What Is All-on-4? The Short Answer
All-on-4 is an implant technique that supports a complete fixed set of teeth (a full-arch bridge) on only four implants in an edentulous jaw. Two implants are placed upright at the front and two are tilted at the back. The concept was described in studies published in the early 2000s and has more than 20 years of clinical follow-up data.
- 4 Implants per JawFor the upper, lower or both jaws
- Provisional Fixed TeethSame day or within 1–3 days in suitable cases
- Final BridgeAfter about 3–6 months of healing
- AnaesthesiaLocal anaesthesia, optional sedation
- Bone GraftingOften avoided thanks to tilted implants
- Time in Istanbul2 visits of about 5–7 days each
How Does the Technique Work?
With conventional implants, each missing tooth or small group of teeth gets its own implant, and areas with weak bone often need a sinus lift or bone graft. All-on-4 instead makes the most of the bone you already have: by tilting the back implants, the surgeon avoids the sinus in the upper jaw and the nerve canal in the lower jaw. The four implants create a wide support base from the front of the jaw to the back.
The bridge is screwed onto the implants. You cannot take it out yourself, but your dentist can remove it for maintenance and check-ups. This is the key difference from removable dentures.
Benefits
- Fixed teeth instead of a denture, with no plate covering the palate
- Provisional fixed teeth on the day of surgery in suitable cases
- Often avoids sinus lifts or bone grafts
- Fewer implants and a shorter surgery
- Comfortable for people who gag with removable dentures
Limitations to Know About
- It is not suitable for everyone; a CBCT scan decides
- A soft diet is needed while wearing the provisional bridge
- Remaining teeth that cannot be saved are removed during surgery
- If an implant fails, the prosthetic plan must be reassessed
- Lifelong hygiene and yearly check-ups are essential
Who Is All-on-4 Suitable For?
All-on-4 is usually planned for adults who have no teeth left in one jaw, or whose remaining teeth cannot be saved because of advanced gum disease, fractures or decay. Age alone is not a barrier; general health and bone structure are what matter.
Usually Suitable
- Fully edentulous patients, or those who need all teeth removed
- Denture wearers whose dentures are loose or uncomfortable
- Patients with bone loss at the back but enough bone at the front
- Patients with well-controlled diabetes or blood pressure (with medical approval)
Needs Further Assessment
- Uncontrolled diabetes or immune system disorders
- A history of radiotherapy to the head and neck
- Intravenous medication for bone loss (e.g. bisphosphonates)
- Heavy smoking or severe teeth grinding (bruxism)
- Very limited bone even at the front of the jaw
Important: Please tell us about all medication you take and any long-term conditions before you travel. Where needed, we will ask for a note from your GP or specialist.
The All-on-4 Treatment Process, Step by Step
Treatment has two main phases: surgical and prosthetic. At Klinik İstanbul the surgical phase is led by an oral surgeon and the prosthetic phase by a prosthodontist; both plan your treatment together.
- Day 1
Examination and 3D Scan (CBCT)
An oral examination, panoramic X-ray and cone-beam CT measure your bone volume and the position of the sinus and nerve canal. We also review your medical history.
- Days 1–2
Digital Planning and Impressions
Implant angles and positions are planned, and tooth shade, length and smile line are agreed with you. Impressions are taken for the provisional bridge.
- Surgery Day
Extractions and Implant Placement
Under local anaesthesia (with sedation if needed), any teeth that cannot be saved are removed and the four implants are placed. Surgery for one jaw usually takes 2–3 hours.
- Same Day – Day 3
Provisional Fixed Bridge
If the implants achieve sufficient initial stability, a screw-retained provisional bridge is fitted. You fly home with fixed teeth.
- 3–6 Months
Healing at Home (Osseointegration)
The implants fuse with the bone. You follow a soft diet and we monitor your healing remotely with photos and video calls.
- Visit 2 · ~5–7 Days
Final Bridge
New impressions are taken, a try-in is done and your zirconia or metal-reinforced final bridge is screwed in. Your bite is adjusted and you are shown how to care for it.
- 1–2 Times a Year
Check-Ups and Professional Cleaning
If necessary the bridge is removed to clean around the implants, and the screws and bite are checked. This can be done in Istanbul or coordinated with a dentist at home.
Planning Your Trip to Istanbul
Most of our international patients come for two trips. Here is what a typical plan looks like:
All-on-4 Compared With Other Full-Arch Options
All-on-4 is not the only solution for missing all your teeth. The table below gives a general comparison of the options we discuss most often.
| All-on-4 | All-on-6 | Implant-Retained Overdenture | Conventional Full Denture | |
|---|---|---|---|---|
| Number of Implants | 4 | 6 | 2–4 | None |
| Type | Fixed (screw-retained) | Fixed (screw-retained) | Removable by patient | Removable by patient |
| Covers the Palate? | No | No | Usually not | Yes (upper jaw) |
| Bone Grafting | Not needed for most | More often needed | Rarely | None |
| Provisional Fixed Teeth | Same day if suitable | Same day if suitable | — | — |
| Chewing Efficiency | High | High | Moderate | Low |
| Relative Cost | Medium–high | High | Medium | Low |
Is All-on-4 Painful? Recovery and Aftercare
You should not feel pain during the procedure because it is performed under local anaesthesia. As with any surgery, swelling, bruising and tenderness are common for 3–5 days; these are usually controlled with prescribed painkillers, antibiotics and cold compresses, and ease noticeably by the end of the first week. We recommend you do not fly until your surgeon has checked you, usually 2–3 days after surgery.
