Are really only four implants used in All-on-4 treatment?

Yes. In the classic All-on-4 approach planned for one jaw, four implants are used. However, it cannot be said that four implants are sufficient for every patient. Depending on the bone structure, forces and prosthesis design, five, six or more implants can be planned.

Is same-day fitting of teeth guaranteed?

No. For a same-day temporary fixed prosthesis to be applied, the implants must achieve adequate initial stability and the prosthesis must be able to be loaded safely. If these conditions are not met, healing is awaited.

Is the prosthesis fitted on the same day permanent?

Mostly no. The prosthesis fitted on the first day is usually the temporary fixed prosthesis used during the healing period. The permanent prosthesis is prepared after the implants and surrounding tissues have healed.

Do all teeth need to be extracted for All-on-4?

Only teeth that cannot be preserved should be extracted. A decision to extract should not be made without evaluating healthy teeth or those that can be preserved in the long term.

Can All-on-4 be done on the upper and lower jaw at the same time?

In suitable patients, both jaws can be operated on in the same surgical period. However, the decision must be made taking into account the extent of the surgery, nutrition, healing capacity, general health and the duration of anaesthesia.

Does an All-on-4 prosthesis look like natural teeth?

Prostheses close to a natural appearance can be prepared. However, the result depends on bone and gum loss, lip support, the smile line, the space required for the prosthesis and the material chosen.

Is the palate covered in an All-on-4 prosthesis?

In fixed upper-jaw prostheses, the entire palate is mostly not covered as in classic full removable dentures. Nevertheless, the shape of the prosthesis may vary according to the amount of lost tissue and the required lip support.

Can All-on-4 implant treatment fail?

Yes. Implant loss can occur due to the implant not integrating with the bone, infection, peri-implantitis, smoking, systemic diseases or mechanical problems. The risk is not zero.

What happens if one of the four implants is lost?

The treatment is replanned according to the position of the implant, the condition of the other implants, the design of the prosthesis and the bone structure. In some cases the implant can be replaced; in others, an additional implant or a different prosthesis design may be required.

When can one return to work after All-on-4?

It is not correct to give a single duration. The extent of the surgery, the number of teeth extracted, swelling, the physical characteristics of the work performed and the patient's healing response affect the duration. A return to a desk job and a return to heavy physical work should not be evaluated in the same way.

Can one eat normally with All-on-4?

After the permanent prosthesis and healing are complete, a significant improvement in chewing capacity can be achieved. However, implant prostheses do not have exactly the same biological structure as natural teeth. Breaking very hard objects or applying excessive force to the prosthesis is not recommended.

Can the prosthesis be used for life without being replaced?

Such a guarantee cannot be given. While the implants remain healthy, the prosthesis teeth or connection parts may wear, fracture or require maintenance or replacement over time.

Can All-on-4 be done for people who smoke?

Implants can be applied to some smokers; however, smoking can adversely affect wound healing, the integration of the implant with the bone and long-term peri-implant health. The amount of use and other risks must be evaluated individually.

Which is better, All-on-4 or All-on-6?

There is no single correct answer for every patient. All-on-6 can provide additional implant support; All-on-4 can offer the possibility of a fixed prosthesis with more limited surgery in a suitable bone structure. The decision must be made according to the tomography, prosthesis plan and chewing forces.

Can an All-on-4 prosthesis be removed by the patient?

No. It is fixed from the patient's point of view. However, when professional care and repair are required, it can be removed by the dentist by unscrewing it.

All-on-4 Implant Treatment İstanbul

Scientific editor: Prof. Dr. Mehmet Oğuz Öztoprak – Specialist in Orthodontics and Dentofacial Orthopaedics
Clinical scientific review: The implant surgery and implant-supported prosthesis sections are, before publication, additionally reviewed clinically by the oral and maxillofacial surgery and prosthodontics physicians who perform the treatment.
Last updated: 22 July 2026

Losing all the teeth or the majority of the existing teeth reaching a condition where they cannot be preserved can affect not only the smile, but also the chewing capacity, speech, nutrition and comfort of daily life. All-on-4 implant treatment is a treatment approach based, in suitable patients, on a fixed full-arch prosthesis in one jaw being supported by four implants.

