All-on-4: a fixed full arch on four implants

All-on-4 is a treatment concept in which four implants are placed in the upper or lower jaw to support a full-arch fixed bridge. The two back implants are often angled, which can make use of available bone and, in some cases, reduce the need for bone grafting. The bridge is screwed onto the implants and is not removed by the patient.

The approach is often considered for people who have lost most or all of their teeth in one jaw, whose remaining teeth cannot be saved, or who struggle with conventional dentures. Many clinics fit provisional teeth soon after surgery, with the final bridge made once the implants have healed.

It is a significant decision. It usually involves removing any remaining teeth in the arch, a period of healing, and long-term maintenance. Alternatives include implant-retained dentures, conventional dentures and All-on-6. A clinician should explain these options and why they would recommend one over another for you.

All-on-4 may be suitable for adults who have lost, or are about to lose, most of the teeth in one jaw. A dentist will need to examine you and review a 3D scan before deciding whether it is appropriate.

• Most or all teeth in an arch are missing, failing or advised to be removed.
• You would prefer fixed teeth to a removable denture.
• Imaging suggests there may be enough bone in the front of the jaw for four implants.
• Any gum disease is being managed and you are willing to keep up careful cleaning.
• You can plan for at least two trips over several months.

Smoking, uncontrolled diabetes, some medications, previous radiotherapy and heavy teeth grinding can all affect suitability or outcome. Some people may be better suited to a different number of implants or a removable option. This is general information, not a diagnosis.

1. 01

   Records and remote assessment

   You share any existing X-rays or scans, photographs and your medical history so the clinic can give initial thoughts. Nothing is final until you have been examined.

2. 02

   Examination and planning

   On your first visit the dentist examines you, takes a CBCT scan and discusses the plan, including tooth shade and shape, any extractions and the type of provisional teeth.

3. 03

   Extractions and implant placement

   Remaining teeth in the arch are removed where planned and four implants are placed, usually in a single surgical session under local anaesthetic, often with sedation.

4. 04

   Provisional bridge

   In many cases a provisional fixed bridge is fitted within a few days if the implants are stable enough. You will be advised to follow a soft diet while healing.

5. 05

   Healing period at home

   The implants and gums are given time to heal, often several months. The gums change shape during this time, which is why a final bridge is usually made later.

6. 06

   Final bridge

   On a later trip the dentist takes new scans or impressions, may try in the design, and fits the definitive bridge, adjusting the bite and showing you how to clean around it.

All-on-4 typically involves two main trips: one for surgery and provisional teeth, and one for the final bridge after healing.

The first trip is usually longer, as it covers examination, surgery and fitting the provisional bridge. The second, often several months later, is for the definitive bridge and may involve a few appointments over several days.

If implants are not stable enough for immediate provisional teeth, or if additional procedures are needed, the plan and number of visits may change. Ask the clinic to set out every expected appointment in writing.

What can change the timeline

• Number of extractions and the condition of the remaining bone
• Whether implants are stable enough for same-week provisional teeth
• Whether one or both arches are being treated
• Healing time between provisional and final bridges
• Laboratory time and any try-in appointments
• General health and smoking

Full-arch treatment varies widely in scope, so a single figure would not be meaningful. These are the main factors that shape a clinic's quote.

• One arch or both
• Implant system and components
• Provisional bridge material and whether it is included
• Final bridge material, for example acrylic on a metal framework or zirconia
• Extractions, grafting and sedation
• Imaging and laboratory work
• Your travel and accommodation for each trip

We do not publish prices on this page. Each clinic sets its own fees and provides an indicative range, which can only be confirmed once a dentist has examined you and reviewed your scans. Ask for a written, itemised plan before you book anything, and check what is and is not included.

All-on-4 combines extractions and implant surgery, so it carries the risks of both. A clinician should discuss these with you in relation to your own case.

• One or more implants may fail to integrate or may fail later; because the bridge relies on only four implants, losing one can affect the whole arch.
• Peri-implantitis can develop around implants, particularly with poor cleaning access or smoking.
• Provisional and final bridges can chip, crack or loosen and may need repair.
• Nerve injury in the lower jaw and sinus complications in the upper jaw are possible.
• Speech, bite and the feel of the teeth can take time to adjust to.
• Removing remaining teeth is irreversible, so it is important to be confident in the decision.
• Recovery after major surgery can affect when you are comfortable to travel; follow your treating clinician's guidance.

A fixed full-arch bridge needs careful, lifelong maintenance, both at home and professionally.

• Clean under and around the bridge every day, often with a water flosser, interdental brushes or special floss.
• Attend regular professional reviews; the bridge may need to be removed periodically by a dentist for cleaning and checks.
• Consider a night guard if you grind your teeth, if your clinician recommends one.
• Tell your home dentist about the treatment and bring full records, including implant system details.
• Agree in advance with the clinic who handles follow-up, repairs and complications after you return home.