All-on-4® – Fixed dental implant prosthesis

The All-on-4® technique is a modern dental restoration solution using dental implants, used for patients suffering from complete edentulism (total loss of teeth) or whose teeth are beyond repair.

The All-on-4® dental implant system is an innovation that has been used successfully worldwide for over two decades. It was developed in 1998 through a partnership between the American company Nobel Biocare and Prof. Dr. Paulo Malo, an internationally renowned surgeon and a collaborator with the DENT ESTET network since 2020. 

The All-on-4® dental implant system is a revolutionary treatment, as it allows a fixed prosthesis to be fitted immediately after the insertion of four implants into the dental arch – something that is difficult to achieve with conventional implants.  

Immediate loading is possible thanks to the primary stability provided by the All-on-4® technique, which involves the strategic positioning of the four implants—two at the front (straight) and two at the sides—at a 45-degree angle.  

“This clever angulation allows the lateral implants to anchor in the areas of the jaw with the best bone density, whilst avoiding sensitive anatomical structures (such as the maxillary sinuses or the mandibular nerve). Thanks to this optimal distribution of forces, the prosthetic restoration can be securely fixed within 24 hours,” explains Dr. Gabriel Zugravu, an expert in advanced dental aesthetics at DENT ESTET clinics.

The All-on-4® technique represents a significant departure from dentures, which are removable and offer a low degree of stability. Furthermore, they can cause discomfort. In contrast, the All-on-4® system offers patients a fixed solution that fully restores masticatory and phonetic functions, radically improving quality of life and self-confidence.

Furthermore, the All-on-4® system eliminates the need for a long waiting period, which would otherwise be required if multiple single-tooth implant procedures (6 or 8) or potential bone grafts were chosen to achieve the results desired by the patient.  

A dental arch is restored with just four implants and a fixed prosthetic restoration, which is usually fitted on the very same day. 

The All-on-4® dental implant system is designed for patients who are completely edentulous, meaning they have no teeth left in one or both jaws.  

The All-on-4® treatment is also recommended for those who have very few teeth in the arch or whose teeth are beyond repair due to severe decay or periodontal disease.

Last but not least, All-on-4® dental implant treatment is a modern, long-lasting solution for patients who wear removable dentures that have lost their stability or cause ongoing discomfort.  

1. Stability – prosthetic restorations fixed by screw retention to All-on-4® implants will not be mobile, a major advantage over conventional dentures
2. No need for bone grafts – the implants are placed in different areas that avoid natural anatomical structures, thus eliminating the need for bone grafts
3. Restoration of chewing function – after the healing period, which can last between 3 and 6 months, you can eat almost any food, unlike with conventional dentures, where certain dietary restrictions are necessary
4. Optimal force distribution – the strategic placement of implants at different angles ensures long-term durability, which significantly improves functionality and comfort
5. Superior aesthetics – oral rehabilitation using All-on-4® implants contributes to a natural appearance of the teeth, as the final prosthetic restoration can be customised to preserve the aesthetics and harmony of the smile. By restoring the dental arches and halting gum recession, the aged appearance of the face is also eliminated. 

The difference between the All-on-4® System and a dental bridge:

Compared to dental bridges, this system provides complete restoration of the dental arch, whereas dental bridges are used to restore edentulous areas with a small number of remaining teeth.  

In situations where extended bridges are used to restore an arch with only a few remaining teeth, this usually requires root canal treatment, the grinding down of the remaining teeth, and the covering of both the remaining teeth and the edentulous spaces.  

The use of these bridges is becoming increasingly rare at present, as they have several disadvantages, such as:

• The bridge may fracture over time if the teeth used are not strong enough
• If one of the teeth develops problems, the entire restoration must be removed
• Hygiene is difficult and allows bacteria to accumulate, a situation that can lead to gum and periodontal problems, and this can also cause issues with the abutment teeth.

The difference between the All-on-4® System and conventional dentures    

If we were to compare the All-on-4® system with traditional full dentures, there are several criteria:

1. Stability – this is very high with the All-on-4® system compared to conventional dentures, which are less stable. These can shift or slip, causing discomfort whilst chewing and speaking.
2. Chewing – following oral rehabilitation with All-on-4®, chewing ability is close to that of natural teeth, whereas with a removable denture, chewing is affected by stability, and certain sticky foods can dislodge the denture from the arch. Furthermore, with removable dentures, certain hard foods can cause the denture to fracture.
3. Impact on the bone – implants keep the bone active and slow down or prevent bone resorption, whereas the pressure exerted by the removable prosthesis on the edentulous area stimulates bone resorption and necessitates frequent replacement of the prosthesis with a new one, until stability is completely lost.
4. Comfort – with implants, comfort is greater after healing, as they do not cover the roof of the mouth, which improves taste sensations and overall comfort. Whereas conventional dentures are less comfortable, they reduce taste sensations, and pressure points, discomfort during chewing and speaking may occur. Furthermore, removable dentures require periodic adjustment. 