In this system, two implants are mostly placed more vertically in the anterior region, while the two implants placed in the posterior region are positioned at an angle depending on the anatomical conditions and the prosthesis plan. Placing the posterior implants at an angle can help distribute the implants over a wider area along the jaw and, in some patients, stay away from anatomical structures such as the sinus cavity or the lower jaw nerve.

Nevertheless, All-on-4 is not a standard package treatment applied to all fully edentulous patients. Whether four implants are sufficient must be determined by evaluating the structure of the jawbone, the distribution of the implants, the teeth in the opposing jaw, the chewing forces, the clenching habit, the shape of the prosthesis to be made and the patient's long-term care capacity.

The consensus report of the International Team for Implantology states that at least four appropriately distributed implants can be used to support a one-piece fixed full-arch prosthesis. However, when deciding on the number of implants, the effect of a possible future implant loss on the prosthesis and the advantages that additional implants may provide must also be taken into account.

In the All-on-4 assessments carried out at Dentapolitan in Istanbul, not only the bone regions where the implants will be placed but also the position, aesthetics, effect on speech, cleansability and occlusal forces of the fixed prosthesis to be made are planned from the very beginning of the treatment. All-on-4 is, in general terms, a full-arch application of dental implant treatment approaches.

What is All-on-4 implant treatment?

All-on-4 is one of the full-arch rehabilitation methods in which the fixed prosthesis to be prepared in place of all the teeth in one jaw is attached onto four implants.

The expression “All-on-4” describes, rather than a specific implant brand, a treatment concept in which a fixed full-arch prosthesis is supported by four implants. The system generally consists of the following components:

Four dental implants placed in the jawbone
Abutments that provide the connection between the implants and the prosthesis
A temporary fixed prosthesis that can be used during the healing period
The final full-arch prosthesis prepared after bone and gum healing

The part visible in the patient's mouth does not consist of individual, independent implant teeth. Usually a connected, one-piece prosthesis—or one segmented according to the planning—that mimics the missing teeth and, where necessary, the lost gum tissue is prepared.

Who can All-on-4 treatment be applied to?

All-on-4 treatment can be considered in the following situations:

In patients who have lost all their teeth in the lower or upper jaw
In those whose majority of existing teeth cannot be preserved due to advanced decay, fracture or periodontal disease
In patients who have difficulty using a removable full denture
In those who experience chewing or speech problems due to prosthesis movement
In suitable patients who want a fixed full-arch prosthesis
In those whose bone structure allows four implants to be placed in positions appropriate for the prosthesis
In patients who can maintain the necessary oral care and professional check-ups after treatment

The presence of some natural teeth in the mouth does not mean that these teeth must automatically be extracted. A decision for full-arch implant treatment should not be made without evaluating the periodontal, endodontic and prosthetic prognosis of natural teeth that can be preserved.

The ITI consensus report also recommends that, in patients who have teeth in their mouth, different treatment options that include preserving the teeth be evaluated as part of the informed consent process.

Who may All-on-4 not be suitable for?

All-on-4 treatment may not be applicable to every patient, or it may be planned after some health problems are brought under control.

Situations that may affect the treatment include the following:

Uncontrolled diabetes
Active and untreated periodontal disease
Inadequate oral hygiene
Advanced and uncontrolled smoking
Some medications or diseases affecting bone metabolism
A history of radiotherapy applied to the head and neck region
Diseases that seriously affect the immune system
A bone structure that does not allow correct distribution of four implants
Physical or cognitive conditions preventing adequate cleaning beneath the prosthesis
Uncontrolled clenching and excessive chewing forces
Unrealistic aesthetic or functional expectations

Some of these conditions are not absolute obstacles. The patient's general health, medications and individual risks must, where necessary, be evaluated together with the relevant medical physicians. Medications must not be stopped by the patient on their own before implant surgery.

What assessments are made before All-on-4?

In All-on-4 treatment, the first question should not only be “Is there enough bone to place an implant?” The position of the implants must be determined according to the final prosthesis to be made.

