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The All-on-4 is a dental system in which a full set of teeth are supported on four dental implants. This is a great solution for toothless patients or with teeth in really bad condition
All-on-4 implants are as the name suggests a full set of artificial teeth on 4 implants. In this article, we will explain the whole concept of this treatment and will provide all the vital for the present or potential patients information.
Undoubtedly, implant treatment has successfully conquered the dentistry world. Practised since 1965, implantation has become the most effective and natural-looking dental treatment. What is also important, implants should last a lifetime supposing there are no complications or accidents in the meantime. Thanks to dental implants, patients could bridge the gap between the teeth, restore the aesthetic look of their smile and boost self-confidence. However, it quickly turned out that patients who missed many or even all of their teeth, and as a result needed a greater number of dental implants as a replacement, would put themselves into a high risk of complications and health problems having so many implants fitted. The implantologists realised this fact, of course, and hence, the All on 4 treatment appeared. The name “All on 4” can be explained as “all the new teeth on 4 implants”. Stepping back in time, the initiator of this treatment was Paulo Maló, a Portuguese dentist, who has played a key role in implant dentistry. He started working on implantation treatment advancement in the early 90s and finally in 1998, together with his excellent team of experts, the All-on-4 treatment has been put into practice.
To fully understand the core of the treatment, we need to understand its fundamental elements which are dental implants and dental prosthesis. A dental implant is a surgical item resembling a screw that is anchored in the jaw. It is made of titanium and owing to this material, the implant put in the jaw is naturally blended in it (it occurs as a biological process called osseointegration) and can replace the tooth root. The role of an implant is to hold a prosthesis (such as a crown, denture or bridge). All on 4 treatment implies a full jaw restoration, so in this case, the prosthesis is a bridge replacing all of the teeth. Depending on the patient’s individual qualifications, the bridge covers from 10 to 14 teeth. With regard to All-on-4 dental treatment, there are 4 implants put in a jaw and they support a full dental bridge. This technique allows for a permanent and aesthetic restoration of 1 or 2 jaws and is the most effective treatment of this kind. The superiority of All-on-4 dental implants over other full jaw restoration treatments is achieved thanks to 3 main characteristics, and great assets at the same time, which are:
Just to elaborate shortly on the above, all on four implants fulfil their function and provide the visible effects as soon as a patient leaves the dentist’s office, where just after placing the implants a patient is provided with a denture. So, All on four patients leave the dentist’s office with a new smile already. Needless to say, the denture put just after implantation is temporary and is to be replaced with a permanent bridge later on. Implants and a jaw need a few months to fully integrate with each other and heal, and only then will the bridge be fitted. However, patients have temporary teeth just after the first visit (implantation). As for the immediate function, the temporary denture restores the aesthetic look of the smile, allows for eating solid food and improves speaking. Regarding permanence, the question “How long do all on 4 implants last?” is one of the most common asked among possible patients. Well, All on 4 is an incredibly long-lasting procedure and taking into consideration the fact that full mouth dental implants are performed for ageing people, the great majority of them keeps them forever. Of course, the durability of a bridge depends much on a patients’ care and oral hygiene but is it asserted that its minimum durability is 20 years, and many a time it is 30 years or even more. As to interference with jaw, if we collate the scope of dental work, which is the widest as it is a permanent full jaw restoration, with the interference to the bone which includes placing 4 implants only, we can see that the technology and advancement in medicine has developed more than remarkably and the interference is minimal in relation to the achieved effects.
The best candidate for All on 4 is the person who has lost most or all of the teeth. If there are still many teeth left, the dentist always tries to save them and offer the different option of treatment. During the consultation, all circumstances will be taken into consideration and decided if All on 4 is a proper treatment
All on 4 treatment is performed mainly to ageing people, but let us elaborate more on the candidacy to this procedure. Well, the most important information to remember is that there are no strict criteria for the candidates’ selection and it is only the implantologist who qualifies patients for all-on-4 after a profound individual examination. Yet, there have been millions of people having this treatment performed and on the basis of the data gathered from them and the dentists, there are some frames as for the candidacy for All-on-four.
