What Are All-on-4 Dental Implants? How They Work, Step by Step

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1. What All-on-4 actually is
2. Why the back implants are angled
3. Who All-on-4 may suit, and who may need a different plan
4. What happens, step by step
5. Recovery: what the first weeks are usually like
6. Living with All-on-4 day to day
7. All-on-4 compared with the alternatives
8. What it costs
9. Frequently asked questions

What All-on-4 actually is

All-on-4 is a way of replacing every tooth in the upper or lower jaw with one fixed bridge that is screwed onto four dental implants. A dental implant is a small titanium screw that sits in the jawbone where a tooth root used to be. On its own an implant can hold a single crown; in All-on-4, four of them share the load of a whole arch.

The approach was first described by Paulo Maló and colleagues in 2003, in a study of people with no lower teeth who had a fixed bridge attached to four implants on the day of surgery. It has been studied extensively since.

The key difference from a denture is that the bridge is fixed. You do not take it out at night or to clean it. Your dentist can unscrew it during a check-up when it needs professional cleaning or repair.

	All-on-4 at a glance
Implants per arch	Four
What is attached	One fixed bridge for the whole arch
Removed at home?	No, only by your dentist
Temporary teeth	Often fitted soon after surgery, if the implants are stable enough
Final bridge	Made once the implants have healed into the bone, usually a few months later
Who places it	A dentist trained in implant surgery

Why the back implants are angled

After teeth are lost, the jawbone tends to shrink, and the back of the jaw is often where bone runs short first. In the upper jaw the sinuses sit just above the back teeth, and in the lower jaw a nerve runs through the bone.

All-on-4 places the two front implants upright and tilts the two back implants so they reach further along the jaw without going into those areas. That lets the bridge extend towards the back of the mouth using the bone that is already there. A systematic review of the research found it gives people with reduced bone a way to avoid grafting procedures, which add surgery and cost. It does not suit everyone, and some people still need grafting or a different design.

Who All-on-4 may suit, and who may need a different plan

All-on-4 is usually considered for people who have lost most or all of the teeth in one jaw, or whose remaining teeth cannot be saved. It is also an option for people who wear a full denture and want something that does not move.

Before any implant treatment, your dentist checks that you have enough bone to hold the implants, that your gums are healthy, and how your general health and medicines might affect healing. healthdirect advises telling your dental team if you are over 60, have osteoporosis, cancer, a bleeding disorder, gum disease or diabetes, or if you smoke. None of these automatically rules you out, but each can change the risk and the plan.

• Enough bone at the front of the jaw for four implants
• Healthy gums, or gum disease treated first
• Medical conditions and medicines reviewed before surgery
• Smoking discussed, because it raises the chance of complications

What happens, step by step

Every plan is different, but most All-on-4 treatment follows the same broad sequence. Your dentist will explain the timing and fees for your own plan before anything starts.

1. Consultation and scans. An examination, x-rays and usually a 3D scan show how much bone you have and where the implants can go.
2. Planning. The implant positions and the shape of the bridge are planned from the scans, and you are given the options, risks and costs to consider.
3. Surgery. Any remaining teeth that cannot be kept are removed and the four implants are placed. This is done under local anaesthetic, and sedation may be offered.
4. Temporary bridge. If the implants are stable enough on the day, a temporary fixed bridge is usually attached the same day or within a few days.
5. Healing. Over about three months the bone grows around each implant and holds it in place.
6. Final bridge. Once healing is complete, the permanent bridge is made and fitted, and your bite is checked and adjusted.

Recovery: what the first weeks are usually like

Some bruising, pain, swelling of the gums or face and a little bleeding are common after implant surgery, and usually settle over the following days. Your dental team will tell you which pain relief to take and whether you need antibiotics.

You will be asked to eat soft foods while the surgical sites heal, and you may be told to use a mouthwash instead of brushing or flossing around the implants for the first two to three weeks. Following those instructions closely matters, because the early healing period is when implants are most vulnerable. If swelling or pain gets worse rather than better, contact the practice.

Living with All-on-4 day to day

Once the bridge is fitted you clean it every day, including underneath where it meets the gum, using a soft brush and tools such as interdental brushes or a water flosser. Regular check-ups let your dentist look for gum and bone inflammation around the implants, known as peri-implantitis, which is one of the main long-term problems the research describes. Our guide to cleaning and maintaining All-on-4 covers the routine in detail.

The bridge itself can wear, chip or break over time, and the material makes a difference. A 2026 systematic review found bridges with a metal and acrylic construction fractured more often than those built with metal and ceramic. For how long the implants and bridge tend to last, see how long All-on-4 implants last.

All-on-4 compared with the alternatives

All-on-4 is one of several ways to replace a full arch. The right choice depends on your bone, your health, how you feel about removable teeth, and your budget. A good consultation covers all of them, not only implants.

Option	Fixed or removable	Implants	Things to weigh
Full denture	Removable	None	No surgery, but can move when eating or speaking and may need relining as the gums change
Implant-supported (snap-on) denture	Removed by you for cleaning	Usually two to four	Far more stable than a denture, with less surgery than a fixed bridge
All-on-4	Fixed	Four	Fixed teeth with fewer implants, often without grafting, but surgery and ongoing maintenance
Full arch on more implants	Fixed	Usually five or more	Spreads the load over more implants, but may need more bone or grafting

What it costs

There is no standard fee for dental treatment in Australia; each practice sets its own, which is why All-on-4 quotes vary so widely. The price depends on whether one or both arches are treated, the bridge material, any extractions or grafting, and the anaesthetic used. Our guide to what changes the cost of All-on-4 explains what a full quote should include, and the practice’s payment plans page lists the ways to pay over time.

Frequently asked questions

Is All-on-4 the same as a denture?

No. A denture rests on the gums and you take it out to clean it. An All-on-4 bridge is screwed onto four implants in the jawbone and stays in; only your dentist removes it.

Can All-on-4 be done in one day?

The surgery and a temporary bridge can often be done on the same day or within a few days, if the implants are stable enough. The final bridge is fitted after a few months of healing, so the full treatment takes longer than a day.

Does All-on-4 hurt?

The surgery is done under local anaesthetic, and sedation may be offered. Afterwards most people have some pain, swelling and bruising for a few days, which is managed with the pain relief your dental team recommends.

Can I have All-on-4 if I have been told I do not have enough bone?

Possibly. The angled back implants are designed to use the bone that is there, which can avoid grafting for some people. Others still need grafting or a different design. Only an examination and scans can tell.

How long does All-on-4 last?

It depends on your bone and gum health, how well the bridge is cleaned, habits such as smoking or grinding, and the bridge material. The bridge may need repairs or replacing over time even when the implants are healthy. Regular check-ups help catch problems early.

Who places All-on-4 implants?

All-on-4 implants are placed by a dentist trained in implant surgery. It is reasonable to ask whoever is treating you about their training and their experience with full-arch implant treatment.

Is All-on-4 covered by Medicare or health insurance?

Medicare does not generally cover adult dental treatment. If you have private extras cover, major dental may contribute part of the cost, subject to your policy’s limits. Veterans with a Gold or White Card may be able to claim. Check with your insurer before you start.