The following assessments can be made at the first examination:

The patient's general health and the medications they use
Cigarette and tobacco use
The retainability of the existing teeth
Gum and supporting bone health
The height, width and density of the jawbone
The position of the sinuses in the upper jaw
The course of the nerve canal in the lower jaw
The distance between the lower and upper jaws
Lip support and facial profile
The amount of tooth and gum visible during smiling
Speech and phonetic requirements
Occlusal relationships and chewing forces
Signs of bruxism or clenching
The patient's capacity to clean the prosthesis

In addition to a panoramic X-ray, a three-dimensional bone assessment with cone beam computed tomography is carried out in patients who require it. Digital intraoral scans, photographs and impressions help plan the temporary and permanent prosthesis before surgery.

Instead of placing implants at random points where bone is present, they must be planned in three-dimensional positions appropriate for the prosthesis. The EFP guideline on the prevention of peri-implant diseases also particularly emphasises that implants be positioned appropriately for the prosthesis and that the prosthesis be designed to be cleansable by the patient.

How is All-on-4 treatment performed?

The treatment process varies according to the patient's existing teeth, bone condition and need for a temporary prosthesis. It generally consists of the following stages.

1. Digital and prosthetic planning

Treatment begins by determining the shape and position of the final teeth the patient will use. Lip support, facial appearance, occlusal height, speech and cleansability are evaluated.

The positions of the implants are planned according to the prosthesis to be made. In necessary cases, surgical guides can be used. However, the use of a digital guide does not eliminate the need for clinical and surgical assessment.

2. Extraction of teeth that cannot be preserved

If there are teeth with an insufficient prognosis in the mouth, the extractions can be done in the same session as the implant surgery or beforehand.

Extracting all teeth in the same session should only be considered after it has been clinically and radiologically determined that these teeth really cannot be preserved. Tooth extraction is an irreversible procedure.

3. Placement of the implants

The procedure is mostly carried out under local anaesthesia. Depending on the patient's level of anxiety, general health and the extent of the surgery, sedation options can additionally be evaluated in suitable patients.

Usually two implants are placed in the anterior region and two in the posterior region. The posterior implants are positioned at an angle in some cases. This approach can increase the anterior-posterior distribution of the implants and reduce the unsupported cantilever extension of the prosthesis towards the back.

Scientific data report that no significant difference has been shown in implant or prosthesis survival between angled and vertical implants used in the appropriate indication to support fixed full-arch prostheses. However, it is recommended that implants be placed vertically if anatomical conditions are suitable, and that posterior implants be planned at an angle if there is a limitation.

4. Preparation of the temporary fixed prosthesis

If the implants provide adequate initial stability and the other clinical conditions are suitable, a temporary fixed prosthesis can be attached to the implants on the same day or within a short time.

However, there is no rule that “if All-on-4 is done, a fixed tooth must be fitted on the same day”. The following factors are evaluated in the decision on same-day loading:

The initial stability of each implant
Bone quality
The distribution of the implants over the jaw
Whether a simultaneous bone graft was applied
The patient's occlusal forces
The habit of clenching or grinding
The rigidity of the temporary prosthesis
The patient's compliance with soft-diet and care instructions

If these conditions are not sufficient, the implants can be left to heal without loading, and a removable temporary prosthesis can be used during this process.

Systematic reviews on immediate loading in fully edentulous upper jaws show that, when suitable patient selection and adequate implant stability are ensured, this approach can be a reliable option; however, the results must be interpreted carefully due to differences between studies.

5. Healing and osseointegration

After surgery, the bone around the implant remodels and biological integration with the implant surface develops. This process is called osseointegration.

The presence of a temporary fixed prosthesis in the patient's mouth does not mean that bone healing is complete. For this reason, the prosthesis and occlusal forces must be carefully monitored in the first months.

6. Preparation of the permanent prosthesis

After bone and soft-tissue healing reaches a sufficient level, digital or conventional impressions are taken for the permanent prosthesis. Occlusion, aesthetics, speech, lip support and the cleansability of the prosthesis are re-evaluated.

The permanent prosthesis can be prepared from different materials. The choice of suitable material must be made not only according to aesthetics but according to chewing forces, the length of the prosthesis, the teeth in the opposing jaw, repairability and care requirements.

What does “same-day fixed teeth” mean?

The expression “same-day fixed teeth” most often refers to a temporary full-arch prosthesis being attached onto the implants on the day of surgery or within a short time.

