All-on-four Implant Treatment

What is All-On-Four Implant Treatment?

All-on-4 implant treatment is a full-arch implant method that aims to restore a fixed set of teeth to a single jaw using only 4 implants for patients who are completely edentulous or whose existing teeth need to be extracted. Instead of removable, shifting teeth that move on the palate, as with classic dentures, a fixed bridge prosthesis screwed onto the implants is used. Thus, the patient does not worry about their prosthesis moving while speaking or chewing.

In this technique, two implants are placed vertically in the front region, and two implants are placed in the back region at an angle (typically 30–45°). The goal is to gain support from the areas with the best bone volume and to create a framework that will support a fixed bridge without encountering anatomical obstacles like sinuses or nerves. This makes it possible to create fixed teeth in most patients without the need for additional surgeries like bone grafts or sinus lifts.

All-on-4 is a scientifically backed system, tracked over many years, that simultaneously restores aesthetics, chewing function, and speech. It is a strong option for patients dissatisfied with full dentures, who say "I want fixed teeth in my mouth," but who lack sufficient bone for individual implants in every region. However, suitability for each patient must be evaluated by the surgical dentist through a detailed clinical and radiological examination.

How Long is the Recovery Time with All-On-Four?

The recovery time for All-on-4 treatment works similarly to classic implant surgery, but the time to functional standing is generally shorter. In the first 3–7 days after surgery; classic surgical findings such as swelling, mild pain, and bruising may occur. During this period, the process can usually be managed comfortably by regularly using the prescribed medications and applying cold compresses.

An average of 3–4 months is waited for the implants to fully fuse with the bone. We call this period the osseointegration process. The advantage of All-on-4 is that during this waiting period, the patient is mostly not left toothless, thanks to a temporary fixed prosthesis. This means that while biological healing continues, the patient can largely resume their social life normally.

The most critical point for long-term success is adherence to a soft diet, good oral hygiene, and follow-up appointments during this 3–4 month period. Excessively hard foods in the early period can increase the load on the implants and negatively affect the fusion process. In summary: Social recovery is fast, while biological recovery has a controlled and scientific timeline.

What is the All On Four Technique?

The All-on-4 technique is a specialized implant placement concept that restores a fully edentulous jaw or a jaw with teeth that need extraction using only 4 implants with a fixed bridge prosthesis. The nuance here is not so much the number of implants, but rather the angle and position of the implants. The implants in the front region are placed vertically, while those in the back are placed at an angle (tilted); thus, maximum benefit is derived from the bone volume while staying clear of risky anatomical structures like sinuses and nerves.

Thanks to this technique, a fixed prosthesis can be made in most cases without the need for bone augmentation surgeries (bone graft, sinus lift). This shortens both cost and treatment duration. All-on-4 cleverly utilizes the bone areas just in front of the sinuses in the upper jaw and the mandibular canal in the lower jaw.

One of the important aspects of the technique is the design of the fixed bridge that will be applied over the implants. A prosthesis design that is suitable for the bone and implant distribution, minimizes food accumulation, and allows for cleaning is essential. In short, All-on-4 is the art of "intelligently gaining support from available bone to achieve a full arch of fixed teeth with the fewest implants."

How is All On Four Treatment Performed?

All-on-4 treatment is a full-arch rehabilitation process consisting of several stages: planning, surgery, and prosthesis. The first step is a detailed clinical examination and evaluation of the jaw bones with 3D tomography. At this stage, the number of implants, their angles, lengths, and the prosthesis design are planned digitally. The better the planning, the more predictable the surgery becomes.

In the surgical stage, necessary tooth extractions are performed and 4 implants are placed in the jaw during the same session. The front implants are placed vertically, the rear ones are positioned at an angle. The procedure is usually performed under local anesthesia; sedation can also be preferred for suitable patients. After the surgery is finished, in most protocols, a temporary fixed prosthesis is screwed on the same day or within 24 hours. Thus, the patient goes through the process without being toothless.

Next comes the 3–4 month healing (osseointegration) period. During this period, a soft diet, hygiene, and check-ups are of great importance. When healing is complete, second impressions are taken, and the permanent fixed bridge prosthesis is prepared and screwed onto the implants. In the final stage, bite adjustment, aesthetic checks, and hygiene education are performed, and the patient attains their permanent full-arch fixed teeth.

What are the Advantages?

The advantages of All-on-4 implant treatment are quite significant both biologically and psychologically. The most fundamental advantage is that it restores a completely edentulous jaw to fixed teeth with a small number of implants. That is, a functional and aesthetic fixed bridge can be obtained with 4 implants instead of 8–10. This also means a reduction in both cost and surgical duration.

Another important plus is that in most cases, there is no need for advanced grafting procedures like bone powder or sinus lifts. This makes the healing process more comfortable and reduces surgical risks. Furthermore, since a large majority of patients leave the clinic with a temporary fixed prosthesis on the same day, they do not experience a "toothless period." This is very valuable for self-confidence and social life.

From a functional perspective, the chewing efficiency of fixed prostheses is significantly better than that of removable dentures. The fact that the prosthesis does not move during speech, laughing, and eating seriously increases the patient's daily quality of life. Additionally, the implants stimulate the jawbone, slowing down bone resorption, thus helping to somewhat prevent the collapse of facial contours. In summary, All-on-4 is a treatment approach that achieves a lot with few implants.

What Should Be Considered After All On Four Implant Treatment?

Points to note after All-on-4 treatment are vital for the long-term, trouble-free success of the treatment. In the first few days, the most important topic is bleeding and swelling control. Regular use of prescribed painkillers and antibiotics, along with cold application as recommended by the doctor, usually speeds up healing. Smoking should be quit if possible; if not, it must be strictly avoided in the first few weeks.

The second critical point is dietary habits. During the temporary prosthesis period, especially in the first 2–3 months, hard-shelled foods, foods that require biting, sticky, and very hard foods should be reduced; soft, well-c