All-on-4 treatment, which is applied using only four implants, offers a fixed and functional prosthesis while providing a natural appearance. The fact that it does not require bone grafting and provides results in a short time are among the most important features that distinguish this treatment from other options.

All-on-4 treatment requires less surgical intervention compared to traditional methods thanks to the strategic placement of implants. In addition, patients can quickly return to their daily lives after treatment.

In this article, you will find the details of All-on-4 treatment, its advantages, the application process and the topics that will help you decide on All-on-4 treatment.

What is All-on-4 treatment?

All-on-4 treatment involves the placement of a fixed prosthesis on four implants—two vertical and two angled—fixed to the jawbone.

In which cases is All-on-4 treatment performed?

Situations in which All-on-4 implant treatment is performed and the characteristics of suitable candidates:

Severe tooth loss or complete edentulism:

Patients who have no teeth in the upper or lower jaw (complete edentulism), most teeth are decayed, broken, or extracted, and there is insufficient support for a fixed prosthesis.

Patients who cannot undergo traditional implants due to bone loss

Patients with bone loss (atrophy) and who do not want additional procedures such as sinus lifting or bone grafting. (In All-on-4, less bone may be sufficient thanks to curved implants.)

Those who do not want to use removable dentures:

Patients who are uncomfortable with removable dentures and want fixed teeth.
Those who have difficulty with dentures moving, palate coating, or eating.

Those who want a fast and single-session dental solution:

Those who want to have functional teeth in a shorter time than conventional implants (within 24-48 hours instead of 3-6 months). (With the "Same day teeth" concept, temporary prostheses can be given immediately after the implants are placed.).

Those looking for an economical and practical solution:

Those who want to have fixed teeth for the whole jaw with only 4 implants instead of 12-16 implants (cost advantage).

Who is not suitable for All-on-4 treatment?

While All-on-4 implant treatment is an excellent solution for many patients, it can be risky or unsuccessful in some cases. Patient groups for whom All-on-4 is not suitable:

Those with very severe bone loss (severe atrophy):

Especially if the bone height in the upper jaw is less than 5 mm, there may not be enough support for the implants.
If there is excessive bone loss in the lower jaw, the risk of nerve (inferior alveolar nerve) damage increases.
These patients may require All-on-6, zygoma implants, or bone grafting.

Uncontrolled diabetes or severe immune diseases:

Diabetes (HbA1c > 7) can lead to loss of implants or infection.
Autoimmune diseases (e.g., rheumatoid arthritis, lupus) may delay healing.
The implant can be done after blood sugar is under control.

Heavy smokers (10+ cigarettes per day):

Smoking reduces bone fusion (osseointegration) with the implant by up to 50%.
The risk of infection and peri-implantitis is very high.

Patients with bruxism (teeth clenching/grinding):

In All-on-4, 4 implants carry the whole jaw, excessive load may cause fracture or loosening of the implants.
Bruxism should be treated first.
Inadequate oral hygiene
Patients who do not brush regularly or neglect dental visits have a high risk of infection around the implant (peri-implantitis).
Implants can be performed after oral hygiene is corrected.

Bone metabolism disorders (osteoporosis, etc.):

Implants may not fuse with the bone in patients taking bisphosphonate medication (in the treatment of osteoporosis) or in patients who have undergone radiotherapy.
Dentist evaluation is essential; sometimes alternative prostheses are recommended.

Young patients (under 20 years of age):

In young patients with incomplete jaw development, implants may cause incompatibility.
They can wait with temporary prostheses and implants after bone development is complete.

Where is the All-on-4 dental implant placed?

Placement for the lower jaw (mandible):

Anterior region: Two implants are placed at a 45° angle in the anterior region (usually in the region of the incisors).
Posterior region (distal): The other two implants are placed vertically or slightly inclined in the posterior part of the lower jaw (in the premolar or molar areas).

Placement for the upper jaw (maxilla):

Anterior region (near the nasal cavity): Two implants are placed upright or slightly inclined in the upper anterior region (usually in the region of the canines or incisors).
Posterior region (near the sinuses): The other two implants are placed at a 30-45° inclination in the posterior part of the upper jaw.

Is sufficient bone volume required for All-on-4?:

For All-on-4 treatment to be successful, you need to have a sufficient quantity and quality of bone tissue in your jaw. If the quality and quantity of bone are insufficient or if you have severe teeth clenching or grinding, these conditions may prevent All-on-4 treatment.

The amount of bone required for the upper jaw (maxilla):

At least 10 mm long and 4-5 mm wide bone is required in the anterior region. In the posterior region, a bone height of at least 5 mm is required below the sinus cavity. The bone structure should ideally be of medium hardness.

Bone quantity for the lower jaw (mandible):

At least 6 mm in width and 12 mm in length are required in the anterior region. In the posterior region, there should be at least 4 mm of bone above the nerve line.