1. Specialist consultation and initial examinations

At DENT ESTET clinics, treatment begins with a thorough specialist consultation, which includes essential digital investigations: a panoramic X-ray, intraoral and extraoral photographs, and a dental CT scan. Based on these investigations and the patient’s dental condition, the implantologist assesses the quality of the bone supporting the future dental implants.

Once these investigations confirm that the All-on-4® technique is the best solution, the patient will undergo a set of blood tests.

2. Performing the necessary extractions and inserting the dental implants

“Treatment with the All-on-4® dental implant system is carried out at DENT ESTET clinics under anxiolysis (conscious sedation), closely supervised by an anaesthetist. This sedation helps to significantly reduce anxiety and the duration of the procedure. Furthermore, the intravenous administration of anti-inflammatory medication contributes to a rapid and comfortable recovery,” explains Dr. Gabriel Zugravu, an expert in advanced cosmetic dentistry at DENT ESTET clinics.

Where necessary, if the patient is not already completely edentulous, the procedure begins with the extraction of teeth or irrecoverable remnants. All areas of infection are also removed, and the four implants are inserted.  

Immediately after insertion, a follow-up X-ray is taken to ensure that the implants are correctly positioned and secured.

3. Fixing the fixed temporary prosthesis (fixed teeth in one day)

Next comes the prosthetic stage, which involves taking an impression of the area and preparing the fixed temporary restoration.

A fixed temporary restoration is fitted to the patient within a few hours. This restoration is fixed, cemented and carefully checked by the technicians at the ASPEN Advanced Dental Technology Laboratory.

Within just one day, the patient enjoys fixed and functional teeth.

4. Fitting the final fixed prosthesis  

At the end of the healing and osseointegration period of the implants, the temporary fixed prosthesis is replaced with the final fixed prosthesis, crafted by the technicians at the ASPEN Laboratory, for maximum durability and aesthetics.

If you’re wondering how much an All-on-4® fixed dental prosthesis costs, you should be aware that the price of such a prosthetic procedure varies depending on several factors.

Thus, the price of an All-on-4® fixed dental prosthesis can be influenced by the number of implants required (at DENT ESTET clinics, the number of implants is 4, but there are clinics where the technique is applied using 6 or 8 implants), the type of implant chosen, the materials used for the internal structure, as well as the quality of the final prosthetic work.  

Compared to a conventional dental implant (where each missing tooth is replaced individually) or a dental bridge (which requires the grinding down of adjacent teeth), the All-on-4® system represents a comprehensive, stable and often more cost-effective solution for patients with no teeth or with teeth that cannot be saved.

At DENT ESTET, the final All-on-4® prosthetic restoration starts at €2,300, with prices varying depending on the materials chosen and the specific details of each individual case.  

For a full overview of the costs, please consult the updated price list on our dental implant pricing page.  

Complete tooth loss in one jaw is no longer an irreversible problem. Thanks to the All-on-4® surgical technique, edentulous patients can benefit from a fixed, rapid and long-lasting solution.

Here are the main benefits of the All-on-4® technique:

• Complete restoration in a single day of a completely edentulous arch or both arches (fixed teeth in a single day)
• Replacement of a removable denture, which is unstable
• Immediate restoration of functionality, by facilitating chewing, which is hindered by conventional dentures or the absence of teeth
• Achieving an aesthetic and perfectly personalised smile, eliminating problems caused by missing teeth, the presence of irrecoverable teeth or conventional dentures that do not allow for individual adaptation.  

1. D.S. Penaloza, R. Zaragozí-Alonso, M. Penarrocha-Diago, Penarrocha-Diago – The All-on-4 treatment concept: A systematic review, medicinaoral.com, 2017
2. Paulo Malo, Miguel de Araújo Nobre et al. - A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up, jada.ada.org, 2011
3. M.A. ELsyad, M. Elgamal, O. Mohammed Askar, G.Y Al-Tonbary - Patient satisfaction and oral health-related quality of life (OHRQoL) of conventional dentures, fixed prostheses and milled bar overdentures for All-on-4 implant rehabilitation. A crossover study, Clinical Oral Implants Research, 2019