All-on-4 Treatment

The ‘All-on-4′ is a dental implant treatment option for those with completely missing teeth. The implants can be placed either in an immediate fashion on the same day as extractions (Teeth-in-a-Day) or in delayed fashion once the extractions sites have healed (Delayed implant placement). The ‘All-on-4′ refers to placement of the entire prosthesis (i.e. teeth) on 4 dental implants. The prosthesis can be either removable or fixed.

The ‘All-on-4′ treatment is a great solution for patients who have lost significant bone in the back of their jaw and where bone grafting is not desired. The dental Implants are positioned in a way that does not require bone grafting while providing great support for the prosthesis. The ‘All-on-4′ technique can be done in both upper and lower jaws.


Four implants are the minimum number of implants for this approach. However, it may be recommended to place 5 or 6 dental implants for additional support. More implants may be recommended for those with a large biting surface or strong chewing habits. The additional implants provide greater stability, strength, and support for the prosthesis. If you love eating harder food, the additional implants will be of great benefit to you

Is it Right For Me?

All on four fixed implant-supported teeth design may be the right option for you if:

  • You want to maximize your chewing ability and eating your favorite food
  • You want the closest feel and appearance of natural teeth
  • You want fixed teeth that are not removed from the mouth
  • You have moderate or no bone loss
  • You need extraction of your remaining teeth and don’t want to use a conventional denture
  • You want to preserve your jaw bone from further damage
  • You want to eliminate all the extra denture flanges from the sides and also from covering your palate
  • You have moderate budget availability

Patients with teeth that require extraction:

A common scenario is a patient who needs all of their teeth extracted due to severe decay or gum disease. Here is how it works:

  • Teeth are extracted
  • Four immediate dental implants are placed on the same day. This is known as immediate implants
  • The implants are allowed to heal for 2-3 months before fabrication of the final implant-supported prosthesis.
  • The implant-supported prosthesis is fixed to the implants with retaining screws and can not be removed by the patient.

How Does It Work?

The implants provide complete support for the teeth and require no support from the gum tissue as in the case for removable complete set of teeth. Therefore, the prosthesis design has no flanges extending into the cheeks or palate, making it most comfortable and natural to the patient. The implants support a framework, either made of Titanium or Zirconia, which in-turn supports the teeth made of either of acrylic, porcelain, or zirconia. The teeth are held to the implants with retaining screws and hence it is fixed and not removable by the patient. Depending on the patient’s bite requirements four to eight dental implants may be recommended best judged by the condition of your oral cavity.

Treatment Stages and Process

The treatment is highly specialized therefore strongly recommended to visit an experienced Prosthodontist and Implantologist. The treatment sequence is:

  1. The Prosthodontist completes clinical evaluation of your mouth, including the condition jaw bone and if required takes impressions for study models and design, as well as assess the bite and aesthetic requirements. An interim denture is then fabricated and tried in the patient for proper fit and assure patient is happy with its aesthetics and design.
  2. Then an specialized 3D x-ray of the jaw required to be done (CBCT- cone beam CT) to assess quality and quantity of bone and to fabricate the final treatment planning that includes the number of implant required.
  3. The Prosthodontist then uses the CBCT for a 3-dimensional computer assisted planning in the computer model of patient’s jaw bone.
  4. The Prosthodontist places the dental implants according to the available jaw bone and requirement of fixed teeth at strategic location with optimal precision and accuracy. The implants are allowed to heal for 3-4 months before fabrication of the final teeth.
  5. Another alternative is the implants are immediately restored with a temporary fixed set of teeth (known as Teeth-In-A-Day). In this case, patient goes home with fixed teeth. The implants are allowed to heal for 3-4 months before fabrication of the final teeth.
  6. When immediate implant restoration is not possible or recommended, then the implants are allowed to heal for 3-4 months before final teeth are made. Patient continues using the transitional denture in the interim.
  7. The expertise Prosthodontist then takes final impressions and fabricates the final fixed prosthesis. The bite is adjusted as it was in natural teeth and the new teeth are checked for overall comfort, function, and aesthetics.