So, the best candidates are those who miss most or all of the teeth along a dental ridge – the main target group are elderly people and alternatively people having had an accident or suffering from teeth decay. In fact, many people being unhappy with their smile to think that All on 4 implants are for them. On the contrary, dentists always try to save the natural teeth if possible and full mouth dental implants are never placed at the will of a patient. Besides, the dental implants can be placed only if a patient has a gum tissue in place and the jawbone structure is sufficient. If a patient doesn’t meet this criterion, there needs to be a preliminary treatment performed first. It is also important that the candidate’s oral health is good and their general health condition allows for surgical interference. People considering this procedure must list all the medications they take because some of them may impair healing. And lastly, smoking is unacceptable due to its negative impact on the healing process. The above conditions are not strict, but rather generic and flexible, so please do not qualify or disqualify yourself for the treatment as only the dentist has the competence to do it.
Let us guide you through all stages of the treatment starting from the first contact with the dentist and ending at the final effects.
The first consultation is crucial for the treatment. It is the time when a dentist thoroughly examines the oral and general health, performs and analyses the X-ray and CBCT scan (cone beam computer tomography), asks the vital questions, e.g. about smoking, dental hygiene, health problems and medications, expectations towards the procedure. Then, the dentist makes the final decision regarding the qualification for All-on-4 treatment. It is also the best moment for the patient to decide whether the dentist meets their expectations. The bond and trust between the dentist and patient are crucial and enable successful and nonstressful treatment. If the dentist does not build trust or his expertise and skills are questionable, the patient should get another expert’s opinion.
At this stage, the proper treatment begins. The visit starts with preparing the jaw for implants. All on 4 is dedicated to toothless patients, so if a patient has some teeth left, they need to be extracted. After that, the implants are fitted. There are 4 implants in one jaw. It is a surgical procedure where a patient is provided with the anaesthetic. Usually, it is enough to apply local anaesthesia with sedation. However, in some extreme cases, like dentophobia, general anaesthesia is also possible. Regardless of the anaesthesia, a patient does not need to worry about the pain during the procedure. Implants are placed in a precisely determined place so that the nerves and sinus remain intact.
The All on 4 treatment starts from a personal consultation at the office, then there is implantation and after this stage, the patient must go through healing time which is around 3 to 6 months. When the gums are healed placement of permanent bridge is performed
The bone and gums need a few months to heal after placing implants. Usually, it takes from 3 to 6 months. Only after this time can the permanent bridge be put. Just after installing implants, the implantologist places healing abutments, thanks to which the gum tissue heals over the implants sites. The temporary prosthesis can be put on these abutments too. Once the gums heal, the healing abutments are replaced with final abutments which will support the permanent prosthesis. Generally, the gums need about 4-6 weeks to heal after abutment placement. Patients can make the recovery goes faster by taking proper care of the gums (e.g. avoiding some food, proper cleaning). When the recovery finishes, the dentist can move on to the last stage of the treatment.
The permanent bridge serves as a new set of teeth and has to fit perfectly. The restorative dentist has to be very precise, even meticulous, to make such All on 4 dentures that look natural, aesthetic and match the patient’s smile. Hence, there are cases where the model of a permanent prosthesis is made during more than one visit. The bottom line of this stage is making the ideal teeth and the length of it can vary widely. In order to make a custom-fit prosthesis, the dentist makes impressions of the teeth, abutments, and jaws. The bridge is also fitted in terms of bite registrations and smile look. When the model is ready, the proper bridge starts to be prepared in a laboratory. Before the permanent placing of the bridge, a patient has a few fittings to assess how it feels in the mouth. If any adjustments are needed, they are made by a prosthodontist of course. The bridge is adjusted and fitted as many times as needed and once the patient agrees for it, it is attached to the abutments. The All-on-4 treatment ends at this stage.
However the recovery is not a direct part of the All on 4 treatment, it plays a major role in the implantation. Looking after the dental implants may hasten or slow the recovery and ability to install the permanent prosthesis. Thus, the time between the implant installation and fitting the prosthesis is extremely important and only the patient has an influence on it. First, the successfulness of oral surgery depends mainly on keeping the mouth clean. After the implantation visit, the dentist always explains how to clean All on 4 dental implants. It involves mainly using a toothbrush, hot salt mouthwashes, regular mouth rinsing. Also, eating after All on 4 implants has to meet the dentist’s instructions. It is advised to keep food away from the surgically interfered area and not to smoke as long as possible. In fact, smoking is the greatest danger and should be ceased until the wounds have healed completely. Regarding the time just after the implantation, patients should avoid drinking cold and hot drinks or eating until the anaesthesia has subsided. The surgical area should not be disturbed with a finger or tongue. Exercises are allowed 48 hours after implantation. Patients often experience bruising or swelling but this is normal and should disappear after a few days, it can be also reduced with the use of ice bags. The main concern, however, is the pain, but there is nothing to worry about. If there is pain after implantation, it will last shortly and the regular painkillers will help.
