ALL-ON 4: COMPREHENSIVE PATIENT GUIDE

What are All-on-4 dental implants?

All-on-4 is a full arch rehabilitation treatment for people who have lost or are about to lose all of their teeth in their upper or lower jaw (or both). All on four implants provide a secure and permanent alternative to removable dentures.

This full arch dental restoration procedure involves the placement of at least four dental implants into the jaw (but sometimes up to 6) into the jaw to secure a full arch (of up to 12) artificial teeth in place.

In most cases, the prosthetic teeth can be fitted to the titanium implants in as little as 3 days after surgery. For most patients, this means they don’t have to be without their teeth for months or even weeks — they can get a new smile and restore complete function in just a few days.

1. The All-on-4 technique places two anterior implants and two posterior implants at a 45-degree angle to help overcome any bone deficiencies and utilise more bone density to support the tooth bridge
   
2. The specialised multi-unit abutments enable the tilted implant placement and provide the stability needed to connect the teeth soon after surgery
   
3. A reinforced tooth bridge is fixed onto the titanium implants with special screws

What is the success rate of All on 4 dental implants?

When planned and performed by an experienced dental surgeon, All-on-4 is one of the most successful dental procedures available.

‍Dr Daniel Adamo, Clinical Director at Dental Implants on Miller, has been performing All-on-4 in Sydney for over 25 years. With his extensive surgical experience and training, our North Sydney clinic is recognised as an All-on-4® Centre of Excellence by Nobel Biocare, the creators of the original All-on-4 treatment concept.

ALL-ON-4 Pros and Cons

All-on-4 revolutionised dental implant treatment for edentulous patients (i.e. those without any teeth).

The specialised components (made by Nobel Biocare) and the innovative angled placement of the back implants mean more people can receive this treatment — even those experiencing jawbone loss.

Before All-on-4, implant treatment for patients who had lost all or most of their teeth would often require more implants, more time and sometimes complicated bone grafting, adding more costs too. 

Without All-on-4’s advancements, dentists were unable to place the prosthetic bridge on the implants for months (sometimes up to 12 months) after surgery. This meant patients would still need to wear a removable denture during this time.

When weighing up the pros and cons of All on 4, the benefits are clear. Its advanced dental technology and technique allow us to place a full arch of artificial teeth on just four implants in the majority of patients. In most cases, this means we can place fewer implants, and we rarely need bone grafting to support placement. For patients, this means a quicker recovery, fewer surgical appointments and a more cost-effective treatment compared to traditional implants. All-on-4 dental implants also facilitate immediate function, allowing patients to speak confidently and eat a wide range of foods just days after the procedure.

Benefits of All-on-4

• Restore teeth and oral function in as little as 3 days
• Improved aesthetics — they look and feel just like natural teeth
• Teeth are securely fixed in mouth — no need for glue or adhesives
• Preserves jawbone quality and prevents further bone loss
• Improves self-confidence and self-esteem, eliminating embarrassment or shame associated with tooth loss or ill-fitting dentures

Disadvantages of All-on-4

• More expensive than removable dentures
• Requires surgery done under sedation
• Recovery and healing time required

In dentistry, there is no one-size-fits-all approach. However, All on 4 has proven to be an excellent option for patients who have loose dentures and struggle to eat or those with failing teeth that want to avoid traditional dentures.

Still, there are no perfect treatments and it’s important to remember that all procedures carry small risks. We’ll discuss these in another section of this patient guide.

Are All on four dental implants right for me?

Most healthy people, no matter their age, will be suitable for All on four dental implants. In fact, there are very few cases where a patient may not be a suitable candidate.

As long as the treatment is carefully planned and performed by an experienced All on 4 dentist, the success rate is also typically very high.

All-on-4 dental implants are a suitable option for patients who have:

• Lost all or most of their teeth
• Failing or severely damaged teeth that cannot be restored with other treatments
• Severe gum disease
• Jawbone loss but sufficient bone structure to support the implants
• Uncomfortable or unstable existing dentures

The best way to determine whether you’re a suitable candidate for this treatment is to book a consultation with a qualified All-on-4 dentist. During this appointment, the dentist will examine your mouth and oral health, take x-rays of your teeth and jaw and assess if All on 4 dental implants are right for you.

Does my medical history matter?

It does — but don’t be discouraged if you have a chronic illness or long-term health issue. Depending on your circumstances, you may still be able to have dental implant treatment.

