All-on-4®

The All-on-4 treatment concept offers an implant-based solution to patients who have lost all of their upper and/or lower teeth. This remarkable method of care helps patients quickly rebuild complete and beautiful smiles. With All-on-4, your new, and complete set of implant-supported replacement teeth feel secure, stable, and much like your very own.

If you currently wear complete upper and/or lower dentures or are slated to have your remaining teeth extracted, you may be a candidate for All-on-4. First Performed by Dr. Paulo Malo in 1998, the All-on-4 treatment concept has helped hundreds of thousands of patients quickly reestablish attractive smiles that look, feel, and function just like a set of natural teeth!

The All-on-4 treatment concept offers a fixed and permanent alternative to removable dentures. Unlike dentures, All-on-4 does not rely on messy dental adhesives or natural suction to hold your new set of teeth in place. With All-on-4, your replacement teeth are permanently secured by dental implants, giving you a smile that looks not only great but also feels secure and stable. You'll feel comfortable and confident as you speak, smile, and chew with ease.

While traditional full arch implants also achieve outstanding results of care, the All-On-4 treatment concept does not involve bone grafting and requires fewer implants to support a full set of teeth. With just four strategically placed dental implants needed to support an entire set of upper or lower teeth, the All-on-4 treatment concept offers a cost-effective and satisfying solution for rebuilding a complete smile. Thanks to this remarkable method of care, patients can experience the satisfaction of having teeth placed the same day as surgery. This key feature allows patients to smile and function with confidence until healing is complete and the permanent restorations installed.

Once it's been determined that you're a candidate for treatment with All-on-4, the process of treatment planning and designing your new smile begins. 3D diagnostic records provide the detailed information required to determine the exact positions of the four supporting dental implants. Then, on the day of surgery, we'll remove any remaining teeth, place the 4 implants, and insert a set of attractive, sturdy, and functional set of temporary teeth. With All-on-4, temporary teeth can be placed right away with a customized, permanent set to follow once the implants become fully integrated with the surrounding bone.

With All-on-4, temporary teeth can be placed right away with a customized, permanent set to follow within just a few months after the implants become fully integrated with the surrounding bone.

Thanks to All-on-4, patients enjoy permanent teeth that look, feel, and function just like real teeth. And with a patient satisfaction rate that exceeds 95%, the All-on-4 treatment concept restores your smile, your confidence, and allows you to enjoy once again the foods you love!

Maintaining your All-on-4 smile requires the same care as a natural smile. By cleaning your teeth twice daily, after meals as possible, and scheduling appointments for routine checkups as well as care, you can keep your new smile strong and healthy for years to come. Our office will demonstrate the most effective methods of oral hygiene and answer all your questions as to how to care for your new smile.

All-on-4® is a fixed full-arch restoration supported by four strategically placed dental implants that anchor a prosthetic bridge. Unlike conventional removable dentures, the prosthesis is secured to implants so it does not shift or require adhesive to stay in place. The design uses two anterior implants and two posterior implants that are often angled to maximize contact with available jawbone and avoid anatomical structures.

This approach replaces an entire upper or lower arch rather than restoring individual teeth one by one, which reduces the number of surgical sites. Many patients benefit from immediate provisional restorations placed the same day as surgery when clinical conditions permit. The result is a stable, fixed restoration that restores chewing function and facial support while simplifying maintenance compared with multiple single-tooth implants or removable options.

Good candidates are adults who are missing most or all teeth in an arch or who are facing extractions of teeth that cannot be reliably restored. Adequate general health and manageable systemic conditions are important, and clinicians evaluate oral health factors such as gum condition, bone volume, and lifestyle habits like smoking. Patients with severe uncontrolled medical issues may require medical clearance or preparatory care before implant treatment.

Some patients who lack sufficient posterior bone for conventional implants can still be candidates for All-on-4® because the posterior implants are often angled to use denser anterior bone. When additional support is needed, clinicians may recommend preparatory treatments such as periodontal therapy or selective grafting to optimize outcomes. A thorough consultation and CBCT imaging determine candidacy and any steps needed to prepare the mouth for implant placement.

Evaluation begins with a review of medical and dental history, an intraoral exam, and imaging, typically including cone beam CT to assess bone anatomy in three dimensions. Digital planning software is used to map implant positions, plan angulation, and design a prosthesis that meets functional and aesthetic goals. This planning helps identify anatomical landmarks, avoid vital structures, and anticipate whether immediate provisionalization is feasible.

During the consultation the team discusses treatment sequencing, expected healing timelines, and the types of prosthetic materials available for the final bridge. Impressions or digital scans and detailed records allow the laboratory to fabricate a provisional prosthesis when appropriate. Clear preoperative instructions and a customized surgical plan improve predictability and patient comfort on the day of treatment.