Like any other treatment, All on 4 has both advantages and disadvantages. Here, we try to point out the main characteristics of All on 4.
All on 4 procedure allows for getting a new set of teeth in one day. In spite of the fact that the treatment lasts for a few months, patients get temporary teeth at the beginning. It adds enormous psychological value by enabling people to speak clearly, smile, and eat without any discomfort. As a result, the main patients’ worries, which are a feeling of shame about the teeth and inability to eat are eliminated early on.
The bad look of the teeth and smile makes many people refrain from social life. They avoid talking to people, smiling and generally showing their teeth to anyone. All on 4 improves the social life to a great extent. Patients start to speak and smile eagerly. Their faces look changes for the better as the lower part is no longer sunken, but rather “filled” with a perfect set of teeth. The psychological condition and self-confidence are considerably boosted.
Unlike regular dentures, which may be uncomfortable and need a replacement with new ones after some time, the All on 4 is performed only once. Patients do not need to worry about falling out or slipping of a prosthesis. It does not require any special care, just regular teeth brushing and flossing, and doing so, patients can enjoy the new set of teeth for dozens of years.
The American Academy of Periodontology claims that the bone which surrounded the tooth root starts to deteriorate (resorb) after tooth loss and wearing conventional dentures does not prevent it. Only implants, which integrate with the jawbone, help to keep it healthy and stable.
All the teeth in a bridge fit together perfectly, do not move or hurt while speaking, drinking or eating and the bite feels stronger and stronger every day. There is no artificial palate, so patients feel as if they had natural healthy teeth. The prosthesis is also non-removable and requires only regular cleaning, which is brushing and flossing, which enhances the feeling of the naturalness of the teeth.
Some of many advantages of All on 4 treatment are; immediate effect (temporary teeth between stages), permanent solution, preserving healthy bones, improving the appearance and reducing dental problems
Thanks to All-on-4 dental implants patients reduce the number of visits to the dentists to the minimum (which involves control visits only). Such treatments as fillings, root canal treatment, veneers, crowns, dentures, etc. are completely eliminated. It also allows for saving a lot of money which otherwise would be spent on future dental treatments.
The All on 4 dental implant procedure’s price is lower than its alternatives in the long term. Assuming that the treatment is performed once and no further dental work would be needed, the treatment is worth the price. More and more clinics offer instalment plans for All on 4 technique so that patients do not feel the pinch at all.
The key to success in All on 4 procedures is a correct recovery after implantation. It is only up to a patient whether the healing goes smoothly and fast or not. It is important to implement all the dentist’s instructions and follow them scrupulously (e.g. do not smoke, do not eat solid food at the beginning, maintain proper oral hygiene). If a patient does not take care of the gums, the recovery will be disrupted and gums may get infected.
There are some criteria for implantation procedures and unfortunately, not everyone has the opportunity to get All-on-4 treatment. If a dentist does not qualify a patient for implantation, the dentures would be an alternative.
Implantation is one of the most effective and successful dental treatments, having more than a 98% success rate. Yet, there is still merely 2% of patients who experience implant fail. In such cases, dentists have to replace the implant with a new one or install dentures instead.
Sometimes, implants do integrate with the bone and the surgery has to be repeated. The main factors for this complication are smoking, some chronic health conditions and medications, poor bone density or nutrition.
During the implantation procedure, the dentist has to be extremely precise and get round all the nerves. However, there have been cases where patients had their nerves damaged, which caused numbness, pain, or paresthesia in the tissues around, e.g. chin, teeth, lips, gums.
Correlating the pros and cons of the procedure it’s clear that the advantages outweigh All on 4 dental implants risks decisively. Patients should be aware of all possible risks and complications, but they should have in mind that it concerns less than 2% of patients. If patients choose the right clinic and a renowned dentist and keep the proper oral hygiene after implantation, they will enjoy the implantation effects and would benefit from All the advantages.
The cost of All on 4 treatment is often a decisive factor for a patient. Needless to say, this procedure is rather expensive and not everyone can afford it. Though, patients should correlate two solutions. On the one hand, there is the All on 4 procedure on which people spend relatively much money at one go, and on the other hand, there are cheaper procedures and probably much more dental visits over the course of years. In fact, it often turns out that one treatment such as All on 4 costs pretty the same as cheaper dentures and further possible visits and dental works. The only difference is that the former requires spending money at once and the latter requires regular expenses on dental care over the years. That is why more and more people decide to have All on 4 dental implants and keep out of any dental problems for the rest of their lives.
