For patients facing the loss of multiple teeth, All-on-4®1 offers a streamlined path to a complete, functional smile in a single appointment. This treatment replaces an entire upper or lower arch using just four strategically placed implants to support a fixed prosthesis. The approach is designed so patients can leave the practice the same day with a stable set of provisional teeth, avoiding extended periods without a full smile.
The immediate-restoration aspect of this technique is often the most meaningful to patients who want to preserve appearance, speech, and the ability to eat comfortably during the healing phase. While temporary prosthetics are used initially, they are designed to function and look like natural teeth, giving you confidence while implants integrate with the jawbone. The result is a practical blend of form and function that addresses both appearance and oral performance.
This section introduces the concept and clarifies one of the biggest questions patients have: you do not have to wait months without teeth. All-on-4® focuses on providing immediate, real-world benefits while following a clinically proven pathway toward a long-term restoration.
All-on-4® is engineered to restore chewing efficiency and facial support by replacing missing tooth structure and by stabilizing the bite. The four implants are placed in positions that maximize available bone, often avoiding the need for complex bone grafts. That carefully planned placement spreads biting forces across the arch, giving a reliable foundation for the prosthetic teeth and a natural distribution of pressure while you chew and speak.
Beyond function, full-arch restorations can improve facial contours that are altered by tooth loss. Replacing missing teeth helps support the lips and cheeks, reducing the sunken appearance that sometimes accompanies long-term tooth absence. Many patients notice a more balanced facial profile after their prosthesis is in place, which contributes to an overall sense of well-being.
Because the restoration is fixed rather than removable, it behaves much like a natural dentition for routine activities. You’ll be able to speak with clarity and enjoy a wider variety of foods compared with traditional removable dentures. The combination of stability and aesthetic improvement is often what makes All-on-4® a transformative option for people who want predictable, long-lasting outcomes.
The journey begins with a comprehensive consultation, including a clinical exam and diagnostic imaging to evaluate bone anatomy and overall oral health. During this phase, clinicians assess whether the All-on-4® approach is a suitable option and outline a tailored plan that considers esthetics, function, and long-term maintenance. Planning software and 3D imaging often play a key role in visualizing implant positions and predicting outcomes.
On the day of the procedure, extractions (if needed) and implant placement are completed during the same visit. The four implants are inserted at specific angles and depths to maximize support and stability. A provisional, fixed prosthesis is then attached to the implants, allowing patients to have a complete set of teeth immediately after surgery. This provisional stage protects the surgical sites while providing functional and cosmetic benefits.
After a healing period that allows osseointegration—the process where bone bonds to the implant—patients return for the final prosthesis. The final restoration is crafted to provide optimal esthetics and occlusion, and it is secured to the implants for long-term use. The multi-step process balances immediate improvements with careful, evidence-based steps to ensure reliable, lasting results.
Like any restorative dental work, All-on-4® requires regular care to ensure longevity. Daily hygiene routines—brushing and cleaning around the prosthesis and implants—are essential. Your dental team will provide specific instructions and may recommend tools such as interdental brushes or water flossers to help maintain the areas around implant abutments. Proper home care reduces the risk of peri-implant inflammation and supports long-term success.
Routine follow-up visits are equally important. Periodic professional cleanings and examinations let clinicians monitor the health of the soft tissues, the integrity of the prosthesis, and the condition of the implants. Early detection of any concerns allows for timely management and helps protect your investment in oral health. With attentive care, many patients enjoy stable results for years to come.
Material choices and fabrication techniques also influence durability. Modern prostheses are made from strong, biocompatible materials engineered to withstand daily use. Your care team will discuss options and choose a solution that balances strength, comfort, and appearance while aligning with your functional needs and preferences.
All-on-4® is an excellent option for many people who are missing most or all teeth on an arch, but candidacy should be determined through a personalized evaluation. Factors such as overall health, bone quality, oral hygiene habits, and specific anatomical considerations are all part of the decision-making process. A thorough clinical assessment ensures the chosen plan is safe, effective, and aligned with the patient’s goals.
At Mercer Island Dental Associates, our approach to planning emphasizes clear communication and individualized treatment pathways. We take time to explain clinical findings, outline realistic expectations, and review the stages of care so patients feel informed and comfortable. A collaborative planning process helps patients make decisions that reflect their priorities and lifestyle.
If All-on-4® is not the ideal option for a particular patient, there are alternative implant-supported or conventional solutions to consider. The hallmark of good care is presenting options based on objective findings and tailoring a plan that provides the best balance of function, esthetics, and longevity.
All-on-4® delivers a reliable pathway for people seeking a fixed, full-arch restoration that combines immediate benefits with predictable long-term outcomes. If you’d like to learn more about how this treatment may apply to your situation, please contact us for more information and to schedule a consultation.