It’s important for your dentist to know your complete medical history so they can ensure they’re providing you with the best treatment options for your health. At your consultation, your dentist will ask you whether you have or have had:

• Diabetes
• Osteoporosis
• Cancer
• Stroke
• Heart attack
• Pacemaker surgery
• Organ transplants
• Haemophilia
• Autoimmune conditions
• Drug use
• Psychiatric illnesses

What about my medications?

Your dentist must also be aware of any medications you take, including the dosage and how long you’ve taken them. At your consultation, your dentist will ask you whether you take or have taken:

• Bisphosphonates for treatment of osteoporosis
• Nonsteroidal anti-inflammatory drugs prescribed for the management of chronic inflammatory conditions including arthritis & pain
• Immunosuppressive drugs to prevent organ transplant rejection
• Glucocorticoids prescribed to suppress inflammation in chronic diseases like asthma, rheumatoid arthritis and autoimmune disease
• Chemotherapy agents used to stop cancer cell growth
• Selective Serotonin Reuptake Inhibitors for treating depression or mental health disorders

Can I get dental implants if I smoke?

Technically, yes. But, if you are a smoker, most clinicians will want you to stop smoking before undertaking treatment as it puts you at a higher risk of implant failure. This is because smoking is a vasoconstrictor and decreases the blood supply to the gums, which affects your ability to heal and increases your chance of complications and infections after dental surgery. For implant success, you need healthy gums — and for healthy gums, you need to stop smoking.

What about alcohol?

While the occasional glass of wine isn’t likely to cause any issues, it’s still important to be aware of the effect alcohol can have on your body’s repair processes. Alcohol has been found to slow down bone repair and reduce bone quality. Additionally, this study found that daily alcohol consumption may have a negative influence on predictable long-term implant treatment outcomes.

Alternative treatments

While All-on-4 is an extremely effective treatment, it’s not the only treatment option available for patients looking to replace all your teeth.

The table below outlines some of the main alternative treatments to All-on-4, as well as their suitability for tooth replacement in the upper jaw, lower jaw or both. We’ll explore each alternative treatment option in detail in the following sections of this guide.

ALTERNATIVE TREATMENT	SUITABLE FOR UPPER JAW	SUITABLE FOR LOWER JAW
Dentures
Standard full mouth implants Dentures
Combination treatment (e.g. single implants, crowns, bridges)
Overdenture

Alternative #1: Dentures

Removable dentures are one of the more affordable options to replace an entire arch of teeth. And often, cost is the main reason why patients choose this option over All on Four implants.

However, it’s important to note that traditional dentures are not an effective long-term solution for edentulous patients. Though they may replace the missing teeth, denture teeth do not replace the missing tooth roots. This means further jaw bone loss (and the complications associated with this) is inevitable.

Benefits of traditional dentures

• More affordable
• No surgery required (unless existing teeth need to be removed)
• No downtime or recovery period
• Easy to clean and repair if damaged

Disadvantages of dentures

• Can feel loose, uncomfortable and unnatural
• Do not look like real teeth
• May impair speech
• Reduced ability to eat and chew and loss of taste — upper dentures cover taste receptors on roof of mouth
• Does not prevent jaw bone loss

Dentures do not stop jaw bone loss

When you are missing multiple teeth, the bone where the tooth used to be will start to deteriorate, causing your jaw bone to lose height and width. Over time, this can cause your lips and cheeks to collapse inwards as they no longer have the bone structure to support them.

Unlike dental implants, dentures do not provide support or stimulate the bone structures surrounding the teeth. This means long-term denture wearers will continue to experience jaw bone loss that can significantly change their face shape and eventually make it difficult to wear dentures at all.

Alternative #2: Standard full mouth dental implants

Standard full mouth dental implants involve the placement of up to 8 straight implants in the jaw to hold a fixed bridge of up to 12 teeth in place. In this traditional implants approach, the implants are placed straight, so it is only suitable for patients with enough bone height and density to support the implants and tooth bridge.

Benefits of full mouth dental implants

• Provides secure, fixed teeth — no need for glues or adhesives
• Restores complete function
• Preserves jawbone quality and prevents further loss

Disadvantages of full mouth dental implants

• Requires a sufficient amount of jawbone for implant success
• Requires surgery done under sedation
• More expensive than traditional dentures

Alternative #3: Combination treatment

If most of a patient’s teeth have a good prognosis, All-on-4 may not be the best solution. This is where a combination of treatments, such as single implants, crowns, bridges or implant-supported bridges may be recommended.