This prosthesis:

Is usually temporary.
Is designed to suit the healing period.
Must be protected from hard and excessive chewing forces.
Is replaced with the permanent prosthesis after the bone and gum heal.
May require occlusion and screw checks at certain intervals.

Presenting the temporary prosthesis fitted on the same day as a “permanent tooth” is not correct. For the final prosthesis to be prepared, the implants and surrounding tissues must heal, the shape of the gum must become more stable and the occlusal relationships must be re-evaluated.

Is a bone graft necessary in All-on-4 treatment?

One of the aims of the All-on-4 approach is to use the existing bone appropriately and, in some patients, reduce the need for advanced bone augmentation procedures. Placing the posterior implants at an angle can help keep away from the sinus or nerve region.

However, All-on-4 does not mean “it never requires a bone graft”.

Bone or soft-tissue procedures may be required in the following situations:

Insufficient bone thickness around the implant
Formation of bone defects after extraction
The implant not being able to be placed in a position appropriate for the prosthesis
Tissue losses in the aesthetic region
The need to ensure a healthy and cleansable tissue structure around the implant

The need for a bone graft is determined by evaluating the tomography and the prosthesis plan together. Placing implants in positions that are difficult to clean or unsuitable for the prosthesis in order to avoid a graft can increase the risk of long-term problems.

What is the difference between All-on-4 and All-on-6?

The main difference between All-on-4 and All-on-6 is the number of implants supporting the fixed full-arch prosthesis. However, the number of implants alone does not determine which treatment is suitable.

In the All-on-6 system, the two additional implants can contribute to:

Distributing the forces over a wider area,
Providing additional support if a problem develops in one of the implants in the future,
Allowing the prosthesis to be divided into sections in some cases,
Different design options in long prostheses or those subjected to high forces.

By contrast, if the amount of bone is limited, if advanced surgery is to be avoided, or if the anatomical structure allows a suitable distribution of four implants, All-on-4 can be preferred.

Scientific consensus reports have not shown a definite superiority in implant survival between fixed full-arch prostheses supported by fewer than five or more implants. However, how the prosthesis will be affected in the event of implant loss, the opposing jaw, chewing forces and care possibilities must be taken into account when determining the number of implants.

For this reason, it cannot be said that “All-on-6 is always better” or that “All-on-4 is sufficient for everyone”.

What treatments can be applied instead of All-on-4?

All-on-4 is not the only treatment option. Depending on the patient's bone structure, expectations, health condition and budget, the following alternatives can be evaluated:

A fixed full-arch prosthesis on six or more implants
An implant-supported removable prosthesis
A lower-jaw overdenture supported by two implants
An upper-jaw removable prosthesis supported by four or more implants
A conventional full removable denture
Partial rehabilitations combined with teeth that can be preserved
Implant-supported partial bridges in suitable patients

In some patients, removable implant-supported prostheses may be more suitable than a fixed prosthesis because they are easier to clean, allow lip support to be arranged more comfortably, or reduce the need for surgery.

The treatment plan must be created according to the patient's biological and functional needs, not with the approach that “fixed is always better”.

What are the advantages of All-on-4 treatment?

The main advantages that All-on-4 treatment can provide in suitable patients are as follows:

A fixed full-arch prosthesis can be prepared on four implants
Higher stability can be provided compared to a removable prosthesis
A same-day temporary fixed prosthesis can be applied in suitable cases
The need for advanced bone grafting can be reduced in some patients
Chewing and speech function are supported
Along with the lost teeth, the gum tissue can also be completed with the prosthesis
The prosthesis can be used without being removed by the patient
The implants can be distributed over a wide area of the jaw

Not all of these advantages may be obtained to the same extent in every patient. Lip support, speech, chewing capacity and aesthetic results depend on the initial anatomical conditions.

What are the limitations and risks of All-on-4 treatment?

All-on-4 is a comprehensive treatment with surgical and prosthetic stages. The possible risks must be explained clearly to the patient.