1All-on-4 is a registered trademark of Nobel Biocare
The All-on-4 treatment concept offers an implant-based solution to patients who have lost all of their upper and/or lower teeth. This remarkable method of care helps patients quickly rebuild complete and beautiful smiles. With All-on-4, your new, and complete set of implant-supported replacement teeth feel secure, stable, and much like your very own.
If you currently wear complete upper and/or lower dentures or are slated to have your remaining teeth extracted, you may be a candidate for All-on-4. First Performed by Dr. Paulo Malo in 1998, the All-on-4 treatment concept has helped hundreds of thousands of patients quickly reestablish attractive smiles that look, feel, and function just like a set of natural teeth!
The All-on-4 treatment concept offers a fixed and permanent alternative to removable dentures. Unlike dentures, All-on-4 does not rely on messy dental adhesives or natural suction to hold your new set of teeth in place. With All-on-4, your replacement teeth are permanently secured by dental implants, giving you a smile that looks not only great but also feels secure and stable. You'll feel comfortable and confident as you speak, smile, and chew with ease.
While traditional full arch implants also achieve outstanding results of care, the All-On-4 treatment concept does not involve bone grafting and requires fewer implants to support a full set of teeth. With just four strategically placed dental implants needed to support an entire set of upper or lower teeth, the All-on-4 treatment concept offers a cost-effective and satisfying solution for rebuilding a complete smile. Thanks to this remarkable method of care, patients can experience the satisfaction of having teeth placed the same day as surgery. This key feature allows patients to smile and function with confidence until healing is complete and the permanent restorations installed.
Once it's been determined that you're a candidate for treatment with All-on-4, the process of treatment planning and designing your new smile begins. 3D diagnostic records provide the detailed information required to determine the exact positions of the four supporting dental implants. Then, on the day of surgery, we'll remove any remaining teeth, place the 4 implants, and insert a set of attractive, sturdy, and functional set of temporary teeth. With All-on-4, temporary teeth can be placed right away with a customized, permanent set to follow once the implants become fully integrated with the surrounding bone.
With All-on-4, temporary teeth can be placed right away with a customized, permanent set to follow within just a few months after the implants become fully integrated with the surrounding bone.
Thanks to All-on-4, patients enjoy permanent teeth that look, feel, and function just like real teeth. And with a patient satisfaction rate that exceeds 95%, the All-on-4 treatment concept restores your smile, your confidence, and allows you to enjoy once again the foods you love!
Maintaining your All-on-4 smile requires the same care as a natural smile. By cleaning your teeth twice daily, after meals as possible, and scheduling appointments for routine checkups as well as care, you can keep your new smile strong and healthy for years to come. Our office will demonstrate the most effective methods of oral hygiene and answer all your questions as to how to care for your new smile.
All-on-4® is a full-arch implant protocol that replaces an entire upper or lower set of teeth using four strategically placed dental implants that support a fixed prosthesis. Unlike traditional removable dentures, the restoration is secured to implants and remains in place for daily function, providing greater stability for eating and speaking. The technique emphasizes immediate restoration so patients can leave with provisional teeth after implant placement.
The All-on-4® protocol also differs in implant positioning and biomechanics, often using angled posterior implants to maximize available bone and reduce the need for extensive grafting. Because the prosthesis is fixed, it transmits chewing forces to the implants and jaw, which helps preserve bone and facial support compared with removable options. This combination of stability and preservation is a primary reason patients and clinicians consider this solution for extensive tooth loss.
Candidacy for All-on-4® is based on a personalized clinical evaluation that considers missing teeth, oral and systemic health, jawbone quality, and hygiene habits. Many people who are missing most or all teeth on an arch and who want a fixed restoration are potential candidates, but factors such as uncontrolled medical conditions, heavy smoking, or active untreated infection can affect suitability. Imaging and clinical tests are used to determine whether implant placement will provide predictable support.
A candidacy discussion also addresses patient goals for function and esthetics, as well as long-term maintenance expectations. If All-on-4® is not the ideal choice for an individual, there are alternative implant-supported or conventional treatments to consider that may better match anatomical or health considerations. A comprehensive consultation is the only way to determine the best, evidence-based option for each patient.
The process begins with a detailed consultation that includes a clinical exam and 3D imaging to evaluate bone anatomy and plan implant positions. On the day of surgery, necessary extractions and placement of four implants are completed, and a provisional fixed prosthesis is attached so patients have functional teeth immediately after the procedure. The provisional protects surgical sites while the implants begin the healing process.
Following the initial phase, a healing period allows osseointegration, during which bone bonds to the implants and stability increases. After adequate healing, the provisional is replaced with a custom final prosthesis designed for optimal esthetics and occlusion. Throughout the process, follow-up visits monitor healing and ensure the restoration meets functional and cosmetic goals.
