All-on-4 is a treatment concept for replacing a full arch of teeth, upper or lower, with a fixed bridge supported by four dental implants. It’s often considered by people who have lost most of their teeth, have teeth that can’t be saved, or are unhappy with loose dentures. This guide explains how it works and what to think about.
How All-on-4 works
Four implants are placed in the jaw. The two at the front are usually placed upright, and the two at the back are often angled. Angling the back implants lets them be longer and anchor in areas of denser bone, which can help some people avoid bone grafting. A full-arch bridge of teeth is then screwed onto the four implants. It’s fixed, so you don’t take it out at home; your dentist removes it for maintenance.
Related approaches use more than four implants (sometimes called All-on-6 or All-on-X), depending on the bone available and the planned bridge.
Who may be suitable?
All-on-4 may suit adults who:
- are missing most or all teeth in one or both jaws
- have remaining teeth that are failing due to decay or gum disease
- struggle with loose or uncomfortable dentures
- have enough bone in the right places, as shown on a 3D scan
- are in good enough general health for surgery
Smoking, uncontrolled diabetes, some medications (such as certain osteoporosis treatments), previous radiotherapy to the jaw and heavy grinding can affect suitability and long-term success, so they need to be discussed in detail.
Planning
Planning is thorough. It usually includes an examination, photos, x-rays and a 3D CBCT scan to measure the bone and locate nerves and sinuses. Your dentist will discuss the shape and colour of your new teeth and explain your options, including alternatives such as implant-retained overdentures (dentures that clip onto implants) or conventional dentures.
Treatment day
On the day of surgery, any remaining failing teeth are removed, the implants are placed, and in many cases a temporary fixed bridge is attached the same day or soon after. This is sometimes described as “teeth in a day”. Whether that’s possible depends on how stable the implants are when placed. Treatment is done under local anaesthetic with sedation, or under general anaesthetic in some cases.
Healing
Over the following months, the bone bonds with the implants. During this time you’ll be given a soft diet to avoid overloading the implants, and you’ll have review appointments. Swelling, bruising and discomfort are common for the first week or so.
The final bridge
Once healing is complete, usually after several months, the temporary bridge is replaced with a final bridge. Final bridges can be made from materials such as acrylic over a metal framework or zirconia, each with different strength, appearance and maintenance needs. Your dentist will explain the options.
Living with All-on-4
- Cleaning: brush twice a day and clean under the bridge with a water flosser, interdental brushes or special floss, as your dentist shows you.
- Maintenance visits: regular reviews and professional cleans are essential. Periodically, the bridge may be removed for a thorough clean and check.
- Repairs: bridges can chip or wear and may need repair or replacement over the years.
- Night guard: often recommended if you grind.
Risks
All-on-4 is major surgery and carries risks. These include pain, swelling and bruising, infection, bleeding, nerve injury causing numbness, sinus complications for upper implants, an implant failing to integrate, and later inflammation of the gum and bone around implants (peri-implantitis). The bridge can fracture or loosen. If one implant fails, the treatment plan may need to change. Your dentist must explain the risks that apply to you and what happens if complications occur.
Questions to ask
- Am I suitable, and what are my alternatives?
- What’s included in the fee: scans, extractions, sedation, the temporary bridge and the final bridge?
- What material is the final bridge made from, and how long might it last?
- What maintenance will I need, and what will that cost?
- What happens if an implant fails?
Learn more on our All-on-4 dental implants page.
A complimentary smile makeover consultation, including an OPG x-ray, examination and photos, is available for eligible patients considering veneers, implants, full-mouth implants, Invisalign or orthodontics. Conditions apply.
Frequently asked questions
Can I really get teeth in a day?
In many cases, a temporary fixed bridge can be fitted on the day of surgery or shortly after. This depends on how stable the implants are when placed. The final bridge is fitted after healing, usually several months later.
How long does All-on-4 last?
With good care and regular maintenance, implants can last many years. The bridge on top may need repairs or replacement over time due to wear. Smoking, grinding and poor cleaning reduce longevity.
Can I take the bridge out?
No, it’s fixed to the implants and can only be removed by your dentist, usually during maintenance visits.
Is All-on-4 suitable if I’ve been told I don’t have enough bone?
Angling the back implants can sometimes allow implants to be placed without bone grafting, but this depends on your scan. Some people still need grafting or other approaches.
What does All-on-4 cost?
Costs vary considerably depending on the number of implants, whether extractions and sedation are needed, and the materials used for the bridge. A written, itemised quote should be provided after your consultation and scans. Conditions apply.
Book at Parramatta Dentistry
Parramatta Dentistry is at Suite 25, Level 3, 27 Hunter Street, Parramatta, a short walk from Parramatta Station. We’re open Monday to Friday, 9am to 6pm, and HICAPS is on site, so you can claim from your health fund on the day and pay only the gap, if there is one. Call (02) 8090 1109 or book online.
This article is general information only and isn’t a substitute for personalised advice from your dentist. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.