Short answer: All-on-4 is an approach in which a fixed row of teeth is placed, usually on four implants, in a jaw where all the teeth are missing or are about to be lost. The back implants are often placed at an angle to make use of the existing bone. It is not suitable for everyone; the decision is made after the bone condition, general health and oral care habits have been assessed through an examination.
What kind of approach is all-on-4?
In conventional implant treatment, more implants may be planned depending on the number of missing teeth. With the all-on-4 approach, all the teeth in a jaw are replaced with a one-piece prosthesis fixed on a limited number of implants. The front implants are usually placed upright and the back ones at an angle. This angled placement can help reduce the need for bone grafting in some patients; however, this does not apply to every patient.
The prosthesis is fixed; the patient does not take it in and out. When necessary, it can be removed by the dentist for maintenance and check-ups. For an overview together with the other options used for people with no teeth, see our article on treatment options for people with no teeth.
Who is it considered for?
All-on-4 may generally come up in the following situations:
- People who have lost all the teeth in one jaw
- People whose remaining teeth cannot be saved because of advanced gum disease or decay
- People looking for a fixed option because of problems with a removable full denture
- People with limited bone in the back area for whom planning with angled implants is possible
On the other hand, some situations call for more careful assessment or may require a different plan: these include uncontrolled diabetes, the use of certain bone medicines, a history of radiotherapy to the head and neck, heavy smoking, a severe teeth-clenching habit and very limited bone. That is why the decision is made not by looking at a single image but through a detailed examination and imaging.
How does the process work?
- Examination and imaging: The bone structure is assessed with an examination of the mouth, a panoramic X-ray and usually 3D imaging. General health and the medicines being taken are reviewed.
- Planning: The position and angle of the implants and the design of the prosthesis are planned. Digital planning tools may be used. We explain this stage in our article on digital planning for implants.
- Surgical stage: If needed, the remaining teeth are extracted and the implants are placed.
- Temporary teeth: If the initial stability of the implants is sufficient, a temporary fixed prosthesis can be attached to the implants within a short time. This is not possible for every patient; the dentist decides by assessing how firmly the implants are held in the bone. If it is not suitable, a different temporary solution can be used during the healing period.
- Healing period: There is usually a wait of a few months for the implants to fuse with the bone. During this time it is important to eat soft foods and follow the recommended care rules.
- Permanent prosthesis: Once integration is complete, an impression or scan is taken and the permanent prosthesis is made and fitted.
Expressions such as "teeth in a day" do not reflect the whole of this process. Although temporary teeth can be fitted within a short time in some suitable patients, the permanent prosthesis and full healing take time. For general information on planning, take a look at our article on implant planning.
Possible risks
As with any surgical procedure, the all-on-4 approach also carries some risks. These include an implant not fusing with the bone, inflammation around the implant (peri-implantitis), fractures in the prosthesis or loosening of screws, and difficulties during the period of getting used to speaking and chewing. Because the whole jaw is supported by a limited number of implants, a problem with one implant can affect the entire prosthesis. That is why regular check-ups and good oral care are especially important.
Daily care
- Clean the underside of the prosthesis where it meets the gums and the area around the implants every day. A water flosser, interdental brushes and special floss can help in these areas.
- Brush at least twice a day with a soft-bristled brush.
- Avoid biting hard objects; if you have a teeth-clenching habit, tell your dentist, as a protective guard may be recommended.
- Avoid smoking.
- Attend check-ups at the intervals your dentist recommends; when needed, the prosthesis can be removed for professional cleaning.
For detailed cleaning tips, see our implant cleaning guide. We compare the options for one or a few missing teeth in our article implant or bridge.
The adjustment period
In a treatment where all the teeth are replaced, getting used to the new teeth can take time. In the first weeks, some sounds may come out differently when speaking, the lips and cheeks need to adapt to the new structure, and chewing may feel different. In most cases these symptoms ease over time. People moving from a removable denture to a fixed structure may notice changes in their eating and speaking habits. It is important to tell your dentist about any discomfort during the adjustment period at your check-up appointments; small adjustments can be made to the prosthesis if needed.
Frequently asked questions
Can you get teeth in a single day with all-on-4?
In some suitable patients, temporary fixed teeth can be fitted shortly after the implants are placed. However, this is not possible for every patient, and the permanent prosthesis is made after the implants have fused with the bone.
Can all-on-4 be done for everyone?
No. Bone condition, general health, medicines being taken, smoking and oral care habits are assessed. For some patients a different number of implants or another prosthesis option may be more suitable.
Can the all-on-4 prosthesis be taken out?
The prosthesis is fixed and is not taken out by the patient. When necessary, it can be removed by the dentist during check-ups and maintenance.
What can you eat after all-on-4?
Soft foods are preferred during the healing period. The return to a normal diet is made on the dentist's advice according to the condition of the implants; even after the permanent prosthesis, you need to avoid biting very hard objects.
How can you find out what suits you?
The information here is general; the right option for you is determined through an examination and the dentist's assessment. For appointments and directions, see our contact page.
