The Ultimate Guide to All on 4 Dental Implants
When all your teeth are missing, getting one implant for each tooth is not only expensive but also an extensive procedure. Hence, the All-on 4 implant procedure is a great alternative to replace all missing teeth with only four implants.
But what are all-on-4 dental implants?
The all-on-4 dental implant is a technique that replaces the missing teeth with a bridge or a denture using four titanium posts in each jaw.
This article discusses the procedure, cost, and complications of all-on-4 implants.
All-on-4 Dental Implants
The All-on-4 dental implant system is a modern option for a full mouth restoration process using only four implants to retain a full prosthesis.
It provides esthetics and functions just like natural teeth.
All on 4 Dental Implants
Together with his colleagues, Paulo Malo, a dentist, developed this concept in 2003 and collaborated with Nobel Biocare, one of the leading implant companies in the world. 
They restored a full-arch using only four titanium implant posts by placing two posts vertically in front and two tilted posts in the back.
These four posts can support an entire arch of 12 to 14 teeth.
Am I a Candidate for All-on-4 Dental Implants?
Implants are titanium posts that act as imitation roots inside the jaw that support the bridge or denture for patients with missing teeth.
Dental implants provide better esthetics and improve the dental and physical health of the person.
An implant-supported prosthesis like the one used in the All-on-4 procedure allows for:
- fewer diet restrictions,
- improved speech, and
You may be a suitable candidate for All-on-4 if you are healthy and will be able to tolerate the stress of anesthesia and surgery.
People who are on medications like steroids or cancer therapy may not be good candidates for All-on-4.
Find more details below!
All-on-4 is an ideal option when you have: 
✅ Missing teeth
✅ Healthy gums
✅ Good oral and general hygiene
✅ Sufficient jaw bone structure (~10 mm in each arch)
All-on-4 is not suitable if you have:
✅ Thin jaw bone
✅ Soft and brittle bone
✅ Parafunctional habits 
✅ Chronic diseases such as cancer, diabetes, hemophilia, and autoimmune diseases
Difference Between All-on-4 & Conventional Implants
The most significant difference between these two is that conventional procedures require several surgeries and prolonged healing time.
The all-on-4 is an improved technology of traditional implants. It can replace natural teeth with only four titanium posts per arch.
Difference between the all-on-4 and conventional implants
|Number||Four titanium posts per arch||Each tooth with one implant|
|Angle||Placed at an angle of 45°||No angulation|
|Duration||4-6 months||4-6 months|
|Bone graft||Bone graft is rarely needed ||Bone graft is needed|
|Procedure||Minimally invasive||Multiple surgeries|
|Cost||Affordable >price because of less number of implants||Expensive if you replace each missing tooth with an implant|
What Is the Procedure for All-on- 4 Dental Implants?
The All-on-4 implant system is a quick way to restore missing teeth with a new set.
After all necessary extractions and appropriate healing, your dentist surgically inserts four titanium posts into your jaw and places a permanent denture over these posts.
All on 4 Dental Implant Procedure
All-on-4 treatment procedure consists of 2 phases: surgical and rehabilitation.
After taking records and treatment planning, the whole procedure takes about 2 hours per arch, or approximately 4 hours for the whole mouth.
Each patient is different, so additional time may be needed for the procedure.
Step 1: Evaluation and Treatment Planning
Your dentist examines your mouth and the remaining teeth by taking dental x-rays and CT scans.
These scans check your bone density and help the dentist plan the treatment procedures.
There are two ways to perform All-on-4 surgery. They are: 
- Conventional surgery by raising a gum flap
- Guided surgery or flapless procedure
You can discuss the proposed treatment plan, cost, and procedure with your dentist during this stage.
Step 2: Surgical Procedure
✅Step 2A: Local Anaesthesia
Your dentist will use local anesthesia to numb the area and possibly recommend a method of sedation.
Sedation promotes relaxation while the local anesthesia prevents any pain during surgery.
Your dentist will extract any remaining teeth, clean the gum and socket.
✅ Step 2B: Conventional Surgery
It is a traditional method in which your dentist creates an incision on the gum to expose the bone.