Problems that may be seen in the surgical period:

Bleeding
Swelling and bruising
Infection
Delay in wound healing
The implant not being able to achieve adequate stability
The implant not integrating with the bone
Sensory change due to nerve tissue in the lower jaw
Sinus-related complications in the upper jaw

Prosthesis-related problems:

Fracture of the temporary prosthesis
Loosening of the prosthesis or abutment screw
Wear or fracture of the prosthesis teeth
Difficulty adapting to speech
Biting the lip or cheek
Food accumulation
Difficulty cleaning beneath the prosthesis
Change in the tissue fit beneath the prosthesis over time
The permanent prosthesis requiring maintenance or repair

In ITI data, among the most common problems in temporary acrylic full-arch prostheses are prosthesis fracture, screw loosening and fractures of the veneering material. In permanent prostheses, wear and fracture of the artificial teeth or veneering material, screw loosening and the need for adjustment due to tissue changes are reported.

Peri-implant mucositis and peri-implantitis can also develop around the implant. Peri-implantitis is a condition in which the supporting bone is lost together with inflammation around the implant and which can be difficult to treat. For this reason, the cleansability of the prosthesis and regular professional follow-up are an inseparable part of the treatment.

Is All-on-4 treatment painful?

Implant surgery is mostly performed under local anaesthesia. During the procedure, pain control is aimed for in the surgical area; the patient may feel pressure, vibration or touch.

After surgery:

Tenderness
Swelling
Mild bleeding
Bruising
Temporary limitation in mouth opening

may be seen.

The level of discomfort depends on the number of teeth extracted, the extent of the surgery, whether a graft was applied and the patient's individual healing response. For this reason, generalisations such as “All-on-4 causes no pain at all” or “it is definitely very painful” are not correct.

In the event of progressively increasing pain, fever, a bad taste or discharge, uncontrolled bleeding, prolonged numbness or a noticeable sensation of movement in the prosthesis, the clinic should be contacted.

How should one eat after All-on-4?

Even if a same-day temporary fixed prosthesis has been fitted, the integration of the implants with the bone continues. It is important not to place excessive load on the prosthesis during the initial healing period.

Soft and easily chewed foods can be preferred for the period determined by the physician:

Eggs
Well-cooked fish
Yoghurt and soft dairy products
Vegetable purees
Warm soups
Soft pasta and rice
Well-cooked vegetables
Soft foods cut into small pieces

Hard-shelled nuts, ice, hard bread crust, raw vegetables, sticky foods and foods that apply high force to the prosthesis should be avoided during the healing period.

Feeding only on liquids is not necessary for most patients. The nutrition plan must be personalised according to the patient's general health and the extent of the surgery.

How is an All-on-4 prosthesis cleaned?

The All-on-4 prosthesis is not removed daily by the patient; however, the underside of the prosthesis and the area around the implants must definitely be cleaned.

The following tools can be recommended for care, according to the patient:

A soft-bristled toothbrush
A single-tufted brush
An interdental brush of a suitable size
Special floss for implant prostheses
A floss threader
An oral irrigator

An oral irrigator should be used as an aid in suitable patients, not as a replacement for mechanical brushing. The use of brushes or floss that can reach beneath the prosthesis must be demonstrated practically in the clinic.

When the prosthesis is designed, sufficient space must be left that can be cleaned by the patient. The EFP guideline recommends that implant-supported prostheses be prepared in a way that provides access both to home oral care and to professional check-ups.

Can an All-on-4 prosthesis be removed?

The All-on-4 prosthesis is fixed from the patient's point of view; it is not removed by the patient during daily use. However, when the prosthesis requires a check-up, maintenance or repair, it can be removed by the physician by unscrewing it.

The implants themselves remain within the bone. If infection, implant loss or another medical necessity arises, the implant can be removed surgically. For this reason, the statement that “All-on-4 implants can never be removed” is not correct.

How long does All-on-4 treatment take?

The total duration of the treatment varies according to the patient's initial condition.

The factors affecting the duration are as follows:

The number of teeth to be extracted
The presence of active infection
The need for a bone graft
The initial stability of the implants
Whether a same-day temporary fixed prosthesis can be applied
The healing capacity of the jawbone
The need for adjustment of the temporary prosthesis
The permanent prosthesis material and production process

In suitable patients, the surgery and the temporary fixed prosthesis can be completed on the same day or within a short time. Nevertheless, for the final prosthesis to be prepared, it is usually necessary to wait for bone and gum healing.

Fitting a fixed temporary tooth on the first day does not mean that the entire treatment is completed in one day.

What is the lifespan of All-on-4 implants?

