Ortoimplant DENTAL SPA · All-on-4 / All-on-6 / All-on-X fixed teeth
How All-on-4 restores a complete arch of teeth on four implants, how it differs from a denture, and when more implants make sense. Honestly, without overstatement.
Losing almost all of your teeth changes both the way you eat and the way you feel in company. All-on-4 is one of the most reliable ways to restore a complete arch of teeth as a fixed solution, anchored in the jaw rather than as a denture you take out.
In this text we explain how the method works, how it differs from a denture, when it makes sense to choose more implants, and what happens with patients who are short of bone. We write honestly: All-on-4 solves a great deal, but it is not magic and it does not suit everyone in the same way. The aim is that after reading it you will know which questions to ask at your examination.
The basics
What the All-on-4 method is
All-on-4 is a method that allows a completely edentulous jaw to be rehabilitated by placing four titanium implants, onto which a fixed bridge carrying the whole arch of teeth is attached. The name says it all: the entire arch (all) is carried on four (on four) implants.
What sets All-on-4 apart from an approach in which one implant is placed per tooth is the intelligent distribution. The two front implants are placed upright and the two rear ones at an angle, so as to use the area of bone that is still firm. Because of this, in the great majority of cases extensive bone grafting is avoided, and the whole treatment has fewer stages than it would if every tooth were replaced separately.
In short: four implants, one fixed bridge per jaw, support in the existing bone. The result is firm teeth that are not removed at home and that behave close to natural teeth when eating and speaking.
Health and appearance
How All-on-4 affects oral health and appearance
All-on-4 does not only restore the aesthetics of a smile. Fixed teeth across the whole arch once again let you bite and chew food you may have been avoiding with a denture, and a stable bite also helps you speak more clearly.
There is a biological side as well. When a tooth is lost, the bone beneath it is no longer loaded and gradually recedes. Implants transmit chewing forces into the bone and so help to slow that recession, much as the natural tooth root once maintained it.
An important, honest note about caries and periodontal disease. Implants and ceramics cannot develop caries, so caries on the replaced teeth disappears. That still does not mean the end of every concern about your mouth. The gums and bone around the implants can still become inflamed (peri-implantitis) if hygiene is neglected, so regular cleaning and check-ups remain obligatory. In other words, All-on-4 removes some old problems, but it does not release you from care.
Comparison
All-on-4 compared with a conventional denture
A conventional removable denture is a legitimate and more affordable solution that serves many people well. For some patients, however, it brings familiar difficulties: a feeling of discomfort, sore spots, movement while eating or speaking, and dependence on denture adhesive. With an All-on-4 bridge those concerns largely disappear, because the restoration is fixed and anchored on the implants.
The honest conclusion is not that a denture is bad, but that it answers a different need. For anyone to whom stability and a feeling closer to natural teeth matter, All-on-4 is usually the better fit. At Ortoimplant DENTAL SPA we are primarily focused on fixed implant-prosthetic solutions, while a conventional removable denture is made only exceptionally, when there is a justified individual indication for it.
Variants
All-on-6 and All-on-X: when more than four implants
The number in the name says how many implants are used per jaw. Alongside All-on-4 there is also All-on-6 (six implants) and All-on-X, a term used to describe that the number of implants is chosen according to the individual patient rather than to a fixed rule.
More implants can be of benefit when there is enough bone and when the load is to be distributed further, for example in the upper jaw, which is as a rule softer than the lower one. The optimal number of implants is the one the patient’s particular anatomy calls for, whether that is four or six. And it is not only their number that matters, but also their position, the quality of the bone and the way the load will be distributed.
Four implants
All-on-4
A proven, frequently used approach. It makes use of the existing bone and in most cases avoids grafting.
Six implants
All-on-6
Additional support and force distribution when there is enough bone, often considered in the upper jaw.
Individual
All-on-X
The number of implants is chosen according to the patient’s anatomy and plan, not according to a fixed number.
The key thing to remember is that a larger number of implants is not automatically better. The choice is a clinical decision that depends on the amount and quality of bone, the position of the nerves and sinuses, and on what we want to achieve. More on the differences in the text All-on-4 or All-on-6, what is the difference.