Dentists drill holes in the bone to insert the implant post. All-on-4 surgery involves placing two posts in front and two at the back on both sides of the arch.
This strategic placement supports the bridge or denture with minimal implants.
Implants in the upper arch placed in the back are kept at 30 to 45° to bite plane to avoid damage to the sinus. 
The doctor slightly tilts the implants towards the tongue in the lower arch to prevent damage to the primary nerves.
After implant placement, your dentist will stitch the flaps back together.
✅ Step 2C: Guided Surgery
All-on-4 surgical guides act as templates for surgery. A surgical guide is made beforehand by analyzing anatomy via pre-surgical imaging.
The guide helps avoid sinuses or nerves when the titanium posts are placed. A guide used on the lower arch can also help retract the tongue during surgery.
Surgical guides can help prevent surgical complications.
After surgery, the dentist will take an impression or hard print of your teeth.
Using this hard print, they will fabricate the temporary dentures with acrylic resins.
You can use a temporary denture on the same day of surgery (2-3 hours after surgery) or the next day.
Advantages of the immediate denture after surgery are:
- Minimal bone loss
- Better healing
- High success rate
- High stability
- Comfortable chewing
- Rapid restoration of function and esthetics
The healing of the gums and osseointegration of the bone occurs about 3-6 months after surgery.
Osseointegration is the process in which the bone cells attach to the implant. 
It forms a strong bond between the jaw bone and the implant surface and provides stability.
Titanium posts are biocompatible and can bind to the bone. It has high strength, rigidity, and fracture toughness; hence, it is a good hard tissue substitute.
Once osseointegration is complete, your dentist will check your bone condition and the implant’s stability before fabricating the final permanent denture or bridge.
The entire arch of teeth is replaced on top of four titanium posts.
Following are the steps in the fabrication of the final denture:
Step 1: Removal of the provisional denture.
Step 2: Preparation of an impression with a soft putty material to make a stone model of the mouth. The lab uses the stone model of the mouth to fabricate a custom prosthesis.
Step 3: Preparation of resin pattern over the implant and taking their CAD/CAM scans.
Step 4: Fabrication of final denture using metal acrylic, ceramic, or zirconia crowns on titanium framework.
Step 5: Placement of the final permanent denture over the posts and tightening of the screws.
These dentures mimic natural teeth, provide an excellent esthetic appearance, and are comfortable to wear.
The dentures are fixed prostheses, and only your dentist can remove them.
Your dentist will give you specific instructions after treatment.
You may experience swelling, bleeding, and bruising in your mouth immediately after surgery.
The doctor will prescribe pain medications, antibiotics, and anti-inflammatory drugs to take for about 5 to 10 days after surgery.
After all-on-four procedures, the total recovery time is 2 to 3 days, and you can resume work within 3-4 days.
The following are the instructions to maintain all-on-4 teeth:
- Eat soft foods
- Maintain good oral hygiene
- Brush & floss twice a day
- Avoid smoking
- Go for regular checkups
It is essential to visit your dentist regularly for implant maintenance.
Soft Food Diet Post Dental Surgery – Tips from our U.S. registered nutritionist
Survival Time of All-on-4 Implants
The survival rate of dental implants depends on proper care and good oral hygiene methods.
However, before undergoing the procedure, the following factors should be viewed accurately:
- The quality of bone
- Number of implants
- Length of implant
- Patient’s systemic conditions
Advantages and Disadvantages of All-on-4 Implants
The all-on-4 has a wide range of advantages that include all the benefits of conventional dental implants.
This restorative procedure is efficient, cost-effective, and time-saving.
Here is the list of its advantages and disadvantages:
- High success rate
- Well-spaced implants
- Short treatment duration
- Provides stability to dentures
- Minimally invasive to the oral tissues
- Restores immediate function and aesthetics
- Angled implants dismiss the need for bone grafts
- Short recovery time compared to conventional surgery
- In most cases, implants are placed on the same day after the extraction
- Requires the presence of at least 10mm bone thickness
- The technique involves the use of the latest technology like CAD/CAM
- Extensive laboratory fabrication procedures
- Often, experienced dentists are required for surgical procedures
- Expensive without insurance coverage
- Prone to infections if not performed well
Source: ResearchGate 
How Much do All on 4 Dental Costs?
