All on 4

The Ultimate Guide to All on 4

Last fact-checked: 25 January 2021

Replace a whole arch of teeth in one day with the All-on-4® treatment concept and save up to 75% at one of Dental Departures' global providers

This innovative mouth restoration treatment, provided by Nobel Biocare®, uses four implants to support a fixed dental prosthesis, which is attached on the same day of surgery. 

What Is the All-on-4® Treatment Concept?

This mouth restoration technique uses four dental implants to support an entire arch of replacement teeth in either the upper or lower jaw, or both (dual arch).

After a consultation to ensure healthy bone structure and absence of infection, patients are able to undergo the initial surgical phase of the treatment in one day, leaving the dentist's office with a natural-looking provisional fixed bridge that can be used to eat semi-solid/soft foods almost immediately. 

The concept is unique in that the two rear implants are longer compared to other methods; these are inserted into the jaw at near-45-degree angles rather than the 90-degree angle that traditional implants are placed. This negates the need for bone-grafting.

After the implants have properly fused with the jawbone (healing phase), the patient returns to the dentist, normally four to six months later, to have their provisional (temporary) fixed bridge replaced with a permanent one, thus completing the treatment and restoring teeth function to approximately 90%. 

Suitable Candidates for the All-on-4® Treatment Concept

If you have lost several or most of your teeth or want to replace ill-fitting dentures with a comfortable, stable and natural-looking set of permanent teeth, you may be a suitable candidate for this mouth restoration technique.

It should be noted that:

  • Prospective patients should be in good overall health in order to undergo surgery.
  • For those with gum disease or other oral health issues, a dentist will clear any infections and address other problems before surgery. 
  • Patients who have bone loss may still be suitable candidates as the All-on-4® treatment concept requires less bone density compared to other treatments thanks to the unique positioning of the four implants. 
  • Age generally does not determine whether a person is a suitable candidate for dental implants. 

What Does the Course of Treatment Entail?

Pre-surgical appointment: 

The patient first attends a pre-surgical appointment, during which the dentist will determine their suitability for the All-on-4® treatment concept. Several tests, such as x-rays, 3D cone beam images and photo evaluations, will be taken so that the dentist can formulate a detailed treatment plan. 

Custom-made immediate denture is processed:

Using information from the pre-surgical appointment and impressions of the patient's mouth, a specialist dental laboratory processes an immediate denture which will be attached during the surgical phase.

Surgical phase:

Before the placement of the implants, any remaining teeth are extracted. The implants can then be inserted at predetermined positions in the jaw.

Using abutments and coping cylinders screwed onto the implants, an immediate denture is attached. This is then trimmed down to become a fixed implant bridge to complete the surgical phase. 

Note:

  • The procedure may be carried out under local anesthesia with IV sedation, or under general anesthesia in the case of longer, more complex surgeries. Other sedation options may also be available, depending on the clinic and its facilities. 
  • Both jaws can be operated on during the same session (dual arch surgery). 
  • Surgery can take between two and six hours, depending on the complexity of the procedure.

Healing phase:

After surgery, the patient returns home with their new, natural-looking teeth. However, it should be noted this is the provisional (temporary) restoration. 

Over the next three to four months, the implants fuse with the bone (a process called osseointegration), during which time the patient is generally advised to follow a diet of semi-solid/soft foods, as well as adhere to a hygiene and maintenance routine as prescribed by the dentist. 

Final restoration phase:

After four to six months, the patient returns to the same dental clinic to have their temporary bridge removed and replaced with the permanent one (final prosthesis). 

This stage may involve further tests and adjustments; however, the process is non-invasive, as the temporary bridge is simply unscrewed before being replaced. 

A detailed step-by-step full arch rehabilitation guide (PDF) by Nobel Biocare can be found here

Is the All-on-4® Treatment Concept Suitable for Dental Tourists?

This mouth restoration procedure is an excellent option for dental tourists thanks to the innovative way in which the implants are placed—reducing the overall treatment time and number of steps involved. 

The primary reason most patients cross borders for their treatment is affordability—with full mouth restorations like these costing upwards of USD $25,000 in the US.

However, by heading abroad, patients can make savings of between 50-70% at one of our verified All-on-4® treatment concept providers. 

It should be noted that, in general, patients will have to make two separate trips to their chosen destination (the surgical phase and final restoration phase). 

Patients should also talk with their dentist and follow their advice before booking flights. For instance, it would be advisable to rest for a few days following surgery before flying (or driving) home. 

Does the Fixed Bridge Require Special Care? What Else Should I Consider?

