What is All-on-4 and how does it work?

All-on-4 is a technique developed by Portuguese implantologist Dr Paulo Malo in the late 1990s. Instead of placing six to eight implants per arch (the traditional approach to fixed full-arch restoration), All-on-4 uses just four implants positioned at precise angles to maximise the amount of bone contact each implant achieves.

The two front implants are placed vertically into the anterior jaw where bone is typically dense. The two rear implants are tilted at a 30 to 45 degree angle, engaging the denser bone further back in the jaw and avoiding the maxillary sinuses (upper jaw) or the inferior alveolar nerve (lower jaw). This angulation means that patients who would otherwise need bone grafting before conventional implant placement can often proceed with All-on-4 without grafting.

The four implants are then connected with a fixed bridge carrying 10 to 14 teeth. Unlike dentures, this bridge is screwed directly to the implants and cannot be removed by the patient. It feels, looks, and functions like natural teeth.

The All-on-4 process step by step

Step 1: Consultation and planning

Your first appointment includes a full clinical examination, a CBCT (3D) scan of your jaw, and a discussion of your goals. The CBCT scan shows us the exact dimensions and density of your bone, the position of nerves and sinuses, and any existing teeth or roots that need removal. Using this data, your implant dentist plans the precise position, angle, and depth of each of the four implants using digital planning software.

Step 2: Impressions and temporary bridge fabrication

Before surgery day, we take impressions or digital scans of your mouth. Our dental laboratory uses these to pre-fabricate a temporary bridge that will be fitted to your implants on the day of surgery. This means you arrive for surgery knowing you will leave with teeth.

Step 3: Surgery day

On the morning of surgery, any remaining teeth are extracted. The four Straumann implants are placed into the planned positions in the jawbone. Multi-unit abutments are attached to each implant, and the pre-fabricated temporary bridge is connected and adjusted for comfort and bite alignment. The entire procedure typically takes 2 to 4 hours per arch under local anaesthetic with optional IV sedation.

You leave the same day with a full set of fixed teeth. These temporary teeth are functional for eating soft foods immediately.

Step 4: Healing period (3 to 6 months)

Over the next 3 to 6 months, the Straumann implants undergo osseointegration, fusing permanently with your jawbone. Straumann's SLActive surface accelerates this process compared to conventional implant surfaces. During this time, you wear the temporary bridge and attend periodic check-up appointments so we can monitor healing and adjust the bite as needed. You gradually return to a normal diet as healing progresses.

Step 5: Final bridge fitting

Once osseointegration is confirmed (typically via a torque test and clinical assessment), we take new impressions for your final permanent bridge. You choose from three prosthesis materials: acrylic composite, layered porcelain, or monolithic zirconia. The laboratory fabricates the bridge over approximately 2 to 3 weeks, and it is fitted and fine-tuned at your final appointment.

Prosthesis material options

The material you choose for your final All-on-4 bridge affects the appearance, durability, weight, and cost of your restoration. Here is how the three options compare.

Acrylic composite ($25,000 to $28,000 per arch)

Acrylic is the most established All-on-4 prosthesis material and the most affordable option. It is lightweight, which some patients prefer, and it can be repaired chairside if a tooth chips. The main trade-offs are that acrylic can stain over time (particularly with coffee, tea, or red wine), is more prone to chipping than the other options, and typically has a shorter lifespan (10 to 15 years before replacement). Acrylic is a good choice for patients who want to manage costs or who prefer a lighter-feeling bridge.

Layered porcelain ($28,000 to $32,000 per arch)

Porcelain-layered bridges use a metal substructure (titanium or chrome-cobalt) with individual porcelain teeth bonded on top. They offer a more natural translucency and colour depth than acrylic, better stain resistance, and a lifespan of 15 to 20 years. They are heavier than acrylic, and if a porcelain tooth chips, the repair may require removing the bridge and sending it to the laboratory. Porcelain is a good middle-ground option balancing aesthetics, durability, and cost.

Monolithic zirconia ($32,000 to $35,000 per arch)

Zirconia is the premium prosthesis material. It is milled from a single block of dental-grade zirconium oxide, making it virtually chip-proof and highly resistant to staining. Modern zirconia can be layered and characterised to closely replicate the translucency of natural teeth. It is the heaviest option but also the most durable, with expected lifespans of 20 to 30+ years. Zirconia is our recommendation for patients who want the longest-lasting, lowest-maintenance result.

Why we use Straumann implants for All-on-4

All-on-4 places unique demands on the implant system. Four implants must support 10 to 14 teeth and withstand full chewing forces from day one. The implants must achieve high initial stability at the time of placement (primary stability) and integrate with the bone as quickly as possible (osseointegration). Straumann's technology is specifically designed for these demands.

• BLX implant design: Straumann's BLX is engineered for immediate-loading protocols like All-on-4. Its tapered body and progressive thread design achieve high primary stability even in softer bone, meaning the temporary bridge can be safely loaded on the day of surgery
• SLActive surface: The hydrophilic SLActive surface accelerates the initial phase of osseointegration, reducing the risk of implant failure during the critical early healing period. Published data shows SLActive cuts initial healing time from 6 to 12 weeks down to 3 to 4 weeks
• Roxolid material: The titanium-zirconium alloy is 50% stronger than pure titanium, which matters when four implants must bear the load of a full arch
• Component system: Straumann's prosthetic component system is the most widely used in the world, with a lifetime availability guarantee. This means your bridge can be maintained, adjusted, or replaced at any practice that uses Straumann, anywhere in the world, for the rest of your life

Recovery after All-on-4

Days 1 to 3

Expect swelling, bruising, and moderate discomfort. Swelling typically peaks on day 2 or 3. Cold packs applied 20 minutes on, 20 minutes off help manage swelling. Prescribed pain medication and antibiotics should be taken as directed. Eat only very soft foods: smoothies, yoghurt, mashed potato, scrambled eggs, soup. Rinse gently with warm salt water. Do not use a straw.

Days 4 to 7

Swelling begins to subside. Most patients transition from prescription pain medication to over-the-counter paracetamol or ibuprofen. Bruising may appear along the jawline or neck and fades over the next week. Continue soft foods. Most patients feel well enough to return to desk work by day 5 to 7.

Weeks 2 to 6

Discomfort is minimal to none for most patients. The soft diet continues to protect the implants while they integrate with the bone. You can introduce firmer soft foods like pasta, fish, and cooked vegetables. Avoid anything hard, crunchy, or chewy (nuts, crusty bread, steak, raw carrots).

Weeks 6 to 12

Osseointegration is well underway. Your dentist will assess healing at regular check-up appointments. You can gradually begin reintroducing firmer foods. By week 12, most patients are eating a near-normal diet with the temporary bridge.

Months 3 to 6

Once osseointegration is confirmed, the process of designing and fitting your final permanent bridge begins. After the final bridge is placed, you can eat a completely normal diet including foods that were off-limits with dentures: steak, corn on the cob, apples, crusty bread.

All-on-4 costs at Pakenham Creek

The cost of All-on-4 at Pakenham Creek Family Dentist using Straumann implants:

Payment options include HICAPS, Afterpay, Zip Pay, SuperCare (superannuation access), and NDP interest-free plans. We also offer staged payment aligned with treatment milestones.

• Single arch (upper or lower): $25,000 to $35,000 depending on prosthesis material
• Both arches: $50,000 to $70,000
• Optional IV sedation: $500 to $800 additional
• Optional general anaesthetic: $1,500 to $2,500 additional (hospital day-surgery)