All-on-4 price ranges between $17,000 – $30,000 per arch. Depending on your requirements, additional charges can be applied.
All-on-4 dental implant costs depend on your health condition, the number of missing teeth, bone density, and material choice for the implant.
Charges may vary depending on:
- Dental x-ray, CT, and CBCT charges
- Type and material chosen
- Specialist’s experience
- The number of dentists involved
Find below the price range of all-on-4 implants and insurance and dental plans at different locations.
- The average cost of all-on-4 dental implants is around $25,000 per arch
- For implants with acrylic or composite crown, the cost starts from $15,000 - $24,000 per arch and for porcelain crowns, cost is about $21,000 - $30,000
- The lowest price for all-on-4 dental implants is $10,950 per arch
- Insurance does not cover all-on-4 charges always, but few companies cover the partial treatment cost
- The average cost of all-on-4 is approximately $3,600 to $12,000 per arch
- The lowest price for all-on-4 is $17,999 per arch
- It is a cosmetic procedure, so insurance companies may only cover part of the treatment cost.
- The price of all-on-4 is $23,000 to $27,000 per arch
- The lowest price for all-on-4 is $18,000 per arch.
- Insurance companies like Medipay, Denticare, and Mac credit usually cover the cost of dental implants under the category of ‘major dental,’ which includes the cost of surgery and emergency treatment.
On your first visit, ask your dentist the cost of an all-on-4 implant to help you decide your treatment plan and discuss the insurance coverage for implants.
All-on-4 is not a treatment procedure, but it is an investment for your oral health, function, and esthetics. So invest it wisely!
4 implants abroad at the price of 2 in the US!Get FREE quote!
Materials Used in All-on-4 Implants
Hybrid fixed dentures are made of either acrylic, zirconia, or porcelain. These dentures or bridges provide excellent esthetics.
Titanium is the perfect choice for implant posts because it closely matches the human body and is biocompatible.
It fuses with your jaw bone via a process called osseointegration and functions as part of it.
The choice of material for implants depends on esthetics, durability, patient age, cost, and opposing teeth.
All-on-4 Dental Implants – Denture Materials
Customized shape and size
Easy to repair
Wear down easily
|Zirconia||Very strong and durable||Expensive
Hard to repair
Clicking sound on chewing
What Are the Complications of All-on-4 Dental Implants?
The success rate of dental implant treatment is high; however, 5 to 10% of cases fail shortly after the procedure or after several years.
Following are the potential complications that can occur after the treatment:
Peri-implantitis is an inflammatory process affecting the tissue around a dental implant that leads to loss of supporting bone.
You may experience excessive bleeding from the gums, infection, awful breath, and unpleasant taste.
When peri-implantitis occurs, your dentist temporarily removes your denture. He then cleans the gums and implants with disinfectants.
Then, he remounts the bridge and dentures over the implant. He checks the bite to see if any discomfort remains after placing the implant.
Peri-implantitis | All-on-4 Dental Implants Complication
- Speech problems
- Nerve damage
- Persistent pain
Consistent dental care and regular follow-up help prevent these complications.
Fracture of the Implant
Implant body fracture is rare, but it may occur because of excess pressure before osseointegration, design, or material failure.
You may experience bleeding from the gums and loose or ill-fitting crown.
When an implant fracture occurs, your dentist will remove and replace it with a new implant.
Fracture of the Denture
It is a prevalent problem in the lower arch.
Your dentist can repair the broken dentures with the help of acrylic resins and fix the loose screws by retightening them.
Implant cost varies depending on the number, condition of your gum and bone quality.
Extra dental procedures such as extraction, x-ray scans, and bone graft surgery will also add to your cost.
Dental insurance can cover part of the procedure cost so ask your dentist about the insurance coverage before treatment.
People may opt for cheap implants rather than spend money on expensive procedures.
Risks associated with cheap implants are:
- Aesthetically unattractive
- Poor quality material
- Higher chances of implant failure and complications
Alternatives to All on Four Implants
Although all-on-four implants are highly popular, you have two options to choose from if you want something more affordable and less invasive.