Solutions in case of insufficient bone:

If the bone is too thin, bone augmentation may be necessary. If bone height is low, short implants or special angled placements may be tried.

Especially in patients with severe bone resorption, the standard All-on-4 criteria (required bone height and width) may not be met. In such cases, alternative All-on-4 approaches may be considered:

All-on-4 hybrid:

This is the concept of using standard implants in combination with extra-maxillary implants that extend to the zygomatic bone in the maxilla.

All-on-4 double zygoma:

This is the concept where four extra-maxillary implants are used, extending only to the zygomatic bone in the maxilla. The zygomatic implants provide posterior support without the need for bone grafting.

How is All-on-4 treatment performed?

The implementation of All-on-4 treatment involves surgical and prosthetic procedures. This procedure uses only four implants for full arch restoration.

All-on-4 treatment procedure:

Conventional surgery:

This involves making an incision in the gum and lifting the flap using conventional planning and a standard All-on-4 Guide.

Guided surgery:

Accurate positioning of the implants is achieved using a customized surgical template with 3D diagnostic and treatment planning. This approach can be performed without flap removal.

Treatment planning:

An intraoral examination is performed, and radiographic examinations are performed to assess the height, width and quality of the bone. Then, the positions and angles of the implants are planned.

Surgery:

Flap removal or a flapless approach can be applied.
Implant sites are prepared in the jawbone. If necessary, the correct position and angle are ensured by using the All-on-4 Guide. Implant sites in the posterior regions can be drilled at an angle of up to 45°.
If there are extraction sites, these are thoroughly cleaned, and, if possible, the implants are placed between the extraction slots.

Abutment connection:

After the implants have been inserted, straight or angled (17° or 30°) multi-unit abutments are attached to the implants to adjust their angle and correctly position the screw access holes of the prosthesis. If angled implants are 30° or more, splinting may be required.

Temporary prosthesis:

On the day of surgery, a temporary fixed prosthesis (usually acrylic) is prepared and screwed in immediately after the implants are placed.
This temporary prosthesis can be made using postoperative impressions or by modifying an existing immediate prosthesis. The prosthesis is prepared using abutment replicas, temporary caps (copings), guide pins/laboratory screws, and acrylic.
The temporary prosthesis provides splinting by connecting the four implants together.
The temporary prosthesis is adjusted according to masticatory function.

Healing process:

The healing process of All-on-4 treatment is shaped by postoperative care and prosthesis adaptation.

First 24-48 hours after surgery (acute period):

Pain and swelling:

Painkillers and ice compresses are recommended for the first 2 days.
Swelling usually peaks on the 3rd day and then decreases.

Bleeding:

Light bleeding is normal (do not spit or rinse your mouth for 24 hours).

First 1 week (use of temporary prosthesis):

Temporary prosthesis insertion:

Fixed temporary teeth are given 24-48 hours after surgery.
Chewing can be done with light pressure, but hard foods should be avoided.

Stitches:

Self-dissolving sutures are usually used and fall off in 7-10 days.

Oral care:

A special soft brush and saline mouthwash (from day 3) are used.

3. 2-6 Weeks (bone-implant fusion process)

Lower jaw: 2-3 months; upper jaw: 3-6 months.

During this period, the prosthesis should not be overstrained (foods such as nuts and hard bread should not be eaten).

Control appointments:

1st week, 1st month, and 3rd month dental check-ups are required.
After 3-6 Months (permanent prosthesis placement)
When bone-implant fusion is complete, the temporary prosthesis is removed and a permanent porcelain prosthesis is made.

Aesthetic and function adjustments:

The color, shape and bite balance of the teeth are optimized.

What should be considered after All-on-4 treatment?

There are some important points you should pay attention to after applying the All-on-4 treatment concept.

In the post-treatment period, you should practice effective oral care at home. Your dentist will teach you specific cleaning methods suitable for your denture type and oral structure.
It is important to attend regular check-up appointments with your dentist, both to check the effectiveness of your treatment and to assess your oral health.
If you notice any fractures in the denture or feel any discomfort or looseness when biting, you should contact your dentist as soon as possible.

Advantages and disadvantages of All-on-4:

Advantages of All-on-4:

May not require bone grafting (additional bone)
Can be applied without sinus lifting or bone grafting thanks to curved implants.
Can be used even in patients with advanced bone resorption (atrophy).
Fast treatment and same-day teeth
Temporary dentures can be placed 24-48 hours after the implants are placed.
Achieving functional teeth in a shorter time (instead of 3-6 months) compared to conventional implants.
Fewer implants, lower cost
While 6-8 implants are required in traditional methods, only 4 implants are used in All-on-4.
It provides a cost advantage, as the surgery is simpler.
Fixed prosthesis comfort (unlike removable prostheses, it does not require insertion and removal; it gives the feeling of natural teeth). Since there is no palate coating, taste and speech are more comfortable.
High success rate

Disadvantages of All-on-4:

4 implants carry the entire jaw, so the force per implant is higher.
Long-term risk of wear or loosening (especially in those who chew hard foods).
Although it requires limited bone support, it may not be suitable in very advanced atrophy.
All-on-6 or zygoma implants may be more suitable for those with extreme bone loss.
Because the posterior implants are curved, the size and shape of the prosthesis may be limited.
Some patients may require a wider tooth design.
Regular check-ups are essential because of the risk of gingivitis (peri-implantitis).
Special cleaning tools (interdental brush, water flosser) may be required.
In smokers and diabetic patients, healing is slower, the success rate may decrease, and the risk of infection may increase.