First 2 Weeks
- Cold compresses on and off for the first 48 hours
- Lukewarm or cold liquids and puréed food
- No smoking or alcohol
- Gentle cleaning with the prescribed mouthwash
- Sleep with your head raised
Week 2 Until the Final Bridge
- Fork-mashable soft diet (avoid hard or sticky food)
- Daily cleaning with interdental brushes and a water flosser
- Keep your remote follow-up appointments
- Tell us if you grind your teeth at night
Contact us straight away if you notice increasing swelling, fever, bleeding that will not stop, or a loose or broken bridge: +90 544 216 20 60 (phone and WhatsApp).
Possible Risks and Complications
All-on-4 is a well-documented treatment, but like any surgery it carries risks. You should know them before you decide:
- Implant failing to integrate: The risk is higher in smokers and in uncontrolled diabetes. It is usually solved by placing a new implant.
- Fracture of the provisional bridge: The most common issue during healing, usually from eating hard food; it can be repaired.
- Peri-implantitis: Poor hygiene can cause inflammation and bone loss around implants; regular check-ups help prevent it.
- Temporary numbness or sinus problems: CBCT-based planning minimises these risks; they are rare.
- Short-term speech changes: Some sounds may feel different at first; most people adapt within a few weeks.
Our All-on-4 Team
Klinik İstanbul was founded in 2015 by specialist dentists from different fields. Your All-on-4 plan is built on the joint assessment of three specialists: the endodontist decides which teeth can be saved, the oral surgeon performs the implant surgery and the prosthodontist designs your bridge.
Dr. Emrah Genceli
Specialist in Oral and Maxillofacial Surgery and Periodontology. Graduated from Istanbul University Faculty of Dentistry in 2007 and completed his specialist training in Oral and Maxillofacial Surgery at Yeditepe University.
Prof. Dr. Çağatay Dayan
Specialist in Prosthodontics. Completed his specialist training and PhD at Istanbul University Faculty of Dentistry and has published national and international scientific work. Full-arch fixed and removable rehabilitation is one of his main areas.
Dr. Tolga Sandıkçı
Specialist in Endodontics (Root Canal Treatment). Graduated from Yeditepe University and completed his specialist training there in 2012. Before treatment he assesses whether your existing teeth can be saved, helping avoid unnecessary extractions.
What Affects the Cost of All-on-4?
We give you a written, itemised quote once your X-rays or CBCT have been reviewed. The main factors are:
All-on-4 Frequently Asked Questions
How Many Days Do I Need in Istanbul for All-on-4?
Most patients need two visits. The first, for examination, surgery and the provisional fixed bridge, usually takes 5–7 days. The second, for the definitive bridge, takes place about 3–6 months later and also lasts about 5–7 days.
Is All-on-4 Painful?
The procedure is done under local anaesthesia, so you should not feel pain during it; sedation is available on request. Swelling and tenderness are common for 3–5 days afterwards and are usually managed with the medication your surgeon prescribes.
Will I Leave With Fixed Teeth on the Same Day?
If the implants achieve sufficient initial stability, a screw-retained provisional fixed bridge can be fitted the same day or within a few days. Your surgeon makes this decision during the operation.
I Have Been Told I Have Bone Loss. Can I Still Have All-on-4?
Tilting the back implants often avoids the need for a sinus lift or bone graft. However, suitability can only be confirmed with a cone-beam CT scan; if bone is severely limited, a different plan may be recommended.
What Is the Difference Between All-on-4 and All-on-6?
All-on-4 uses four implants per jaw and All-on-6 uses six. Where bone volume allows, especially in the upper jaw, six implants may provide additional support. The right option depends on your bone, bite and expectations.
How Long Does an All-on-4 Bridge Last?
Long-term follow-up studies report high implant survival rates for All-on-4. Longevity depends on oral hygiene, smoking, teeth grinding and regular check-ups; the teeth of the bridge may need maintenance or renewal over the years.
Can I Send My X-Rays Before I Travel?
Yes. You can send a recent panoramic X-ray or CBCT scan via WhatsApp for a preliminary assessment. A final treatment plan is only confirmed after an in-person examination and CBCT in Istanbul.
Where Is Klinik İstanbul?
Klinik İstanbul Ağız ve Diş Sağlığı Polikliniği is at Büyükdere Caddesi No: 95/3, Mecidiyeköy, Şişli, Istanbul. Opening hours are Monday to Friday 10:00–19:00 and Saturday 10:00–16:00. Phone and WhatsApp: +90 544 216 20 60.
Written and Medically Reviewed By
Dr. Emrah GenceliOral and Maxillofacial Surgeon- Prof. Dr. Çağatay DayanProsthodontist
- Dr. Tolga SandıkçıEndodontist
Scientific Sources
- Maló P, Rangert B, Nobre M. All-on-Four immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003;5 Suppl 1:2–9.
- Maló P, de Araújo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142(3):310–320.
- Soto-Peñaloza 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.
The information on this page is for general guidance and does not replace a clinical examination. Treatment plans, timelines and results vary from person to person; the right treatment for you can only be decided after an examination and radiological assessment by a dentist.
