.webp)
All-on-4 dental implants are a full-arch rehabilitation protocol: four implants placed per arch, with two anterior implants in a vertical position and two posterior implants angled at 30–45 degrees, supporting a fixed bridge that is delivered on the same day as surgery. The protocol was developed by Paulo Maló to maximise the use of available bone while avoiding sinus augmentation in the upper jaw. At Dazzle Dental Clinic, it is the most commonly performed full-arch treatment and the basis of our MIRA affordable protocol.
Why Four Implants, Not More
The question patients frequently ask is why four implants can support a full arch of teeth when twelve to fourteen teeth are being replaced. The answer is biomechanical: a bridge distributes load across all its support points simultaneously. Four well-positioned implants with adequate AP spread (anterior-posterior distance of at least 20mm) can support a full arch bridge under normal occlusal forces without each implant needing to be individually overloaded. The angled posterior implants extend the effective posterior reach, increasing AP spread without requiring implants in the most posterior bone where sinus proximity limits options.
Adding more implants (All-on-6) increases load distribution and reduces distal cantilever — preferable when bone allows — but four implants is mechanically adequate in well-selected cases.
The Clinical Benefits That Are Specific to All-on-4
Same-day provisional teeth: The temporary bridge is placed at the end of the surgical appointment. Patients arrive without functional teeth and leave with a fixed provisional bridge. This is not a denture; it does not come out. It functions for eating soft foods from the first day.
No sinus augmentation required in most upper jaw cases: The angled posterior implants place their apices in the denser bone anterior to the sinus — the region where more bone height is available. This eliminates the 6–8 month sinus lift healing period that conventional full-arch treatment would require in a patient with posterior maxillary atrophy.
Bone preservation: Implants transmit occlusal load to the bone, stimulating bone maintenance. The progressive bone loss that occurs under conventional dentures does not occur with implant-supported prostheses. This is a long-term functional and facial structural benefit.
Published 10-year outcomes: All-on-4 survival data from multiple independent centres shows 95–98% implant survival at 10 years. The prosthesis — the bridge itself — may require replacement or repair over that period (particularly acrylic-on-metal bridges which wear), but the implants supporting it are well-documented for long-term function.
Who Is a Candidate
All-on-4 is appropriate for patients with full-arch tooth loss or failing dentition who have adequate bone in the anterior jaw and who can achieve 35 Ncm insertion torque at the posterior implant sites. CBCT assessment determines this. Patients with very severe posterior and anterior bone loss may require zygomatic implants rather than or in addition to All-on-4 angulation. Patients with uncontrolled diabetes, active periodontitis in remaining teeth, or active smoking have higher failure risk and are counselled accordingly before treatment proceeds.
Cost at Dazzle Dental Clinic
MIRA All-on-4 (cost-optimised protocol): ₹2,00,000 per arch, acrylic-on-metal bridge. Premium All-on-4 (Nobel Biocare/Straumann, monolithic zirconia bridge): ₹3–4 lakh per arch. Full-mouth (both arches): MIRA ₹4L, premium ₹6–8L. Itemised breakdown provided at consultation; no hidden fees.
FAQs
Q1: What is the difference between All-on-4 and dentures?
All-on-4 is a fixed bridge anchored to implants — it does not come out, does not shift during eating, and does not rest on the gum surface. Dentures sit on the gum and resorb bone progressively over years. All-on-4 preserves bone; dentures do not. The functional difference in biting force is significant: dentures restore approximately 20–25% of natural bite force; All-on-4 restores approximately 70–80%.
Q2: How is All-on-4 cleaned?
The bridge is cleaned daily with a water flosser (to flush under the bridge at the gum margin), interdental brushes sized to fit under the bridge, and a soft toothbrush. At Dazzle, hygiene technique is demonstrated at the post-surgical appointment and reinforced at 6-monthly hygiene appointments. See our All-on-4 maintenance guide for the complete protocol.
Q3: What can I eat after All-on-4?
First 6–8 weeks (provisional bridge period): soft diet — no hard, crunchy, or chewy foods. After the final bridge is delivered: most normal foods. The final zirconia bridge can sustain normal bite forces. Hard ice, hard bread crusts, and directly biting into whole apples are advised against for any implant prosthesis long-term.
Q4: What happens if one implant fails?
Individual implant failures during osseointegration occur in approximately 2–5% of cases. If one of the four implants fails, the provisional bridge is supported on the remaining three while the failed site heals and is reassessed for re-implantation. All-on-4 has less redundancy than All-on-6; this is one reason All-on-6 is preferred when bone volume allows.