When there is not enough bone in the jaw
What if bone is missing
All-on-4 is already designed to make use of the existing bone and to avoid grafting in most cases. In some patients, however, bone loss is so pronounced that even this is not enough for the conventional approach. The solution does not have to disappear then, only the technique changes.
In such cases we apply advanced implantology techniques with which we look for safe bony anchorage according to the patient’s individual anatomy: zygomatic (Zygoma) implants, which are anchored in the firm cheekbone, pterygoid implants, which use firm bony anchorage in the posterior part of the upper jaw, transnasal implants, which use the Z-point, an anatomically firm area of bone beside the nasal cavity that can provide stable anchorage even with pronounced bone loss in the upper jaw, and transsinus implants, in which the direction of the implant is planned through the area of the maxillary sinus in order to make use of the available bony anchorage. The goal stays the same, fixed teeth, but the route to it is adapted to the anatomy.
Why this matters: it is precisely why patients who have been told elsewhere that implants are not for them can often still get fixed teeth. Whether it is feasible in your particular case can be assessed reliably only after a clinical examination and 3D CBCT diagnostics. More in the text implants without bone, Zygoma and advanced techniques.
The course of treatment
The course of the procedure and recovery
Treatment begins with a clinical examination and complete digital X-ray diagnostics, including a 2D orthopantomogram and 3D CBCT, on the basis of which we plan the position of every implant before the procedure itself. In some patients guided implantology is used, in which the digital plan is transferred precisely into the operating theatre by means of an individually made surgical guide.
We carry out the procedure itself under local anaesthesia and potentiated intravenous analgosedation, supervised by an anaesthesiologist. Analgosedation is a controlled state of reduced consciousness whose depth is adapted to the patient and the procedure, and in more extensive All-on-4 / All-on-X procedures patients mostly sleep through them.
In All-on-4 and All-on-X therapy we apply the immediate loading protocol, so as a rule the patient receives a temporary fixed bridge on the same day the implants are placed.
We further support recovery with DENTAL SPA treatments that we adapt individually to the patient and carry out before, during and after the procedure. They include lymphatic drainage before the procedure, ozone therapy and intravenous supplementation of vitamins, minerals and amino acids during the procedure, and magnetotherapy with torsion fields after the procedure, together with hyperbaric oxygen therapy (HBOT) when it is indicated. The aim is to support the body during the procedure and recovery, to reduce postoperative discomfort and to create more favourable conditions for healing. The permanent fixed bridge is made after the implants have finished fusing with the bone (this process is called osseointegration and as a rule takes about three months).
Evidence
Durability and success: what the literature says
All-on-4 is neither a new nor an experimental method. It has been in use for more than two decades and there is extensive professional literature about it, so durability can be discussed on the basis of published data rather than impressions.
The systematic review by Soto-Penaloza and colleagues concludes that All-on-4 offers a predictable way of treating an atrophic, resorbed jaw without bone regeneration procedures, with high implant survival rates, though the authors honestly point out limitations in the length of follow-up and in the methodological quality of some of the studies.2 The clinical report by Malo and colleagues, one of the groups that developed the method, reports an estimated five-year survival of about 98 % at implant level for the completely edentulous upper jaw.1
A more recent systematic review by Gaonkar and colleagues, which also followed longer periods, reports cumulative implant survival rates of between roughly 94 % and 98 % across periods of six to eleven years, with no significant difference between axially placed and tilted implants.3
How to read those figures: high survival rates refer to groups of patients in studies and do not guarantee the outcome in an individual case. Durability depends on bone quality, diligent hygiene, regular check-ups and general health. A fixed bridge on implants requires regular maintenance and over the years it can be repaired or renewed as needed, while the implants remain in the bone.
“We do not promise the patient a number, but an honest, predictable and long-term successful plan. All-on-4 is a mature, well documented method and the gold standard of fixed rehabilitation of an edentulous jaw, and our job is to assess whether it suits you specifically and, through proper planning and execution, to secure the long-term success of the treatment result.“
Frequently asked questions
What is the All-on-4 method?
