totally edentulous rehabilitation has allowed thousands of clinicians around the world to achieve this essential goal for their patients.

The oral rehabilitation of these patients has two components: surgical and prosthetic. The surgical stage follows the All-on-4® surgical protocol - an innovative technique developed in the early 90’s at MALO CLINIC that allows for immediate function, full-arch, implant supported prosthetics. This widely applicable surgical protocol allows for a simple and immediate rehabilitation with a provisional bridge fixed on 4 implants, with minimum cantilevers, 3-4 hours after the surgery.

The final prosthodontic work is also of extreme importance. The MALO CLINIC Bridge (MALO CLINIC Protocol prosthetic stage) was developed to give a high aesthetic, precise and consistent result, following a simple clinical and technical procedure.

The MALO CLINIC Protocol for the totally edentulous has proven to be highly successful, with 98% success rate for the All-on-4® surgical protocol in the mandible (up to 10 years follow-up) and a 98% success rate for the All-on-4® surgical protocol maxillary techniques (up to 5 years follow-up).

Learning Objectives

• To understand the current treatment options for patients with failed dentition
• To understand different surgical and rehabilitation protocols and their outcomes when rehabilitating patients with implant supported restorations
• To understand the principles, advantages and biomechanics of the All-on-4® concept
• To learn the techniques of surgical implant placement, abutment connection and temporization, as well as the final prosthetic steps

Professor Paulo Malo received his dental degree from the Faculty of Dental Medicine at the University of Lisbon in 1989. He founded the MALO CLINIC in 1995 where he developed the MALO CLINIC Protocol (surgical techniques and innovative products such as the All-on-4® treatment concept, a new Zygoma implant and protocol, the NobelSpeedy implant and the advanced technical solution MALO CLINIC Bridge), recognized worldwide by the dental and medical community as setting a new standard in Fixed Oral Rehabilitation.

Professor Malo is a visiting professor at several universities, has published numerous scientific journal articles and is co-author of several textbooks. He lectures regularly at international conferences and has also received several distinctions and awards for his medical/dental breakthroughs and his management, leadership and entrepreneurial skills.

Qualifications: DDS PhD

When next Monday morning we meet our patients, what we need are solutions and treatment plans that are not technique sensitive, and that are predictable, minimally invasive and possible at a reasonable cost without any compromise in quality. Obtaining these combined benefits may seem impossible; in reality it is readily achievable. Marco Degidi will examine the pros and cons of different approaches, emphasizing synergies and possible drawbacks. Particular focus will be given to the WeldOne and Conometric Concepts, both created by the presenter. We all know very well how important it is for implants to be rigidly splinted during the healing phase and this cannot be achieved with a simple acrylic restoration. Thanks to the intraoral welding technique, it is a simple task to manufacture directly inside the patient’s mouth a rigid and reliable titanium framework that provides predictable support for an immediate restoration. The Conometric Concept makes it possible to manufacture fixed implant-supported restorations that do not require any screws or cement. The Conometric Concept can be used for single teeth, partials or full arches, and with temporary or final prostheses that are either immediately or stage loaded. Many types of restoration materials can be used. The prosthesis can be removed only by the dentist, not by the patient. Drawing on his extensive clinical experience, the speaker will explore these topics and present the scientific basis for his conclusions.

Learning Objectives

• Guidelines for the correct construction of an electrically welded prosthesis
• Indications for using conometrically fixed prostheses
• How to parallelize abutments to a conometric prostheses
• How to construct conometric prostheses from different types of material
• Temporary prostheses and durable prostheses: inclusion criteria

Dr Degidi graduated from the University of Bologna in 1981 and he is both MD and DDS. He is an Adjunct Professor, Postgraduate Master in Clinic Implantology, University of Bologna. Dr Degidi has extensively published (more than 137 articles on PubMed) on his fields of interest: immediate loading, implant aesthetics, biomaterials, primary stability. He is the inventor of the WeldOne Concept (intra oral welding) as well as of the Conometric Concept (cementless fixed restorations). Currently he is in private practice dedicated to implant surgery and prosthetics.

Qualifications: MD DDS

This innovative technique developed at the MALO CLINIC allows a terminal dentition or a full edentulous patient to have a fixed provisional bridge with minimum cantilevers just few hours after surgery. The implants are placed in immediate function allowing patients to recover their masticatory function on that same day with good aesthetic results.

We are, however, sometimes faced with cases that are more challenging and present a higher level of complexity requiring some variations in the standard protocol. For instance, in severely atrophic maxillae, this technique is complemented with Zygoma anchored implants when necessary.

This session will review the MALO CLINIC Protocol's principles and present the updates, its most recent technical advancements and new products to solve extremely complex cases (maxilla and mandible). In fact, continuous development of new implant and component designs aiming for an improved clinical performance also leads to the applicability of new implant lines to the MALO CLINIC protocol surgical principles, ultimately allowing for the rehabilitation of an even wider range of cases. Clinical examples will be showed to illustrate the wide evidence-based application of the technical and scientific novelties the All-on-4® surgical protocol has gone through.

Learning Objectives

• To recognize the evolution this treatment concept has gone through and the new products developed to improve the technique and overcome extremely complex cases
• To know the indications for the use of the modified technique using Zygoma implants
• To evaluate the pros and cons of the Extra-maxillary technique
• The All-on-4® evolution (NobelSpeedy, NobelParallel CC, NobelZygoma)

Professor Paulo Malo received his dental degree from the Faculty of Dental Medicine at the University of Lisbon in 1989. He founded the MALO CLINIC in 1995 where he developed the MALO CLINIC Protocol (surgical techniques and innovative products such as the All-on-4® treatment concept, a new Zygoma implant and protocol, the NobelSpeedy implant and the advanced technical solution MALO CLINIC Bridge), recognized worldwide by the dental and medical community as setting a new standard in Fixed Oral Rehabilitation.

Professor Malo is a visiting professor at several universities, has published numerous scientific journal articles and is co-author of several textbooks. He lectures regularly at international conferences and has also received several distinctions and awards for his medical/dental breakthroughs and his management, leadership and entrepreneurial skills.

Qualifications: DDS PhD