All-on-4 and All-on-6: Which is right for you?

To help you decide which of All-on-4 and All-on-6 is right for you, you will find a comparison of both treatments in the table below:

Feature	All-on-4	All-on-6
Number of Implants	4 implants (2 straight in front, 2 angled in back)	6 implants (usually straight, sometimes angled)
Bone Requirement	Can be applied with low bone density (angled implant advantage)	Requires better bone support (straight implants preferred)
Sinus/Nerve Compatibility	No sinus lift needed (angled implants bypass the sinus)	Anatomical compatibility is more important due to more implants
Prosthesis Stability	Supported by 4 implants, less load distribution	More balanced and sturdy chewing with 6 implants
Long-Term Durability	Higher risk of wear or loosening (especially with hard foods)	Offers a longer-lasting and more stable solution
Cost	More economical (fewer implants and surgical procedures)	More expensive (2 additional implants and planning)
Treatment Duration	Temporary teeth can be placed in 1-2 days	Similar process, but planning may take longer due to more implants
Ideal Candidates	Patients with advanced bone loss Those seeking an economical solution Patients wanting quick treatment with fixed teeth	Patients with better bone support Those seeking long-term durability Frequent consumers of hard foods

All-on-4 prices:

Prices may vary depending on the clinic, city, materials used, and scope of treatment, so average ranges are given:

Country Price Range (Euro)

Turkey: €4,000 - €7,000

UK: 15,000 - 25,000 €

USA: 20,000 - 30,000 €

Germany: 12,000 - 20.000 €

For current prices, you can contact Antalya Dental A.R.T Clinic.

F.A.Q:

Is the All-on-4 procedure painful?

No, since the procedure is performed under local anesthesia, no pain is felt during the procedure. There may be mild pain and swelling during the recovery period; these are normal.

How long is the All-on-4 treatment time?

Implant placement usually takes 1-2 hours.
Initial relief: After 1 week,
Full recovery: 3-6 months (wait for permanent prosthesis).

How long will All-on-4 last?

With proper care and regular check-ups, it can be used for 20 years or more without any problems.

Do All-on-4 implants damage the jawbone?

No, the implants protect the jawbone by slowing bone resorption. Unlike traditional dentures, they prevent bone loss and prevent the facial structure from collapsing.

Will my speech be affected by All-on-4?

There may be a slight lisp for the first 1-2 weeks, but this is temporary. As fixed dentures function similarly to natural teeth, your speech will improve over time and become completely normalized.

Are All-on-4 dentures difficult to care for?

No, brushing, flossing, and using an interproximal brush are sufficient, like normal teeth. In addition, professional cleaning is recommended twice a year. It is much easier than removable dentures.

Is there an age limit for All-on-4 treatment?

It is suitable for anyone over 18 years of age who has completed jaw development. There is no upper age limit; it can be successfully applied even in patients over 80 years old.

Can I do sports after having All-on-4?

Yes, you can do sports such as swimming, running, and fitness. You should be careful only in sports such as boxing and wrestling where there is a risk of facial impact.

Can the color of All-on-4 prostheses be changed?

Yes, you can choose the degree of whiteness you want when making a permanent prosthesis. Also, the color can be adjusted with polishing afterwards.

What is the difference between All-on-4 and bridge prosthesis?

In All-on-4, neighboring teeth are not touched, and it can be applied even in complete edentulism. In addition, All-on-4 is a longer lasting solution than a bridge.

What materials are used in All-on-4?

Implants are made of titanium or titanium alloys, while prosthetic teeth are made of durable materials such as acrylic, porcelain, or zirconium.

How should I eat after the All-on-4 procedure?

After All-on-4 is placed, it is recommended that you follow your dentist's advice to manage the healing process well and prevent swelling and bleeding.
For the first 2 weeks, you should consume foods that are liquid or pureed, neither too hot nor too cold.
First 15-30 days: Pasta, rice, grains, eggs, fish, finely chopped vegetables, and soft fruits should be consumed.
Second month and beyond: Normal diet should be followed, and hard foods should be avoided.

Is there a difference between All-on-4 implants and natural teeth?

They provide results that are very close to natural teeth in terms of appearance and function. However, greater attention to oral hygiene is required.

All on 4 Dental Implants in Antalya, Turkey Cost

All on 4 Implants Turkey