Benefits of combination treatment

• No need to remove existing natural teeth that may be healthy or able to be repaired
• Natural teeth can be saved through restoration
• No need to undergo a major and irreversible surgical procedure

Disadvantages of combination treatment

• Can be expensive
• May involve a lengthy treatment 
• May require multiple procedures

Alternative #4: Overdenture

An overdenture is a removable tooth replacement option for those looking to replace all of their lower teeth. Traditional denture wearers often find their lower dentures are more likely to slip and move than their upper dentures. Overdentures provide a more secure solution for the lower teeth.

An overdenture involves the placement of two dental implants at the front of the bottom jaw which are topped with magnetic attachments. A denture fitted with locator magnets is then able to be clipped on and off the implants.

Benefits of overdentures

• More secure than traditional removable dentures
• No need for denture glues or adhesives
• The magnetic force reduces denture movement, relieving pressure on the gums and jawbone

Disadvantages of overdentures

• Only suitable for replacing teeth in bottom jaw
• More expensive than traditional dentures
• Requires a sufficient amount of jawbone for implant success

Alternative #5: Do nothing

Some patients with severely broken down or failing upper and lower teeth may choose not to receive any treatment at all. Yet this option can be detrimental in a number of ways.

There are biological implications, such as losing the ability to eat and speak, and jaw bone loss which can affect your facial structure and cause your lips and cheeks to collapse inwards over time. Additionally, missing teeth can also have a devastating impact on your emotional and social wellbeing.

Patients who choose to do nothing should consider the negative impact of missing teeth and be aware of the complications that can follow this approach.

Benefits of doing nothing

• Zero cost

Disadvantages of doing nothing

• Severe bone loss is inevitable
• Complete loss of function — ability to eat and speak deteriorates
• Higher risk of oral diseases

All on 4 procedure step-by-step

All-on-4 is a complex treatment that requires a lot of careful planning and precision by your dentist. But for patients, the entire process is relatively quick and straightforward. Below you’ll find a step-by-step guide to the All on 4 dental implants procedure so you know exactly what to expect from this treatment.

Step 1: Consultation

All-on-4 treatment should always begin with a comprehensive consultation with your implant dentist. During an initial consultation, the dentist will conduct a clinical examination of your mouth, take x-rays and 3D scans of your teeth and jaw, assess your suitability for treatment and answer all your questions. If applicable, they may discuss alternative treatment options. Some clinics may also give you the opportunity to see their different tooth bridge options.

Step 2: Planning

After your consultation, the dentist will begin planning your dental implant placement using special implant planning software. This is a very important step in the All-on-4 procedure as it will help your dentist ensure the implants are placed in the ideal position and avoid vital structures, such as nerve canals. Meanwhile, your new tooth bridge will be expertly crafted to suit your facial features and structure, while ensuring optimal function.

Step 3: Implant placement

On the day of your implant surgery, you will be put under IV sedation (also called twilight sedation) which will help you remain relaxed and free from discomfort during the procedure. The dentist will then surgically place the 4 dental implants (or more) into your jaw. It typically takes between 3 to 4 hours to secure the implants into each jaw. If required, any remaining teeth will also be removed to insert the implants. After surgery, you’ll spend about an hour or two in recovery as you ‘wake up’ from sedation. When ready, a family member or friend will need to escort you home as you won’t be able to drive.

Step 4: Connecting the implant teeth

Most patients can have their initial bridge connected to their implants in as little as 1 to 3 days after surgery. Initially, patients will receive a temporary bridge made from acrylic to be worn for approximately 3 to 6 months while the jawbone and gums completely heal. Once the tooth bridge is connected, the dentist will advise the correct aftercare and cleaning for the implants and new teeth.

Step 5: Two-bridge solution

For patients who have opted for a two-bridge solution, they will receive their final tooth bridge around 3 to 6 months after surgery once healing phase is complete. The upgraded tooth bridge is typically made with durable materials like titanium or zirconia, providing a lot more strength and a longer lifespan than the acrylic version.

How much do All-on-4 dental implants cost in Australia?

This is because there are several key factors that influence the cost of All on 4 treatment, including:

1. Implant and tooth bridge quality
2. One- or two-bridge process
3. The technology your dentist uses
4. The experience and training of your dentist
5. Your oral health and whether you require additional procedures, such as gum disease treatment or bone grafting

At Dental Implants on Miller, our price for All on 4 treatment starts from $19,499 per jaw. Get our price guide below for more information on the costs involved and payment options.

