All-on-4

Hello, I'm Dr. Merhdad Soheili, owner and dentist here at Azar Dental, and today I’d like to speak about a topic that I’ve been asked many times by patients: All-on-4.

All-on-4 is a general concept of the number of implants we place on edentulous jaws. It could be only one or totally edentulous patients who’ve lost all of their teeth on upper and lower arches. As I mentioned, it is a general concept because it’s not always doable or logical to restore a full arch of 14—or at least 12—teeth on only four implants. It depends on many factors: patient’s age, diet, health, size of the arch, and other elements. That’s why I often prefer to call it “All-on-X,” because in many cases we need more than four implants to achieve proper force distribution and ensure the prosthesis is sturdy, functional, and long-lasting. Prosthesis here means the bridge on the upper or lower jaw—or both. That is the essence of the All-on-4 concept.

Who Is a Good Candidate for an All-on-X Implant?

A good candidate for All-on-4—or All-on-X—implant-supported bridges or prostheses depends on many factors: the patient’s overall health, medical conditions, the amount of bone present, and whether bone augmentation or grafting is possible if the bone is insufficient. The width and height of the bone are critical. Hygiene is equally important. Since All-on-X patients no longer have their natural teeth, it’s important to identify why teeth were lost in the first place—trauma, gum disease (periodontitis), or decay. Most commonly, tooth loss is linked to poor oral hygiene. Educating patients to maintain excellent oral hygiene before and after implants is essential, as no advanced dentistry will succeed long-term without proper maintenance.

How Long Does It Take to Make an All-on-X?

The timeline varies greatly. If enough bone exists to place the necessary implants (four, six, eight, etc.), treatment can move quickly. However, in cases where teeth were lost many years ago, bone resorption may require augmentation. Small grafts may heal quickly and allow simultaneous implant placement, while larger grafts can take a year or more.

Prostheses are typically one-piece bridges made of acrylic, porcelain, or combinations with titanium, chosen based on the case. If multiple pieces are desired rather than a single bridge, more implants are usually required.

Can We Have One Implant Per Tooth?

While possible, it is not advisable to place one implant per tooth. Too many implants can increase the risk of bone loss and gum complications.

How Long Do All-on-X Implants Last?

The goal is for a lifetime. Modern implants are designed to last indefinitely, but outcomes depend heavily on hygiene, medical conditions, and unpredictable trauma.

Care and Maintenance of All-on-X

Maintenance is a shared responsibility between patient and dental team. Patients need to use specific flosses, water picks, and brushes, often tailored to their prosthesis design. Consistent follow-ups with the dentist and hygienist are essential to long-term success.

Potential Problems or Complications

Complications can include failure from trauma, poor hygiene, or medical conditions like diabetes. Bone or gum loss may occur, or screws holding the bridge may loosen or break. Thankfully, such issues are not common.

Are All-on-X Implants a Permanent Solution?

All-on-X is not the only solution but is one of the best. Unlike removable dentures, All-on-X bridges are fixed, offering superior function, stability, and psychological comfort. While more expensive, the quality-of-life benefits are significant.

Are All-on-X Implants a Good Option for Seniors?

Yes. For many seniors, implant-supported overdentures or All-on-X solutions provide better function than traditional dentures. Overdentures may be preferable for those who struggle with hygiene, as they can be removed and cleaned more easily, while fixed bridges require more rigorous maintenance.

Dentures or All-on-4: What’s the Difference?

Traditional dentures sit on the gums and bone, often with adhesive, and can slip during eating or speaking. All-on-4 uses four (or more) implants to secure the prosthesis, creating a stable, functional solution that feels like natural teeth. In many cases, the prosthesis can be placed on the same day as implant surgery. However, adequate bone is required, so not all patients qualify.

The All-on-4 Procedure at Azar Dental in Princeton, NJ

At Azar Dental, your initial appointment includes a comprehensive exam, X-rays, 3D CT scans, study models, and photographs. We then provide a thorough assessment, diagnosis, and treatment plan, outlining the advantages and disadvantages of your options so you can make the best choice for your needs.

The first step is implant surgery, which may include extractions or bone grafts as needed, followed by implant placement. After healing and integration, impressions and records are taken to create your final prosthesis.

Follow-up visits are essential: typically every three months for the first two years, then every six months, to monitor implant stability, prosthesis fit, and gum health.