All-on-4 is a method in which the whole arch of teeth in one jaw is carried on four titanium implants. The two front implants are placed upright and the two rear ones at an angle, so that bone which is still firm is used and extensive grafting is avoided in most cases. A fixed bridge is attached to those implants, one the patient does not take out of the mouth, though clinical staff can remove it at the practice when needed.
How soon do I get teeth after placement?
In All-on-4 and All-on-X therapy we apply the immediate loading protocol, so as a rule the patient receives temporary fixed teeth on the same day the implants are placed, or at the latest within 24 hours of implantation, and is not left without teeth. The permanent fixed bridge is made after osseointegration is complete, that is, after the implants have fused with the bone, which as a rule takes about three months.
How long does recovery take?
Most patients return to their usual activities within a few days. Mild swelling and tenderness in the first days are expected and are controlled with painkillers and clear instructions. Healing of the wound and soft tissues takes from a few days to about two weeks, when the sutures are usually removed, while the fusing of the implants with the bone, that is, osseointegration, takes several months, most often around three. We further support recovery with individually adapted DENTAL SPA treatments that we carry out before, during and after the procedure.
How long does All-on-4 last?
All-on-4 is designed as a long-term solution, not a temporary one. Peer reviewed studies report high implant survival rates over periods of several years, with diligent hygiene and regular check-ups. A fixed bridge on implants requires regular maintenance and over time it can be repaired or renewed as needed, while the implants remain in the bone. Long-term success depends on hygiene, regular check-ups and general health.
What if I am missing bone?
Conventional All-on-4 is already designed to use the existing bone and to avoid grafting in most cases. Even when patients are told they do not have enough bone for implants, that does not necessarily mean fixed teeth are impossible. Where the deficit is pronounced, that is, in atrophy of the jawbone, we apply advanced techniques such as zygomatic (Zygoma), pterygoid, transnasal and transsinus implants, with which we look for safe bony anchorage according to the patient’s individual anatomy. Whether such a solution is feasible in your particular case can be said only after an examination and a 3D CBCT scan.
Is placement painful?
We carry out the procedures under local anaesthesia and analgosedation, so patients mostly sleep through the procedure and feel no pain. After the procedure mild swelling and tenderness are expected, and these are well controlled with medication. To support recovery, comfort and the patient’s well-being we also provide individually adapted DENTAL SPA treatments.
In what way is All-on-4 better than a conventional denture?
Unlike a removable denture that rests on the gums and can move or cause sore spots, the All-on-4 bridge is fixed and anchored on the implants, so it is stable while eating and speaking and is not removed at home. In addition, the load transmitted through the implants helps to preserve the bone. At Ortoimplant DENTAL SPA we are primarily focused on fixed implant-prosthetic solutions, while a conventional removable denture is made only exceptionally, when there is a justified individual indication for it.
When is All-on-6 chosen instead of All-on-4?
All-on-6 means six implants per jaw instead of four. More points of support can be of benefit when there is enough bone and when the load is to be distributed further, especially in the upper jaw, whose bone is as a rule softer. The number of implants is not a measure of quality but a decision adapted to your anatomy, the amount of bone and the plan. What is right for you is assessed on the basis of a 3D CBCT scan.
Sources and references
- Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. All-on-4 immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and long-term (5 years) outcomes. Clin Implant Dent Relat Res. 2012;14(Suppl 1):e139-e150. pubmed.ncbi.nlm.nih.gov/22008153
- Soto-Penaloza D, Zaragozí-Alonso R, Peñarrocha-Diago M, Peñarrocha-Diago M. The all-on-four treatment concept: Systematic review. J Clin Exp Dent. 2017;9(3):e474-e488. pmc.ncbi.nlm.nih.gov/articles/PMC5347302
- Gaonkar SH, Aras MA, Chitre V, Mascarenhas K, Amin B, Rajagopal P. Survival rates of axial and tilted implants in the rehabilitation of edentulous jaws using the All-on-four concept: A systematic review. J Indian Prosthodont Soc. 2021. pubmed.ncbi.nlm.nih.gov/33835063
Content undergoes professional review before publication. This text is general information and does not replace a clinical examination. Book a free consultation