About the procedure
In the All-on-4 concept, a fixed prosthesis is placed on 4 angled implants in a jaw that is completely edentulous or whose teeth cannot be saved. In most cases, temporary fixed teeth are fitted the same day; the patient is never left without teeth.
After a 3–4 month osseointegration period, the permanent zirconia prosthesis is delivered on the second visit.
The All-on-4 decision is made by evaluating the CBCT scan together with the condition of the existing teeth; patients with teeth that can be saved are first told about that option. A temporary fixed prosthesis is fitted if the implants reach sufficient initial stability; if not, integration is awaited with a temporary removable denture. The permanent prosthesis is made at the second visit, when gum contour, speech, and lip support are reassessed.
- ✓Fixed teeth the same day
- ✓Freedom from removable dentures
- ✓A full arch with few implants
Suitability
Who is it suitable for?
May be suitable
- ✓Patients with no remaining teeth in one or both jaws.
- ✓Those whose teeth cannot be saved because of gum disease or advanced decay.
- ✓Patients whose full denture does not stay in place and who struggle with speaking and eating.
- ✓Patients who cannot have many implants placed in the back because of bone loss, but who have adequate bone at the front.
- ✓Patients whose general health is suitable for surgery and who can attend check-ups and the second visit.
Should be postponed or is not suitable
- —Insufficient bone for implants even in the front; extensive grafting or different implant options are needed.
- —Uncontrolled systemic diseases, bisphosphonate use, and a history of radiotherapy to the jaw.
- —Patients who cannot give up heavy smoking; the risk of implant loss rises noticeably.
- —Severe bruxism; separate planning is needed because of fracture during the temporary prosthesis period and overloading of the implants.
The final decision on suitability is made after a physician examination and tests.
Process
How does it proceed, step by step?
- 01
Scan and prosthesis plan
Bone is measured with a CBCT scan, and the teeth to be extracted and the implant angles are determined; the temporary prosthesis is prepared in advance from the existing teeth or denture.
- 02
Surgery day
Under local anesthesia or sedation, the necessary extractions are done and four implants are placed; an impression is taken.
- 03
Temporary fixed prosthesis
The same day or the next day, the temporary prosthesis is screwed onto the implants; bite and speech are checked.
- 04
Check and return
Within 5–7 days the sutures are removed, and the prosthesis and hygiene are checked; the patient returns home with diet and care instructions.
- 05
Integration and remote follow-up
A soft diet continues for 3–4 months; remote follow-up is done through photographs and a panoramic X-ray.
- 06
Permanent prosthesis
At the second visit, an impression, a tooth try-in, and delivery are done; the screw access holes are sealed and a care plan is given.
Recovery
Recovery timeline
Day 1
Swelling, bruising, and soreness are expected; cold compresses are applied, and you eat liquids and puréed foods.
Days 2–3
Swelling is at its peak; soft foods, plenty of fluids, and the prescribed medications continue.
Week 1
The sutures are removed and the bruising fades; you begin to get used to speaking with the temporary prosthesis.
Month 1
The gums heal; the soft diet continues, avoiding raw vegetables and tough meat.
Months 3–4
Integration is complete; the second visit for the permanent prosthesis takes place.
Year 1
Bone around the implants is evaluated with a follow-up X-ray; the prosthesis is cleaned and the screws are checked.
Timeframes are averages; they vary by person and by the scope of the procedure.
Results
Before / After
Before and after examples of All-on-4 are shared during the consultation.
We show our patients' photos only within the scope of their written consent and in one-on-one consultations; we respect the wishes of patients who prefer not to be published on the open internet. Let us send you results from cases similar to yours together with the physician's assessment.
Let us be open
Risks and points to consider
Every medical procedure carries risks. The points below are the main known issues for this procedure; a risk assessment specific to you is made during the consultation.
- Failure of one or more implants to integrate; it is most often seen in the first months and requires replanning.
- Fracture of the temporary acrylic prosthesis from hard food; this is why a soft diet is mandatory during the integration period.
- Inflammation around the implants and gum inflammation under the prosthesis; it develops when cleaning under the prosthesis is neglected.
- Numbness of the lip and chin related to nerve proximity in the lower jaw; mostly temporary, rarely permanent.
- Over time, wear of the prosthetic teeth, screw loosening, and changes in lip support; the prosthesis may need to be replaced over the years.