On the day of surgery, failing teeth may be extracted, implants are placed according to the digital plan, and a provisional prosthesis can be attached when primary implant stability permits. Many patients do leave the clinic with an immediate fixed provisional bridge that restores esthetics and basic chewing function while bone integrates with the implants. The provisional is designed to protect the surgical sites and allow soft tissues to heal under stable support.

Postoperative instructions cover oral hygiene, dietary guidelines during the initial healing phase, and medications for pain or infection control when indicated. Follow-up visits are scheduled to monitor soft tissue healing and implant integration, and any necessary adjustments to the provisional prosthesis are made. The final definitive bridge is typically delivered after a healing period once osseointegration is confirmed.

Final All-on-4® bridges can be fabricated from high-strength ceramics, hybrid prostheses with a metal or reinforced substructure, or layered materials selected for the patient’s functional needs and aesthetic expectations. Material selection depends on factors such as bite force, parafunctional habits, desired translucency for natural appearance, and maintainability. Your restorative team will explain the trade-offs between strength, repairability, and appearance for each option.

Laboratory workflows informed by digital impressions and face-bow or bite records ensure the final prosthesis aligns with occlusion and facial proportions. The definitive bridge is adjusted for fit, bite, and esthetics before final delivery to minimize long-term complications. Ongoing reviews help confirm that the material chosen continues to meet the patient’s functional demands over time.

Immediate postoperative recovery commonly involves mild to moderate swelling and discomfort that is managed with prescribed or recommended medications and cold therapy. Patients are typically advised to follow a soft-food regimen for a period while tissues heal and to avoid behaviors that stress the implants, such as heavy chewing or tobacco use. Good oral hygiene and adherence to postoperative instructions support predictable healing.

Osseointegration, the process by which bone bonds to the implant surface, usually takes several months and is monitored through clinical exams and imaging as needed. During this period the provisional prosthesis provides function and esthetics while final integration occurs. Once the team confirms stable integration, the provisional is replaced with the custom final restoration and routine maintenance protocols begin.

Long-term care includes twice-yearly professional exams and cleanings unless your clinician recommends a different schedule based on individual risk factors. Daily home care involves brushing the prosthesis and cleaning around implant access points using interdental brushes, water flossers, or specialized flosses as recommended by your dental team. Maintaining excellent plaque control and addressing any soft-tissue inflammation promptly are key to preserving implant health.

Regular evaluations include clinical checks and periodic radiographs to monitor bone levels and prosthetic condition, while the restorative team inspects components for wear or loosening. Managing systemic health factors such as diabetes and avoiding smoking also supports implant longevity. Promptly reporting unusual symptoms such as persistent pain, mobility, or swelling helps ensure early intervention when needed.

As with any implant procedure, risks include infection, delayed healing, implant failure, and prosthetic complications such as screw loosening or wear. Careful case selection, sterile surgical technique, and diligent postoperative care reduce the likelihood of complications. If problems arise, clinicians address them through targeted therapies such as local infection management, prosthetic adjustments, or, in rare cases, revision of implant components.

Risk mitigation begins at diagnosis with imaging and planning to avoid vital structures and to assess bone quality, and continues with follow-up care to detect issues early. Smoking cessation, control of systemic conditions, and adherence to maintenance visits further decrease complication rates. When concerns occur, timely clinical assessment and a coordinated treatment plan help restore function and comfort.

All-on-4® leverages implant angulation and anterior bone density to maximize support from the available jaw structure, which often reduces the need for extensive posterior grafting. By placing posterior implants at an angle, clinicians can engage denser cortical bone and avoid anatomic limitations like the maxillary sinuses or the inferior alveolar nerve. This strategic placement allows for a robust foundation even in patients with some posterior bone loss.

While some patients still require grafting or additional preparatory procedures, the All-on-4® concept is designed to simplify the surgical plan for many candidates and shorten the overall treatment timeline. Detailed CBCT analysis and digital planning identify when bone augmentation is necessary versus when the angled implant strategy is sufficient. The result is a treatment pathway that can be more streamlined for appropriate cases without compromising long-term support.

Crowns Now Family Dentistry integrates digital diagnostics, CBCT imaging, and coordinated restorative and surgical planning to deliver All-on-4® treatments tailored to each patient’s anatomy and goals. Our multi-disciplinary approach ensures that implant placement and prosthesis design align with functional needs and facial aesthetics while following proven clinical protocols. The team emphasizes careful case selection and clear communication throughout evaluation, surgery, and restorative phases.

Patients receive detailed preoperative guidance, structured follow-up, and personalized maintenance plans to support long-term implant health. Clinical decisions are supported by contemporary technology and laboratory workflows that aim to optimize fit and function for the final bridge. Contact the practice to schedule a consultation and learn how the All-on-4® option may apply to your individual situation.