Dental Implant Series Part 4 – All on Four Implants

What is it?

Over centuries dentists have evolved over three dozen dental procedures for replacing teeth which are missing or falling. One of the most sophisticated procedures is the all-on-four® implant procedure. Simply put, four metal screws are implanted into each jaw bone, and a structure containing a set of twelve or fourteen artificial teeth is attached to it. Obviously, the original teeth must have fallen out and any remaining teeth must be extracted prior to attachment of the new teeth. The all-on-four® procedure is a patented procedure which was developed in the 90’s under a grant from Nobel Biocare.




Once the dentist and the patient make a mutual decision to go for an all-on-four® procedure on one or both jaws, all existing teeth on that jaw must be removed. Usually all the teeth are already mobile, and have to be removed at some stage, or spontaneously fell out during mastication or speech. In case bone has been damaged or missing in the area where the implants have to be made, bone must be grafted. For this purpose bone has to be acquired from another part of the body, e.g., the skull or the iliac crest of the patient. The graft will take three to six months to cure and be ready for the implants.


The Implants

When the quality and quantity of jaw bone is considered to be satisfactory, four implants are placed in the jaw bone by drilling holes. The material of choice for dental implants is titanium and its alloys. The implants are usually tapered so they can tap into the bone without creating too much stress, and firmly stand their ground after placement. These four screws form the structure on which the set of teeth is going to attached later.


Installation of the Teeth

The attachment of the new set of teeth comes two three months after the implants have been secured in to the jaw bone, and found satisfactory. The new set of teeth will have twelve or fourteen teeth, which can be provided in the form of a removable or a fixed denture. Treatment of the other jaw will demand the same procedure for that jaw. The artificial teeth used for fabrication of the prosthesis may be porcelain, acrylic or any suitable material.



Cost of this procedure is very high, running into tens of thousands of dollars, and not everybody can afford it. However, compared to implanting all teeth one by one this is cheaper and technically a more feasible process.


Advantages of All-on-four® Dental Implants

  • Improvement in tooth stability: This dental procedure ensures enhanced tooth stability that allows comfortable chewing while eating. The four root implants fixed on the jawbone have all the necessary strength to give patient’s teeth the much needed stability allow him/ her to chew any type of food very comfortably.
  • Improved Esthetics: Once completed the structure preserves the facial structure, or may even be used to slightly improve it. Conventional techniques involving eight to ten implants for supporting a full bridge are known for having caused a deterioration in the facial structure. This has a poor effect on the appearance of the person.
  • Improved Smile: Deterioration of the jaw bone can cause wrinkles, and cave-ins on the face around the lips. This procedure will virtually cure that, giving a very beautiful smile.
  • No more tooth falling embarrassments: All teeth are firmly held, and there is no chance of one or more teeth falling out when eating hard food.
  • Endurance: A properly executed procedure will last the patient a lifetime.
  • Cost Effectiveness In The Long Run: Since a whole set of teeth is bridged on four implants it cost less than conventional dental implant procedures.



This procedure has some drawbacks also which should be weighed against the advantages.

  • Instability: Natural molars have more than one root. The whole natural tooth set is supported on many roots, whereas the all-on-four® tooth set is anchored on just four screws in the anterior of the jaw. This may produce fluctuations in arch stability.
  • Difficulty in Replacing Implants: If the procedure fails, it may be very difficult or costly to replace the structure.


If you’re considering all-on-four® implants, don’t hesitate to contact us at Dr. Ku’s office in Fort Worth. We can examine your mouth and determine if this is the best option for you. We’ll discuss further details and set up the best plan to better your oral health.

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