What Is the All-on-Four Technique? Advantages and Costs

All-on-Four is an advanced approach for fully edentulous patients (or those requiring extractions), placing four implants per arch and delivering a same-day provisional fixed prosthesis. Developed in the late 1990s by Portuguese Dr. Paulo Malo, this technique has offered a fast and comfortable solution to millions of patients with complete tooth loss. It often avoids major grafting even in posterior bone loss.

How It Is Performed

Planning: CBCT identifies optimal bone areas. Digital software pre-calculates implant angles. Surgical guide prepared if needed.
Preparation: Teeth requiring extraction are removed, oral infections cleaned.
Surgery: Two anterior implants are placed upright (~90°) and two posterior implants at an angle (~45°) to bypass resorbed areas and increase contact.
Immediate Loading: A provisional fixed bridge is screwed in the same day in many cases. Patient leaves surgery with fixed teeth.
Definitive Prosthesis: After 3–6 months of healing, the definitive hybrid or zirconia bridge is delivered.

Who Is Suitable for All-on-Four?

Fully edentulous patients: All teeth missing or unsalvageable in one or both arches.
Removable denture users: Those unsatisfied with existing dentures seeking fixed solutions.
Bone loss patients: Especially those with posterior bone loss wanting to avoid major grafting.
No upper age limit: Successful applications even in patients in their 80s.
Not suitable for: Uncontrolled diabetes, severe osteoporosis, active infection, heavy smoking. These conditions must be controlled first.

Advantages

Speed & Comfort: Leave with fixed teeth the day of surgery. Traditional technique required 3–6 months of edentulism.
Less Surgery: Minimizes need for sinus lift/large grafts.
Lower Cost: Four implants instead of six to eight per arch.
Function: No palatal coverage; better chewing and taste.
Esthetics: Natural-looking tooth and gum combination.
High success: 10-year clinical data shows 95%+ success rate.
Bone preservation: Implant pressure halts bone resorption.

All-on-4 vs All-on-6 Comparison

All-on-6 technique places 6 implants per arch. Comparison:

Implant count: All-on-4 → 4 implants | All-on-6 → 6 implants.
Cost: All-on-4 is more economical (2 fewer implants).
Bone requirement: All-on-4 requires less bone; advantage for bone loss patients.
Surgery time: All-on-4 is shorter (30–60 min difference).
Long-term durability: All-on-6 provides more implant support; but All-on-4 shows similar success long-term.
Decision: Which technique is suitable depends on clinical assessment. All-on-6 preferred with sufficient bone, All-on-4 if bone is limited.

Long-Term Results and Success Rates

5-year success: 97–98%
10-year success: 94–95%
Prosthesis lifespan: Provisional 3–6 months, permanent hybrid/zirconia 10–15+ years.
Failure causes: Smoking, uncontrolled diabetes, poor hygiene, overloading (bruxism).

Adaptation Period

Adaptation to new fixed prosthesis takes 2–4 weeks:

Week 1: Soft diet (boiled vegetables, yogurt, soup, minced meat), speech practice.
Week 2: Transition to soft-to-medium foods.
Weeks 3–4: Almost normal diet; first follow-up appointment.
Months 3–6: Osseointegration complete; permanent prosthesis delivered.

Maintenance Requirements

Daily: Soft-bristle brushing morning-evening; interdental brush (super floss); water flosser (Waterpik) recommended.
Monthly: Have area under prosthesis cleaned by dentist.
Every 6 months: Professional scaling and check-up.
Things to avoid: Chewing hard objects (ice, pen), night guard needed for bruxism.

Cost Drivers

Implant brand (premium Straumann/Nobel Biocare vs. local brands).
Surgical complexity (bone grafting needed, number of extractions).
Provisional prosthesis (basic same-day or premium material).
Final prosthesis material: Hybrid acrylic/composite (more economical) or zirconia (more esthetic and durable).
Clinic location and clinician experience: Experienced implantologists have different pricing.
Technology used: Digital planning, surgical guide, same-day 3D printed prosthesis.

Overall, it is often a cost-effective full-arch solution with the comfort of a fixed restoration. Prices in Turkey are 60–70% more affordable than Europe, driving significant dental tourism.

Frequently Asked Questions

Is All-on-4 really completed in one day?

Surgery and provisional fixed prosthesis are done same day. However, permanent prosthesis is delivered after 3–6 months of healing. “Same-day teeth” refers to the provisional prosthesis.

Is it painful?

Performed under local anesthesia and sedation if needed. No pain during procedure. Post-op moderate pain for 3–5 days controlled with prescribed medications.

I’m elderly, am I eligible?

Age is not a barrier if your general health is good. Successful All-on-4 applications performed in patients 80+ years old. Cardiology/internal medicine approval may be required.

How long does it last?

Implants 20+ years, permanent prosthesis 10–15 years. Zirconia prosthesis lasts longer than acrylic.

All-on-4 or All-on-6 better?

Depends on situation. All-on-6 provides more stability with sufficient bone; All-on-4 more suitable and economical if bone is limited. Dentist evaluation is decisive.

Does All-on-4 make speaking difficult?

Mild adaptation period for first 1–2 weeks. Returns to normal by weeks 3–4. Speech exercises given by your dentist help.

Can All-on-4 be done if I smoke?

Yes but success rate drops. Smoking weakens osseointegration by 30%. Quitting 6 months before and after treatment strongly recommended.

All-on-4 at Dent Alesta Izmir Cigli

At Dent Alesta Dental Clinic in Izmir Cigli Atasehir, we offer All-on-4 technique with digital 3D planning, surgical guides, premium implant brands, and same-day provisional prosthesis. We prepare dedicated appointment schedules and accommodation recommendations for patients coming from Menemen, Mavisehir, Karsiyaka, Bayrakli, and Bostanli.

For more detailed information about All-on-4 treatment, visit our dental implants page or our implant-supported prosthetics page for full-arch solutions. For appointments, call +90 540 002 00 35 or fill out our online appointment form.