The other important aspect of the cost is what exactly is included in the price. Certainly, All on 4 is a complex procedure consisting of several stages and visits and some prices count only the implantation without a permanent prosthesis, some exclude temporary teeth, etc. Thus, patients need to be careful as to the costs and make sure that the given price includes all stages of the treatment.
So, now we will answer the most frequent question among possible patients, which is: how much does the All on 4 procedure cost?
Very often the cost of All on 4 treatment is a decisive factor for the patient, therefore, it is extremely important to make sure what is included in the price and what experience the doctor has
The UK has the average price for the complex All on 4 treatment ranging from £13 000 to £16 000 per one arch. This price includes the consultation, CBCT scan, and X-ray examination, implants, abutments, temporary dentures, and permanent prosthesis. Regarding the treatment of 2 jaws, the average full mouth dental implants cost in the UK is £27 000. Needless to say, there are clinics offering more competitive prices for the same service and while searching for the data to this article, we found a clinic offering the All on 4 prices of £11 000. Likewise, there are clinics with much higher prices for the same work, e.g. £25 000 for the upper jaw.
While looking for a clinic, patients have to remember about 3 main aspects. Firstly, the prices vary mainly because private dentists can set any prices they wish. If they are convinced of their expertise, experience, and skills, they can charge more for their service, and if some count on more patients, they can reduce prices. It is, for the most part, a pure economy. Secondly, the cheapest all on 4 implants UK cost even £10 000, but it is extremely rare and only single dental offices offer such a price. Patients who are given such a low all on 4 price must ask about the price components. It happens that dental offices offer a price of £6000, but they don’t notify that it is only for the implantation. Patients just need to be cautious about the price. And lastly, if patients look for a reputable dentist and professional treatment made with the use of good value materials, they shouldn’t choose the cheapest treatment they find, but rather make a deep research of the dental practices and their charges.
Dental treatment in the UK does not belong to cheap services and a great number of people use the NHS system to reduce the costs. Each treatment is categorized into one of three bands. The NHS bands are as follows:
*These costs are slightly different in Wales: band 1: £14,30, band 2: £46, band 3: £199,10.
The simplest services, like a check-up and diagnosis, belong to the band 1, the more complex treatments, e.g. fillings, root canal treatments or teeth extraction, belong to the band 2. The band 3 includes sophisticated treatment like dentures, crowns or bridges. Regarding All on 4 dental implants on NHS, they may be available on the NHS only when there is a medical need for such a treatment. For example, if a patient cannot wear dentures (because of face damage, accident, oral cancer, etc), the implantation can be covered by NHS.
The detailed description of 3 categories for NHS implantation treatment is given by Oxford University Hospitals NHS Foundation Trust:
If patients think they might be candidates for full mouth dental implants cost NHS refund, they should always try to apply for it. There are many websites, helplines, and institutions that can help and give further instructions about the procedure course, necessary documents, and further steps.
If the treatment is a too expensive in-home country, a great alternative is to do the treatment abroad. Current travel options, bargain prices on airline tickets, great knowledge of English among foreigners doctors are just a few factors that support finding All-on-4 treatment abroad at affordable prices
People for whom All on 4 in the UK is too expensive and who are not qualified for an NHS refund have a great alternative, which is performing full mouth dental implants abroad. The 21st century is the time when medical tourism has been flourishing. The open borders, direct and cheap flight connections, the prevalence of the English language among doctors and clinics, openness to foreign patients, and finally affordable prices for all on 4 dental implants abroad have resulted in more than 15 million medical tourists in 2017, and this trend has been incessantly on the rise. With regard to dental treatment, the most popular are all on 4 in Turkey, Hungary, and Poland, and the most common nationalities of medical tourists are American, German, British and Scandinavian. Currently, the majority of clinics offer the whole treatment and stay packages including not only the treatment cost but also the accommodation, transfers and sometimes the flights. In fact, it does not differ from regular holiday packages. Focusing on All on 4 abroad treatments, the prices in the Western European countries, like the UK, Germany, France, Norway or Denmark, but also the United States, are even twice as expensive as all on 4 in Poland or Turkey. All on 4 in Hungary is also a cheaper option. Even including the flights and accommodation, patients save thousands of pounds on the treatment. The detailed information answering the question How much does the All on 4 dental implant cost? is given in the chart below:
One of the options for patients who can not be qualified for All on 4 treatment is the bridge on implants. It is very similar to a standard dental bridge, the only difference is that instead of own teeth, implants are used to anchor edges of the bridge
As was discussed earlier in this article, not everyone can be qualified for the All-on-4 procedure. It does not mean that patients are left without any help. On the contrary, they get alternative treatments instead. Among these treatments, there are:
It is a bridge consisting of as many crowns as missing teeth. The main difference between a regular bridge and implant-supported bridge is that the former is attached to the natural teeth and the latter is put on implants anchored on two edges of the bridge. When a patient has a few single teeth left, a dentist would not always be eager to remove them to perform All on 4. If the teeth are in good condition, they would stay in their place and the dentist will perform bridges instead of extracting healthy teeth.