A removable prosthetic for missing teeth and surrounding tissues.
A fixed restoration that bridges the gap created by missing teeth.
How Are All-on-4 Implants Different From Dentures?
Implants are a substitute for tooth roots and act as artificial roots. In comparison, dentures are removable prostheses and a replacement for missing teeth.
Implants do not compress your gums like traditional dentures and are fixed and comfortable, whereas conventional dentures are removable and less comfortable while talking and chewing.
All-on-4 prevents bone resorption and saves bone structure, but dentures speed up bone resorption because of pressure on the gum and bone.
All-on-4 Dental Implants vs Denture Materials
|Esthetics||Provides natural look||Can change your facial profile|
|Biting force||Strong biting force||Less chewing capacity|
|Taste sensation||Better taste sensation||Less taste sensation|
|Speech||Better speech ability||Difficult to talk|
|Surgery||1 or 2 surgeries needed||No surgery required|
Implants Similar to All-on-4
All on 4 is a product from Nobel Biocare. There are other international brands with the same concept.
Mis Multifix-MIS SEVEN
- Affordable treatment cost
- Used in less thickness 
Sky fast and fixed-Sky bredent
- Immediately restored
- Minimal surgical procedures 
RevitaliZe Patient Solutions
- Immediate replacement 
- Immediate replacement
- Indicated in diabetes 
With recent advances, all-on-4 dental implants can get you a more stable solution than other teeth replacement options.
We hope that this guide can help you make the right decision while opting for full mouth implants.
Contact us and claim a free quote to connect to the best dentists who offer affordable all-on-4 overseas.
Yes, because all-on-4 dental implants give you a more natural look and restore function than conventional dentures.
All-on-4 dental implants are suitable for you if your teeth are missing or few missing teeth cannot be saved, presence of good oral hygiene, adequate bone strength, and absence of gum diseases.
Diseases like cancer, uncontrolled diabetes, and bleeding disorders are a few contraindications for the All-on-4 procedure.
Infrequent problems such as denture fractures and loose implants may occur in a few people because of the poor quality of material used.
Also, there is a possibility of surgery-related complications like infections, peri-implantitis, excessive bleeding, nerve damage, and persistent pain.
You need an experienced dentist and proper follow-up to resolve these problems.
All-on-6 dental implants are better than all-on-4 because the extra two posts in all-on-6 implants allow a better chewing force transmission.
Hence stress distribution takes over a large area. As a result, your jaw bone structure is maintained and the implants last longer.
All-on-4 is not painful because your dentist administers local or general anesthesia during the surgical procedure.
Though, after surgery, you may notice slight swelling and feel mild pain which can be relieved with pain medications.
You’ll be able to resume work within 2-3 days.
You can start eating on the same day after surgery.
Eat soft foods such as ice cream, yogurt, pudding, or soup that do not harm gums and are comfortable to chew at the surgical site.
- From the third day onwards, you can start eating eggs, pasta, or semi-solid foods.
- After one week, you can resume a regular diet but avoid hard and crunchy foods until the fourth week after surgery.
- Avoid smoking for 3 to 4 months because it delays wound healing and osseointegration of the implant.
- Avoid alcohol consumption on the 1st and 2nd week after surgery.
The cost of all-on-4 varies significantly but ranges between $17,000 to $30,000.
In Canada, the price is $3600 to $12000 per arch. In Australia, the price range is $23,000 to $27,000 per arch.
The cost of all-on-4 depends on the type and quality of tooth bridge or denture, training and expertise of your dentist, type and quality of the material, and additional treatment plans.
All-on-4 implants can last for 20 years or more with proper care. The success rate reported after 10 years is more than 94%. 
All-on-4 is more comfortable than traditional implants. Here, only four titanium posts are used compared to six to eight in traditional implants per arch.
Traditional implant treatment takes a long time because of additional procedures like sinus augmentation and bone grafting.
Unlike conventional implants, the all-on-4 implants have a faster healing time, shorter treatment duration, and do not require a bone grafting procedure.
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