Bringing All-on-4 back to its roots

Dr Larry Benge is one of the pioneers of All-on-4® in Australia and has seen the popularity of the protocol grow significantly in recent times. Now, with the launch of Next Smile™, he sees an opportunity to guide clinicians offering the procedure a path back to its roots.

I've been on the All-on-4^® journey with Professor Malo since 2007 when I first went to Portugal and I've seen what the gold standard of All-on-4^® is in terms of how it should be done. Having been on this journey, I've also seen first-hand the problems that can occur and I've also seen how very rewarding it is when the process is done in a particular way.

What's happened now, though, is that like every other technique in dentistry, when something comes into vogue, everybody jumps onto the bandwagon. The result is that the All-on-4^® procedure is not being done well by many, many people because they often take a concept and they change it to suit their own ends and that has consequences.

In general terms, what I've seen over the years - and I managed Asia for a long time for the Malo Clinic - are problems caused by the procedure being done incorrectly. And it's not like when you do a filling or a crown and you have a complication, this is big in terms of the problems that can occur if the procedure doesn't go well. So this group we've formed, Next Smile, has the opportunity to get clinicians together that are highly trained, that have gone and invested time in learning and are all committed to a particular gold standard of quality. We all use the same implant, we use the same procedures, we follow the same protocol - the Malo protocol, the protocol with the research behind it that has been tried and tested over many years - and combined, this results in very predictable outcomes for patients.

Next Smile was born based on the need to establish a group that had serious clinical credibility that could first and foremost provide a great platform for educating dentists on the Malo protocol. Most dentists only do one or two All-on-4^® cases a year, if that, whereas the members of this group are doing over a thousand arches a year. It's a significant difference in surgical ability. We want to provide a pathway for all dentists interested in incorporating All-on-4^® into their practices a way to ensure their patients receive the outcomes they are investing in.

So this is really about taking back All-on-4^® and when patients buy All-on-4^®, helping to ensure they're getting what they're paying for - a continually researched, tried and tested solution. Because it's a big investment for the patient. It's a lot of money; a lot of people go into their superannuation to have this treatment and they deserve to receive what they're paying for.

And, personally, by me being really at the tail end of my career, Next Smile is a chance to create a legacy that helps bring young clinicians - and so far we have some very impressive young dentists - through significant training programs in a great environment. So it becomes a legacy for someone to take over when I retire. So all those things together have been contributing to this project.

We also thought that if we become the leading All-on-4^® body in this country, then we now have the reputation to allow us to control the results out there a little better and we would also benefit from being in a bigger group, with obvious buying power in terms of implants, components and all those sorts of things. So that's really been the journey.

Peter Jeffers was running Nobel Biocare at the time we were discussing forming this group, so I head-hunted him to run it. He's very experienced in the industry.

My relationship with Paulo Malo goes back many years and I speak to him two or three times a day, every day of the year. So we're always working on how the protocol could be improved and developing strategies for teaching it, so that gives me my personal stimulation as well because not only do I work on the clinical side, I also work on the business side.

So we've just moved into a huge super centre in Melbourne which has two operating theaters - it's like a hospital - so it's an environment that oral surgeons can use with proper theaters, proper beds, proper recovery. It's in an environment that's a very safe environment. No stone is unturned. The laboratory's also there, so it's a one stop shop. Any complications - and we know there can be complications - it's fixed on the spot so you don't have to go anywhere else. So I think that's peace of mind for people that we look after from beginning to end.