Different types of tooth bridges and how they affect treatment cost

The quality and material of your final tooth bridge plays a large role in the cost of your All on 4 treatment. Tooth bridges made from materials that are more durable, higher quality and offer superior aesthetics, like zirconia, will come at a higher cost than standard acrylic tooth bridges.

Acrylic Tooth Bridge

• More cost-effective
• 2-year warranty
• Faster to make and fit
• Bulkier profile required for strength
  

Zirconia Tooth Bridge

• More expensive
• Highly durable and strong (10-year warranty)
• Translucency looks just like natural teeth
• Stain resistant
• Thinner, more natural profile

Remember: the cheaper option does NOT equal the better option

Some patients may search for the cheapest All on 4 providers or even turn to dental tourism for a lower treatment cost. But it’s important to be wary of any cheaper quotes for All-on-4 treatment.

A cheaper quote can mean…

• Less inclusions
  For example, it may only cover the cost of a one-bridge solution and you may have to pay for an upgrade to your final tooth bridge after your 3-6 month healing period. Likewise, it may not factor in any additional treatments you will require before receiving your implants, such as gum disease treatment, removal of remaining teeth or bone grafting.
  
  
• A less experienced dentist
  Dentists who have invested less time and money in additional training for this treatment may offer cheaper All on 4 prices
  
  
• Cheaper materials
  You likely won’t receive genuine Nobel Biocare components (or their lifetime warranty) 

Payment options for All on 4 treatment

Cost is the number one barrier patients face when deciding to restore their smile with All on 4 dental implants. Before making such a big financial commitment, most patients want to confirm how they will cover the costs of their treatment.

Some of the most common finance options for implant treatment include:

• Personal loan
• Specialised medical finance
• Early release of superannuation

Did you know you may be able to access your super to pay for All on 4?

Some patients may be eligible to access super to cover the cost of medical or dental treatments. This option is not available to all patients or treatments. To apply for the early release of super on compassionate grounds, you must meet certain conditions and eligibility criteria outlined by the ATO.

Before and after images of All on 4 dental implants

See how other patients have restored their smiles with All on 4 treatment. This type of full arch rehabilitation treatment is not just for those who are missing all or most of their teeth. As you can see in the cases below, some patients may still have many of their natural teeth remaining, but they have a poor prognosis and cannot be saved with other restorative treatments.

Case Study #1

Case Study #2

Case Study #3

Case Study #4

Case Study #5

For more of our patients’ transformations, see our All on 4 Sydney gallery.

How to care for All-on-4 implants

Caring for All-on-4 dental implants is much like caring for natural teeth. To ensure the success and longevity of dental implants, patients must follow their dentist’s aftercare instructions carefully and establish a good oral hygiene routine.

Post-op aftercare

Most patients are surprised at how quick the recovery time is after their dental implant surgery. However, it is still very important to rest and relax for a few days after treatment and follow your All-on-4 post-op aftercare instructions carefully.

While all wounds will be closed and any bleeding will be stopped before you leave the surgery, it’s normal for the surgical site to ‘weep’ a small amount of blood for 2 to 3 days after the procedure. Keep in mind this small amount of blood will mix with saliva and may appear to be a greater volume than it is.

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DO	DON'T
Rest	Rush back into your usual routine — allow yourself a few days to rest and recover
Drink plenty of water and other fluids (but avoid hot beverages)	Lie or sleep flat for 48 hours post-op — prop yourself up with an extra pillow
Eat soft, easy-to-swallow, nourishing foods like yoghurt, smoothies or cooled soup for the first 4 weeks after surgery	Do any heavy lifting or exercise
Use OTC pain medication every 4 to 6 hours (or as directed) for the first 2 to 3 days post-op	Eat any hot, hard, crunchy or chewy foods for at least the first 4 weeks after surgery
Use ice packs regularly to help reduce swelling and bruising	Smoke or drink alcohol for at least 7 days after surgery
Follow your dentist’s post-op cleaning instructions	Rinse or spit for 48 hours post-op — swallow your saliva
	Disturb or touch the stitches in your mouth with your tongue or fingers

Cleaning

Maintaining good oral hygiene is essential for the success and longevity of your All-on-4 implants. But cleaning your dental implants doesn’t have to be complicated. By adding a few new steps to your daily oral hygiene routine, you’ll be able to keep your implants and gums healthy.