Immediate provisional teeth are fixed restorations attached to the newly placed implants to provide a complete smile and basic function during the healing phase. These provisional prostheses are designed to be strong enough for everyday activities but may require temporary dietary adjustments to limit excessive forces while osseointegration occurs. The provisional stage balances patient comfort and protection of the surgical sites with the goal of maintaining oral function and appearance.
Provisional restorations also help guide soft tissue healing and allow the clinical team to evaluate esthetics and bite before crafting the final prosthesis. Any required adjustments to fit or occlusion can be identified during this period and incorporated into the design of the definitive restoration. The provisional is an important transitional step that supports both clinical outcomes and patient quality of life.
Initial recovery commonly involves swelling, mild to moderate discomfort, and a short period of modified activity during the first week after surgery. Clinicians provide specific postoperative instructions that may include prescriptions for pain control, recommendations for cold compresses, and guidance on oral rinses to reduce the risk of infection. Following these directions and attending scheduled checkups helps ensure proper healing.
Dietary modifications are often advised during early recovery, progressing from soft foods to more regular textures as healing permits and under clinician guidance. Long-term aftercare focuses on daily hygiene around the prosthesis and implants, as well as routine professional examinations and cleanings to monitor tissue health. Careful adherence to maintenance recommendations supports longevity of the restoration.
Durability of an All-on-4® restoration depends on implant integration, prosthesis design, and the materials selected for the final appliance. Implants are typically titanium or a titanium alloy, which are highly biocompatible and integrate reliably with bone. Final prostheses may be fabricated from acrylic layered over a metal framework, or from stronger ceramic materials such as zirconia, each offering different balances of strength, esthetics, and wear resistance.
Material choice is guided by functional needs, esthetic goals, and clinical considerations like opposing dentition. Strong, well-designed prostheses combined with regular maintenance can provide many years of reliable service. Periodic evaluations allow clinicians to address wear or component issues before they compromise function or comfort.
Daily hygiene for an All-on-4® restoration involves thorough cleaning of the prosthesis and careful attention to the tissues around implant abutments to reduce the risk of peri-implant inflammation. Recommended tools often include a soft toothbrush, interdental brushes sized for the implant spaces, and adjuncts such as a water flosser to dislodge debris where the prosthesis meets the gum. Proper technique and consistency are important for protecting both the implants and surrounding soft tissues.
In addition to home care, regular professional cleanings and examinations are essential for long-term success, allowing clinicians to remove hard deposits and check for early signs of tissue changes or mechanical wear. Your dental team will provide a personalized maintenance schedule and demonstrate cleaning methods tailored to your prosthesis design. Ongoing collaboration between patient and clinician optimizes outcomes and reduces the likelihood of complications.
One advantage of the All-on-4® concept is that angled posterior implants and strategic positioning often allow clinicians to use available bone and avoid complex grafting procedures. In many cases this reduces treatment time and morbidity compared with approaches that require extensive augmentation. However, each patient’s anatomy is unique, and advanced imaging is required to determine whether the existing bone volume is sufficient for predictable implant support.
If bone volume is insufficient in critical areas, grafting or alternative implant strategies may be recommended to ensure long-term stability and function. The treatment plan will explain the reasons for any additional procedures and outline the expected timeline for healing and restoration. Decisions about grafting are always based on clinical evidence and the goal of achieving a durable, functional result.
As with any surgical procedure, All-on-4® carries potential risks such as infection, implant failure, nerve irritation, or complications related to healing. Prosthetic issues such as wear, fracture, or loosening of components can also occur over time and may require repair or replacement. Identifying and addressing early signs of complications through routine follow-up reduces the chance of more significant problems.
Risk can be mitigated by careful case selection, meticulous surgical technique, and adherence to postoperative and maintenance protocols. Patients are encouraged to disclose medical history and lifestyle factors that could affect healing so the clinical team can tailor the plan accordingly. When complications arise, prompt communication with the dental team allows for timely management and the best possible outcome.
To determine whether All-on-4® is an appropriate option, schedule a consultation at Mercer Island Dental Associates where clinicians perform a comprehensive exam and diagnostic imaging to assess oral anatomy and overall health. During this visit the team will review medical and dental history, explain the imaging findings, and discuss treatment goals and expectations. This personalized evaluation is the foundation for an evidence-based recommendation.
If All-on-4® is recommended, the practice will outline the proposed surgical and restorative steps, describe the provisional and final prosthesis options, and present a timeline for treatment and follow-up care. If another approach is better suited to a patient’s needs, the team will explain those alternatives and why they may offer greater predictability. Clear communication and shared decision-making help patients choose the option that best aligns with their priorities.