  • When your implants have first been placed and you have a temporary fixed bridge, you will be advised to eat soft food for a while–certainly not anything chewy or hard that could interfere with the osseointegration process.
  • A rule of thumb is anything that can be cut with a fork can be eaten. 
  • For the first two weeks, patients are instructed to use a special mouth wash. After around 14 days, cleaning with a soft bristle toothbrush can resume. 
  • Teeth function increases to approximately 90% after the attachment of the final prosthesis, allowing patients to eat practically anything they want. 
  • Apart from maintaining a healthy oral hygiene regime–with careful brushing, flossing and regular check-ups, you should not have to do anything different following the completion of the treatment. 

What Are the Costs for the All-on-4® Treatment Concept Around the World?

In the United States, implant-supported mouth restorations like this cost, on average, $25,000 (CAN $33,000; UK £20,000; EUR €23,000; AUS $32,000; NZ $35,500). For more complex treatment with extractions and dual arch surgery, overall costs can exceed $40,000

Savings of up to 75% can be made at one of our global partner clinics. See below for price comparisons:

  • At a Mexico dentist: US $10,000 (CAN $13,600; UK £7,600; EUR €8,900; AUS $13,400; NZ $13,400)
  • At a Thailand dentist:  US $11,000 (CAN $15,000; UK £8,400; EUR €9,800; AUS $14,800; NZ $15,800)
  • At a Bali dentist: US $4,200 (CAN $5,700; UK £3,200; EUR €3,700; AUS $5,600; NZ $6,000)
[Note: These are estimated prices calculated at the time of writing and treatment costs vary depending on a number of factors. Please see our clinic listings for up-to-date prices.]

What About the Quality of Dental Care Abroad? Is it Reliable?

World-class dental clinics can be found in many international destinations, provided you select a suitable dentist with care. This includes the obvious, such as vetting dentist qualifications; specifically, we look at: How long they have been qualified as a dentist? Have they had specialist training? Are they members of any overseas professional organizations, for example, the International Congress of Oral Implantologists?

You should also check out the clinic. Is it accredited locally or internationally? Do the premises look cared for? Is the clinic signed up to any international protocols, like the International Organization for Standardization?

One way of ensuring you are heading to a quality-checked clinic is by booking with Dental Departures.

We conduct background checks on dentist qualifications, professional memberships and clinic affiliations. We also perform onsite visits, collect verified patient reviews, and publish them on our website. With clinic photos, pricing, maps and other useful information, you can search for a dentist and destination, compare prices and book an appointment in confidence.

How Do I Get Started?

Determine your desired destination, then search our site to find Nobel Biocare-authorized All-on-4® treatment concept specialists in the area.

Know before you go: read our verified patient reviews, view clinic photos and take virtual tours of our clinics. Then contact our Customer Care Team or book with us online for great care at the best available prices!

Sources:

David Soto-Penaloza. The All-on-Four Treatment Concept: a Systematic Review. Journal of Clinical and Experimental Dentistry, 2017. Website accessed: 25 January 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347302/

International Congress of Oral Implantologists. Website accessed: 25 January 2021. http://www.icoi.org/

International Organization for Standardization. Website accessed: 25 January 2021. http://www.iso.org/iso/home.html

Siadat H, Rokn A, Beyabanaki E. Full Arch All-on-4 Fixed Implant-Supported Prostheses with 8.5 Years of Follow-Up: A Case Report. J Dent (Tehran). 2018;15(4):259-265. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218463/

All-on-4® treatment concept. Nobel Biocare. Website accessed: 25 January 2021. https://www.nobelbiocare.com/en-us/all-on-4-treatment-concept

Soto-Peñaloza, David & Zaragozí-Alonso, Regino & Penarrocha-Diago, MA & Penarrocha, Miguel. (2017). The all-on-four treatment concept: Systematic review. Journal of Clinical and Experimental Dentistry. 9. 10.4317/jced.53613. https://www.researchgate.net/publication/315370698_The_all-on-four_treatment_concept_Systematic_review

Full Arch Rehabilitation: All-on-4™ Restorative Steps, Roadmap for Success. Nobel Biocare. PDF accessed: 25 January 2021. http://iddentallab.com/wp-content/uploads/2017/02/Nobel-Biocare-All-on-4-Restorative-Steps-Roadmap.pdf

Babbush CA, Kanawati A, Kotsakis GA, Hinrichs JE. Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study. Implant Dent. 2014 Apr;23(2):218-24. doi: 10.1097/ID.0000000000000034. PMID: 24394342. https://pubmed.ncbi.nlm.nih.gov/24394342/