The main difference between All on 4 vs All on 6 is rather obvious. All on 4 consists of 4 implants while All on 6 includes 6 implants. When dentists have doubts about whether four implants would hold a prosthesis, they can anchor six implants to hold a bridge. It usually refers to the upper jaw because it is more difficult to keep the bridge stable there than in the lower jaw.
Complete removable dentures are alternative for the patients who can not have implants or are looking for the cheaper option than All on 4 treatment
This denture rests on only 2 implants in the lower jaw and at least 4 on the upper. It is much cheaper than All on 4 and it is the main advantage of the solution. Also, such an overdenture can be transformed into All on 4 in the future. It has great stability thanks to implants, but at the same time can be taken off at any time without visiting a dentist.
This solution is applied when patients cannot have implants at all or they look for a much cheaper solution than All-on-4. Modern dentures look natural, aesthetic, and they are easily removable. The upper denture covers the roof of the mouth, while the lower one has a U-shape to make the space for the tongue.
All on 4 procedure is tangible evidence for the development and advancement of dentistry. The four implants supporting a permanent prosthesis guarantee a natural-looking, aesthetic and permanent results. It has been a leading solution for toothless and almost toothless patients, who have a chance to change their lives completely from both physical and psychological point of view. It is said that All on four dental implants cost is a lifetime investment where patients need to spend money at once, but avoid any teeth problems in the future. In Western European countries as well as the USA, All on 4 cost may exceed people’s budget, however, there are alternatives provided by flourishing medical tourism. It has never been so easy to travel for the treatment as it is now and millions of people do it without any doubts. Travelling for the treatment allows for considerable savings and at the same time getting a professional service, not to mention a touristic dimension of the travel. Still, whether in a domestic country or abroad, it all boils down to a healthy and happy life, which All on 4 secures.
Please check all on 4 before and after photos of our previous patients.
Done by Krzysztof Gończowski, in Magnadent
Done in MDental (Medicover)
Done in Suba Dental Budapest
Management Association, Information Resources. “Medical Tourism: Breakthroughs in Research and Practice.” IGI Global, 2018. 1-378. Web. 11 Dec 2019. doi:10.4018/978-1-5225-3920-9.
“Introducing Dental Implants” 1st Edition. Churchill Livingstone. Eds. John Hobkirk, Roger M. Watson, Lloyd Searson. 7 Nov 2003.
All-on-four Dental Implant Centers New York & New Jersey
Whatclinic • Healthcare & Beauty • Read Reviews & Compare Prices
The All-on-four Treatment Concept: Systematic Review
David Soto-Penaloza-Regino Zaragozí-Alonso-María Penarrocha-Diago-Miguel Penarrocha-Diago
The Nhs Website – NHS
Klaudia started to work for Clinic Hunter many years ago, just after graduating from the John Paul II Catholic University of Lublin in Poland and since that time, this job has become her biggest passion and inspiration.
She has gained necessary expertise and experience by serving patients from all over the world (mainly the UK, Scandinavian countries, and the USA), taking an active part in numerous live and video trainings with clinics in Poland, Hungary and Turkey, participating in international medical tourism conferences and events, and completing internal Clinic Hunter courses. Now, Klaudia is an accomplished patient advisor specialising in such fields as dentistry, plastic and bariatric surgery and hair loss treatment. Her main idea is helping people nad making their lives better, that is why this job brings her so much satisfaction and joy.
In private, Klaudia is a bike-tour lover. She travelled to over 25 countries and many of them she visited by bike. However, now she spends every spare moment with her little son.
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