It is not scientifically correct to give a fixed usage period that applies to everyone or a “lifetime guarantee” for All-on-4 implants.

The main factors affecting the long-term condition of the implants and the prosthesis:

The three-dimensional position of the implants
Bone and soft-tissue health
The patient's oral care
Smoking
Diabetes and other systemic conditions
History of periodontitis
Clenching and chewing forces
The design and cleansability of the prosthesis
Regular check-up appointments
Maintenance and repair of mechanical parts

While the implants remain healthy within the bone, the prosthesis on them may wear, fracture or need to be replaced over time. For this reason, implant survival and the maintenance-free usage period of the prosthesis are not the same thing.

Although scientific studies report high implant and prosthesis survival rates in full-arch prostheses supported by four implants, the study durations, patient groups and success criteria used differ. For this reason, it is more correct to explain the individual risks to the patient rather than to give a single, definite success percentage.

Does clenching affect All-on-4 treatment?

Clenching and grinding do not always prevent All-on-4 treatment; however, they can increase the forces on the prosthesis and implants.

In patients with bruxism, the risk of:

Temporary prosthesis fracture
Wear of the prosthesis teeth
Screw loosening
Porcelain or acrylic fracture
Excessive load forming around the implant

may increase.

For this reason, before treatment the jaw muscles, existing wear, jaw movements, occlusal relationships and the patient's sleep history must be evaluated. The prosthesis material and occlusal scheme must be planned according to the patient's force pattern; where necessary, a protective night appliance can be considered.

Why do All-on-4 implant prices in Istanbul vary?

The price of All-on-4 treatment should not be evaluated merely as “the price of four implants”. The treatment consists of many surgical and prosthetic stages.

The main elements that can affect the cost are as follows:

Whether single-jaw or double-jaw treatment is carried out
The number of teeth to be extracted
The need for a bone or soft-tissue graft
The scope of the temporary fixed prosthesis
The material and design of the permanent prosthesis
The implant and prosthetic connection system
The use of digital planning or a surgical guide
The need for sedation
The number and type of abutments to be used in the prosthesis
The post-treatment check-up and care programme

Prices given without an examination and a three-dimensional assessment may not fully reflect the patient's real treatment need.

When researching All-on-4 implant treatment in Istanbul, patients should ask not only about the implant brand or the initial treatment fee, but also whether the temporary and permanent prostheses are included in the price, the bone procedures, the prosthesis material used, the follow-up programme and possible maintenance-repair conditions.

Why is follow-up important in All-on-4 treatment in Istanbul?

All-on-4 treatment is not a procedure that can be completed on the day of surgery and forgotten. After the delivery of the temporary prosthesis, the stability of the implants, gum healing, the cleansability of the prosthesis and the occlusal contacts must be evaluated regularly.

At long-term check-ups, the following are examined:

Bleeding and inflammation around the implant
Plaque accumulation
Pocket depth
Bone levels
Cleaning beneath the prosthesis
Screws and connections
Wear in the prosthesis material
Occlusion and chewing forces

The EFP clinical guideline recommends that, after the implants enter function, the patient be enrolled in a supportive implant care programme structured according to their individual risks.

In a city such as Istanbul, with its intense daily life and transport conditions, patients should also take into account, besides the surgical procedure, their accessibility to impression, try-in, temporary prosthesis check-up, permanent prosthesis and long-term care appointments. Dentapolitan provides services in Istanbul with its Bostancı, Ümraniye and Pendik clinics.

Protecting long-term implant and prosthesis health

In All-on-4 treatment, the aim is not only to give the patient fixed teeth in a short time. The implants must be positioned appropriately for the prosthesis, the temporary prosthesis must protect the implants during the healing period, the permanent prosthesis must be cleansable and the chewing forces must be distributed in a balanced manner.

The long-term success of the treatment depends, in addition to surgical planning, on the patient's daily oral care, the control of smoking and systemic risks, the prosthesis material, the management of bruxism and regular professional check-ups.

The All-on-4 decision must be handled after clinical and three-dimensional radiological assessment, together with alternatives such as the possibility of preserving natural teeth, All-on-6, an implant-supported removable prosthesis and a conventional prosthesis.

This content has been prepared for the purpose of general health information. It does not replace an examination, diagnosis or a personalised treatment plan.