How to clean All on 4 dental implants at home

• STEP 1: Brush
  Brush your teeth at least twice a day with a small soft manual toothbrush

• STEP 2: Floss
  Use special implant floss to clean under your tooth bridge and behind your back molars twice a day
  

• STEP 3: Water flosser
  Use a water flosser to help dislodge any food debris that may be stuck in hard to reach places between the tooth bridge and gums
  

• STEP 4: Gum stimulator
  Use a rubber tip gum stimulator to further help dislodge any food debris and stimulate blood flow to aid the healing process
  

• STEP 5: Mouthwash
  Rinse with mouthwash to finish with a fresh, clean feeling

Choosing your clinic

All-on-4 is a life-changing procedure — but it’s also one that is permanent and irreversible. This is why it’s so important to do your research and be very selective when choosing your All on 4 clinic.

Finding a clinic and team that make you feel safe, comfortable and confident is key to ensuring you get an exceptional experience and results.

The seven factors to consider when choosing your clinic

1. Is the clinic using genuine Nobel Biocare components and are they recognised as a Centre of Excellence?
   
2. What training does the dentist have in this procedure?
   
3. How much experience does the dentist have in this procedure?
   
4. Does the clinic work with a reputable laboratory and high-quality materials?
   
5. Does the clinic have a properly qualified medical professional to administer and supervise sedation?
   
6. Is the clinic purpose-built for surgical procedures and recovery?
   
7. Does the clinic offer all options for All-on-4, including various tooth bridge options?

You deserve excellence

Dental Implants on Miller is proud to be recognised by Nobel Biocare as an All on 4 Centre of Excellence — and we’re one of just seven dental practices across New South Wales awarded this title.

What does this mean for you?

• Peace of mind
  A team vetted and trusted by Nobel Biocare — the creator of the All-on-4 concept
  

• Success
  Proven track record of successfully carrying out this advanced procedure
  
  
• Quality
  Authentic Nobel Biocare implants and components with a lifetime warranty

Potential risks

All on 4 dental implants come with many life-changing benefits. But like all medical procedures, there are some potential risks and complications that can occur with this type of dental treatment.

What are some common issues with All on 4 dental implants?

All on four problems are usually very rare so it’s unlikely that you’ll need to worry about any of the below — especially if you’re working with an experienced dental implant dentist.

Some issues that can occur with dental implants include:

• Implant failure
• Infection
• Gum recession
• Nerve damage
• Sinus inflammation

Who is most at risk of developing these problems?

All on 4 dental implants may have a reduced success rate for those who have/are:

• Smokers
• Poor dental hygiene and maintenance
• Pre-existing gum disease
• Pre-existing medical conditions that may impact healing such as osteoporosis ordiabetes
• Immunocompromised
• Had radiation therapy to the mouth or jaw area

What’s the best way to avoid these issues?

• Work with an experienced All on 4 implants dentist
• Follow your dentist’s aftercare instructions carefully
• Keep up good oral hygiene and cleaning habits
• Avoid smoking

Past patient reviews: Learn how others feel about their All on 4 experience

Finding it hard to track down trustworthy All-on-4 patient reviews online?

This is because, in Australia, dental professionals legally cannot publish any patient testimonials or reviews of their treatments or procedures on their websites.

But that doesn’t mean it’s impossible to learn about other people’s first-hand experience with All on four implants. There are a few ways you can learn how other people felt about their All-on-4 treatment, such as:

Ask your provider for lots of before and after photos

Before and after photos will show you the results your potential All on 4 dentist is capable of achieving, as well as how the final outcome can look on different patients.

Speak to past patients

If your potential All on 4 provider offers you the chance to talk to past patients, this is a great sign. It shows how confident the dentist is in their work and patient relationships. Plus, nothing is more valuable than hearing someone else’s first-hand experience.

Check out your provider’s Google reviews

Patients are allowed to post personal reviews on a dental practice’s Google My Business page so this is a good way to see what other patients are saying about their experience with them. But remember to take everything you read in Google reviews with a grain of salt.

Look at patient success and satisfaction studies

Published medical studies on All-on-4 patient success and satisfaction rates are often a great source of truth about this procedure, providing reliable, long-term accounts of real patients.

Here are some key stats from a few recent studies:

• All on 4 has a success rate of 95-97% (according to this 2019 study)

• 95% of patients were extremely satisfied or satisfied with their new teeth (according to this 2012 study on patient satisfaction with the All on 4 procedure)

• 98% of patients would recommend this treatment to others (according to the same 2012 study)

Are you ready to get your smile and your life back?

Book your FREE consultation with Dr Daniel Adamo today or get our price guide to learn everything you need to know about All on four dental implant treatment at our North Sydney clinic, including what to expect, the costs and payment options.

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