An Interview with Paulo Malo, DDS, PhD

Sixteen years ago, Paulo Malo, DDS, PhD, used his successful protocol—All on 4®—to launch an international dental enterprise, the Malo Clinic. Today, the company is in 16 countries and has 38 facilities. Here, he talks with IDT.

Inside Dental Technology: Would you explain your integrated holistic approach to dentistry?

Dr. Paulo Malo: We must take a holistic approach when we treat people in need of total rehabilitation. For example, we need to know if the patient is psychologically healthy. This may mean some patients need counseling before they undergo a total rehabilitation. If a patient is depressed, he or she often wants to change something drastically to feel better. With many of these patients, we have to be careful because they will never be happy. They are trying to solve a problem with something that is not directly related to the real problem. In addition to a psychological checkup, we need a physical checkup. For example, we obviously need to know if the quality of the bone is poor, due to diabetes, age, or osteoporosis. Additionally, after the full-mouth rehabilitation, some patients may need help in terms of speech therapy.

It is not just making a crown or bridge. This is changing people’s lives. The holistic approach is important for total rehabilitation.

IDT: Do you think how you approach dentistry is the way of the future?

PM: The way we approach dentistry is not possible for every dentist. This is very complex and requires a large team. Also, our approach is focused on edentulous people or people with a ‘terminal dentition’ who need major reconstruction. Most dentists will continue to do the work they are doing now, which is root canals and extractions, a bridge here and there. We will see more practices that have different specialties and dental technicians working together in the same practice.

IDT: Does the Malo Clinic have medical physicians on staff?

PM: Yes. We primarily have two types of physicians, plastic surgeons and the ear, nose, and throat (ENT) specialists. We have psychologists, as well. On the dental side, we have dentists in various areas, but there is an emphasis on restorative dentistry and prosthetics. All departments work together on the edentulous cases. Not every patient needs everybody, but there are cases where we do indeed need everyone. Some patients have had oral cancer treatment and lost their upper or lower jaws. Here is where the holistic approach comes into play. This is where we stand out from the crowd. Most of the products and the major techniques that allow us to treat our patients have actually been invented by the Malo Clinic.

IDT: Why did you develop All-on-4?

PM: Bone is a dynamic organ. Most of your jawbone exists only if the teeth are there. When you chew, the roots of the teeth actually stimulate bone formation. When teeth are extracted, the bone starts to disappear, or resorb away, because it has no function. Now your grandmother is 75 to 80 years old and has no teeth and very little bone, but the only way we can give her fixed teeth is with implants. An implant is like a screw. You cannot screw anything into somebody’s jaw if there is not enough bone or if the bone is too soft. So the only way we can have fixed teeth is after a major bone graft. We would have to take bone from the hip or cranium. Your grandmother who is 85 years old with osteoporosis and diabetes should not go through with this surgery, which is 3 or 4 hours long. But, is it fair to have somebody always saying their dentures hurt and we can’t do anything about it? Well, we have to do implants, but there is no bone, and we can’t bone graft. If there is no bone in the maxilla, can we utilize other bones adjacent to it? And what kind of products needed to be developed to place those specialized implants? So, that’s essentially what we at the Malo Clinic did. We came up with a surgical protocol called the All-on-4 protocol, which allows the surgeon to use the little bone that is left in the maxilla or mandible in the best possible way so that we don’t waste any bone. We once thought that in order to place fixed teeth, we would need at least six to eight implants. Through science and innovation, we now know better. You need only four strategically placed implants, positioned in such a way for enough stability, that allow people to chew normally. We have also developed a specialized bridge that completes the reconstruction. With only four implants, there is a lot of pressure on the bridge, so the bridge needs to be a very strong bridge, yet flexible.

IDT: What is your view of the technician’s role in dentistry?

PM: When you do totally edentulous and full-arch rehabilitation cases, it is absolutely impossible to separate the surgeon, prosthodontist, and dental technician. This is a team. Dental technicians, highly qualified specialized surgeons, and prosthodontists are the three main organs. That would be your liver, your heart, and your lungs. Then you have all the other members of the team who make up the rest. You cannot survive without the liver, heart, and lungs. It is as simple as that.