What is All-on-4?

Picture ordering the steak instead of the soup, and laughing at the table with nobody's hand over their mouth. All-on-4 is a full row of fixed teeth for one jaw, held in place by four dental implants.

In plain English

A dental implant is a small post, usually titanium (a metal the body accepts), that a surgeon places in your jawbone to do the job of a tooth root ¹. All-on-4 uses four of those posts to hold one bridge, which is a single piece carrying a full row of teeth, for the whole upper or lower jaw ². Dentists call one full row an arch.

Two implants go near the front of the jaw, straight up and down. Two go further back, tilted at up to 45 degrees ³. The tilt lets the back implants use the bone you already have. That is why many people can skip a bone graft (bone added to the jaw) or a sinus lift (bone added under the sinus in the upper jaw) ³.

The bridge is screwed on and stays in. Only the dentist can remove it ².

Many clinics fit a temporary bridge on the day of surgery. Dentists call this immediate loading, or "teeth in a day" ³. The final bridge comes later, after the implants have fused to the bone.

Who it suits, and who it doesn't

It suits people who are missing all or most of the teeth in one jaw, or whose remaining teeth cannot be saved, and who want teeth that do not slip like a denture ². You need enough bone in the jaw to hold the implants. If you do not, a graft can sometimes add it ². Your general health matters more than your age ⁴, and Cleveland Clinic gives no upper age limit ¹.

It does not suit people with untreated gum disease, severe bone loss, unmanaged diabetes, or who are currently smoking or vaping ¹. In a study that followed 561 treated jaws for 3 to 17 years, smoking lowered implant survival ⁵. Illnesses such as diabetes or leukemia may interfere with healing ⁴. If you grind or clench your teeth, tell the clinic. Fracture of the acrylic bridge was the main complication in that review, mostly in people who grind ³.

How it works, step by step

1. Exam and scans. You will have a panoramic X-ray (one wide image of the whole mouth) and usually a CBCT scan, a 3D X-ray used to plan where the implants go ^6,7.
2. Extractions. Any teeth left in that jaw are removed. Depending on your bone, this can happen in the same surgery as the implants, or months earlier with a healing gap ².
3. Surgery. Four implants are placed in one session.
4. Temporary teeth. With immediate loading, a temporary bridge goes on the same day or soon after ³.
5. Healing. The implants fuse to the bone, a process called osseointegration. Cleveland Clinic gives three to six months, sometimes longer ², and three to nine months on its general implant page ¹.
6. Final bridge. After healing, the clinic takes impressions and makes the final bridge.

Sources do not give a number of trips. The final bridge cannot be made until the implants have fused, so plan on the final teeth being a second trip. The clinic will tell you how many days each trip needs after an exam and X-rays.

What the price usually includes, and what can cost extra

Ask for the quote in writing, item by item. Things that are sometimes in the price and sometimes extra:

• The CBCT scan and X-rays
• Extractions of remaining teeth
• Bone grafts or a sinus lift, if your scan shows you need them
• Sedation
• The temporary bridge
• The final bridge, and whether it is acrylic or zirconia (a hard white ceramic). These are priced differently
• A night guard if you grind
• Follow-up visits, adjustments and repairs
• Your second trip: flights, hotel and days off work

What it costs

Questions to ask a clinic before you book

1. What exactly is in the quote, and what is not?
2. Which implant brand do you use, and can I have the brand and lot numbers in writing?
3. What is the final bridge made of, acrylic or zirconia, and what does each cost?
4. How many trips will I need, and how many days is each?
5. Is the temporary bridge included, and what happens if it breaks before my second trip?
6. Is there a written warranty? What does it cover, what does it exclude, and does it need me to come back for check-ups?
7. Who fixes problems after I go home, and who pays for that?
8. Can I take my scans, X-rays and records home with me?

What can go wrong, and how to lower the risk

An implant can fail to fuse. Across 25 studies, All-on-4 implant survival was 94% to 98% at six to eleven years ³. In that 3-to-17-year study, survival per implant was 97.4% in the upper jaw and 98.9% in the lower, and most upper-jaw failures happened in the first 24 months ⁵.

The bridge can break. Fracture of an acrylic bridge was the most common problem, mostly in people who grind ³. A review of 12 studies found zirconia bridges had less wear and fewer lost bridges than acrylic, but the authors rated the evidence moderate to very low ⁸.

Peri-implantitis is a gum infection around an implant that eats bone. Reported rates range from 10% to more than 40%, depending on how it was measured ⁹. Risk factors include a history of gum disease, smoking, uncontrolled diabetes and poor cleaning ⁹.

Surgery itself carries risks of infection, nerve damage, injury to the mouth and a hole in the sinus lining ².

To lower the risk, stop smoking, get diabetes under control, treat gum disease before surgery, clean around the implants every day, keep your maintenance visits, and ask about a night guard if you grind ^1,9.

Words you'll hear

• Arch: one full row of teeth, upper or lower.
• Immediate load: temporary teeth fitted on the day of surgery.
• Osseointegration: bone growing around the implant to hold it.
• Zirconia: a hard white ceramic used for final bridges and crowns.
• Acrylic (PMMA): the plastic used for temporary bridges and some final ones.

Your own dentist, and the clinic's dentist after an exam, decide whether All-on-4 fits you.

Sources

1. Cleveland Clinic, "Dental Implants: Types, Purpose & Benefits". https://my.clevelandclinic.org/health/treatments/10903-dental-implants
2. Cleveland Clinic, "Implant Supported Dentures: Process, Benefits & Care". https://my.clevelandclinic.org/health/treatments/24303-implant-supported-dentures
3. Gaonkar SH et al., "Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four concept: A systematic review", Journal of the Indian Prosthodontic Society, 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8061444/
4. American Dental Association, MouthHealthy, "Implants". https://www.mouthhealthy.org/all-topics-a-z/implants
5. Uesugi T et al., "The All-on-four concept for fixed full-arch rehabilitation of the edentulous maxilla and mandible: a longitudinal study in Japanese patients with 3-17-year follow-up", International Journal of Implant Dentistry, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10632321/
6. Cleveland Clinic, "Dental X-rays: Purpose & Types". https://my.clevelandclinic.org/health/diagnostics/11199-dental-x-rays
7. U.S. Food and Drug Administration, "Dental Cone-beam Computed Tomography". https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/dental-cone-beam-computed-tomography
8. Marinkovic D et al., "Prosthetic and Biological Complications of Metal-Zirconia versus Metal-Acrylic Implant-Supported Screw-Retained Complete-Arch Prostheses: A Systematic Review and Meta-Analysis", Journal of Clinical and Experimental Dentistry, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC13354045/
9. Javiya P et al., "Peri-implantitis: Etiology, prevention and management strategies", Bioinformation, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12697511/