All-on-Four Implant

What Is All-on-Four Implant Treatment?

All-on-Four (All-on-4) is a modern implant treatment concept that enables a full arch fixed prosthesis to be placed on just 4 implants for patients who are fully edentulous or about to lose all their teeth. Developed by Nobel Biocare, this treatment protocol has more than 20 years of clinical experience worldwide.

All-on-Four treatment performed by Sp. Dt. Aykut Gurel in Atasehir, Istanbul, is supported by digital planning and the Z-GO Guide guided surgery system.

The Treatment Principle

The foundation of All-on-Four treatment lies in 4 implants placed at strategic positions to support a full arch fixed prosthesis:

This design optimizes the distance between implants, ensuring balanced and stable prosthesis support.

• 2 implants are placed vertically in the anterior region. Bone density in this area is generally sufficient.
• 2 implants are placed at a 30-45 degree angle in the posterior region. This angled placement allows longer implants to be used, maximizing the use of available bone.
• The angled posterior implants are positioned in front of the sinus cavity (upper jaw) or the mental nerve (lower jaw).
• A full arch fixed bridge of 10-14 teeth is constructed on the 4 implants.

All-on-Four vs. All-on-Six

The fundamental difference between All-on-Four and All-on-Six is the number of implants used. Each method has its own advantages:

Both treatments deliver full arch fixed prosthesis results. The choice between them is made based on the patient's bone structure and clinical condition.

• Number of implants: All-on-Four uses 4 implants; All-on-Six uses 6 implants
• Bone requirement: All-on-Four can be applied with less bone volume; All-on-Six requires more bone volume
• Bone grafting: Generally not needed with All-on-Four; may be required in some cases with All-on-Six
• Support distribution: All-on-Four provides support at 4 points; All-on-Six offers wider load distribution at 6 points
• Indication: All-on-Four is more suitable for patients with moderate bone loss; All-on-Six is preferred in patients with sufficient bone volume
• Cost: All-on-Four is more economical; All-on-Six includes additional implant costs

Bone Loss and All-on-Four

After tooth loss, a natural resorption process begins in the jawbone. Among implant options for bone loss, All-on-Four stands out because it does not require bone grafting. The angled placement of posterior implants avoids anatomical structures such as the sinus cavity or nerve canal while allowing the most efficient use of available bone.

However, additional evaluation may be necessary for cases with advanced bone loss. In such situations, zygomatic implants or bone augmentation options may also be considered.

Implant Care and Long-Term Success

Regular maintenance and check-ups are essential for the long-term success of All-on-Four treatment. Daily oral care, professional cleaning, and 6-month follow-up appointments extend the life of both the implants and the prosthesis.

Frequently Asked Questions

Can I eat normally after All-on-Four treatment?

During the temporary prosthesis period (first 3-6 months), soft to medium-firm foods are recommended. After the permanent prosthesis is placed, patients can comfortably consume virtually all foods. The fixed nature of the prosthesis provides much better chewing function compared to removable dentures.

Is All-on-Four treatment painful?

The surgical procedure is performed under local anesthesia or sedation; no pain is felt during the operation. Mild to moderate pain and swelling may be experienced in the first 2-3 days after surgery. Prescribed pain relievers and anti-inflammatory medications make this period comfortable.

Should I choose All-on-Four or removable dentures?

All-on-Four offers significant advantages over removable dentures: no risk of movement or falling out since it is fixed, chewing force close to natural teeth, slows bone resorption, and provides a natural appearance. It is a permanent solution that fundamentally improves quality of life.