If you have lost most or all of the teeth in one arch, live with an unstable denture, or have several teeth with a poor long-term prognosis, full-arch implant treatment may be one option to consider.
All-on-4 uses four strategically positioned dental implants to support a fixed full-arch restoration. In selected treatment plans, additional implants may be used, including an All-on-6 approach.
This guide explains the principles behind All-on-4, how treatment is planned, when provisional fixed teeth may be possible, what happens during healing and how the final restoration differs from the first provisional bridge.
Important: All-on-4 is a treatment concept rather than a one-size-fits-all procedure. Implant number, position, immediate loading and any additional surgery depend on the individual clinical assessment.
What are All-on-4 and All-on-6 dental implants?
Both approaches are designed to support a complete upper or lower dental arch using a relatively small number of implants.
All-on-4
Four implants are positioned to support a fixed full-arch restoration. The posterior implants may be angled to make efficient use of the available bone and avoid important anatomical structures where possible.
All-on-6
Some full-arch treatment plans may use six implants rather than four. The number of implants is determined by factors including bone availability, anatomy and the restorative plan.
Why are the implants positioned differently?
In an All-on-4 treatment, the front implants are generally placed more vertically while the posterior implants can be angled.
This configuration can make better use of the bone that remains and may reduce the need for additional grafting in some patients. It does not, however, mean that bone grafting or other procedures are never necessary.
Bone quantity, bone quality and anatomy must still be evaluated before deciding which implant configuration is appropriate.
Read about sinus lift and bone grafting →Planning is as important as the implant surgery
Full-arch rehabilitation requires the surgical and restorative stages to be planned together. Appropriate diagnostic imaging, clinical examination and assessment of the bite help determine where the implants can be positioned and what type of restoration can be supported.
Digital planning can also be used to study implant positions and the relationship between the implants, available bone and the planned teeth before surgery.
Dr Daniel Tafur reviews the implant and restorative plan before deciding whether All-on-4, a different implant configuration or another type of tooth replacement is more appropriate.
Who may consider All-on-4?
Full-arch implant treatment is generally considered when the problem affects most or all of the teeth in an arch rather than just one or two missing teeth.
Multiple missing teeth
Patients who have already lost most or all of the teeth in an upper or lower arch may wish to explore a fixed implant-supported alternative.
Failing remaining teeth
When several remaining teeth have a poor prognosis, the overall treatment plan may involve replacing the complete arch rather than treating each tooth individually.
Problems with dentures
Patients who struggle with movement, comfort or confidence with removable dentures may want to discuss implant-supported options.
If you are missing several teeth but do not need a complete full-arch restoration, see our guide to replacing missing teeth .
All-on-4 compared with removable dentures
Both can replace a complete arch of teeth, but they work very differently. Which approach is appropriate depends on clinical requirements as well as patient preferences.
| Feature | All-on-4 fixed restoration | Conventional denture |
|---|---|---|
| Retention | Fixed to dental implants | Removable by the patient |
| Daily removal | Not normally removed by the patient | Removed for cleaning and care |
| Support | Supported by implants placed in the jaw | Supported primarily by the gums and underlying tissues |
| Cleaning | Requires cleaning around the implants and underneath the bridge | Denture is removed for cleaning |
| Suitability | Depends on bone, anatomy, health and treatment objectives | May be suitable when implants are not wanted or appropriate |
What does “Teeth in a Day” actually mean?
“Teeth in a Day” refers to the possibility of fitting a fixed provisional bridge during the initial implant treatment phase.
It does not mean that the definitive zirconia restoration is fitted immediately.
Immediate loading is only used when the implants achieve the stability required to support a provisional restoration safely. If that stability is not achieved, the healing plan may need to be different.
Provisional teeth vs final zirconia teeth
Understanding this distinction is important because the provisional and definitive restorations have different roles.
Fixed provisional bridge
The provisional restoration provides fixed teeth during healing when immediate loading is clinically appropriate.
It also allows the bite, appearance and soft tissues to be evaluated while the implants integrate.
Definitive zirconia restoration
Once healing and implant integration are satisfactory, the definitive fixed zirconia restoration can be completed.
This stage is planned around the established implant position, bite, function and appearance.
The All-on-4 treatment pathway
Clinical assessment
The remaining teeth, gums, bite and bone are assessed to determine whether a full-arch implant treatment is appropriate.
Implant and restorative planning
Implant positions and the planned fixed teeth are considered together using the available clinical and imaging information.
Implant placement
Four strategically positioned implants are placed for an All-on-4 treatment. Any additional treatment required depends on the individual clinical plan.
Provisional fixed teeth when appropriate
If sufficient implant stability is achieved, a fixed provisional restoration can be used during the healing period.
Healing and osseointegration
The implants are given time to integrate with the surrounding bone while the clinical situation is reviewed.
Definitive restoration
Once healing is satisfactory, the definitive fixed zirconia restoration can be produced and fitted.
Does All-on-4 eliminate the need for bone grafting?
No. Angled implant placement can sometimes allow an All-on-4 treatment to use the available bone efficiently and reduce the need for additional grafting.
However, some patients still require bone regeneration, sinus elevation or another implant approach. This is particularly important in the upper jaw, where the anatomy of the maxillary sinus can affect implant planning.
Sinus lift & bone graftingWhat affects the cost of All-on-4?
The cost of full-arch implant treatment varies because the starting condition is different for every patient.
The condition of remaining teeth, bone availability, additional surgical requirements, whether one or both arches are being treated and the restorative plan can all affect the quotation.
A personalised treatment plan and quotation can be provided after assessment.
Read what affects the cost of dental implants →How do you look after All-on-4 implants?
Fixed teeth do not remove the need for oral hygiene. The bridge, gums and implants all require regular care.
- Clean around the implant restoration every day
- Clean beneath the fixed bridge as instructed
- Attend professional hygiene appointments
- Have the implants and restoration reviewed periodically
- Report looseness, discomfort or unusual changes
Related implant information
All-on-4 questions
Will All-on-4 surgery hurt?
Implant surgery is performed using local anaesthesia. Some post-operative tenderness, swelling or discomfort can occur after surgery, and the clinical team will provide instructions for the recovery period.
Will I have fixed teeth immediately?
A fixed provisional restoration may be fitted during the initial treatment phase when the implants achieve sufficient stability. Immediate loading is therefore determined clinically rather than guaranteed for every patient.
Are the first fixed teeth my final teeth?
No. The first fixed restoration is provisional and is used during healing. After implant integration and clinical review, the definitive zirconia restoration can be completed.
Can All-on-4 be used if I have significant bone loss?
It may be possible in some cases because the implant positions can make efficient use of the available bone. Other patients may require bone regeneration, sinus elevation or a different implant approach.
Is All-on-4 better than dentures?
They are different treatment types. All-on-4 provides a fixed implant-supported restoration, whereas conventional dentures are removable. The most appropriate solution depends on the clinical situation and the patient's objectives.
How much does All-on-4 cost?
The cost depends on the condition of the teeth and bone, additional treatment requirements and the restorative plan. A personalised quotation is provided after clinical assessment.
How long do All-on-4 implants last?
There is no single guaranteed lifespan. Long-term performance depends on factors including implant health, oral hygiene, maintenance, general health, bite forces and regular professional review.
Want to know whether All-on-4 is suitable for you?
A clinical assessment can establish the condition of your teeth, gums and bone and determine which full-arch treatment options are appropriate.