All-on-4: A Proven Solution

Many patients in need of dental implants are unable to receive individual tooth implant replacement due to moderate-to-severe bone resorption or the high cost of implants.

All-on-4 treatment requires no grafting and is a cost-effective implant solution for patients with failing dentition and for many with edentulism. The latest research shows good long-term clinical outcomes and high patient satisfaction.

“The All-on-4 protocol allows implant placement in patients who would otherwise require bone grafting,” says Dr. Richard Panek, a surgeon at the Center For Oral Surgery & Dental Implants. “With All-on-4, the need for grafting is avoided due to tilting the implant position and lowering the risk of possible complications. Over the past 15 years, we’ve seen similar success rates as those published in the scientific long-term studies.”

Proven Clinical Outcomes and Patient Satisfaction

Research shows that All-on-4 treatment predictably provides good clinical outcomes and high patient satisfaction. The following results show longitudinal data for use of All-on-4 treatment in the mandible and the maxilla. Results were published in two articles in Clinical Implant Dentistry and Related Research in 2019.

Follow-up data at 10–18 years on 471 patients with 1,884 mandibular implants showed:

  • 93% implant cumulative survival rate
  • 98% prosthetic survival rate.1

Follow-up data at 5–13 years on 1,072 patients with 4,288 maxillary implants showed:

  • 9% implant cumulative survival rate
  • 2% prosthetic survival rate.2

In terms of patient satisfaction, a study of 250 patients found:

  • 95% of patients are satisfied with their new teeth
  • 98% of patients would recommend All-on-4 treatment to other people.3

Overview of All-on-4 Treatment

All-on-4 treatment provides full-arch rehabilitation without bone grafting using only four implants per arch: Two axial anterior implants and two implants tilted up to 45° in the posterior.

Tilting the two posterior implants in the maxilla and the mandible enhances the bone-to-implant contact. This optimizes bone support even in patients with minimum bone volume, avoiding the need for bone grafting. In the maxilla, tilted implants are more firmly anchored in better quality anterior bone. Tilted implants in the maxilla and the mandible also help avoid vital structures, more efficiently distributing implants along the alveolar crest. The final prosthesis can contain up to 12 teeth. For patients who meet the criteria for immediate loading of implants, a fixed acrylic bridge provides immediate function.

“Overall,” says Dr. Panek, “we’ve found that patients are quite pleased with the experience and outcomes made possible with this treatment.”

Patients Who Might Benefit

Most patients treated with All-on-4 have failing dentition. Many patients with edentulism (missing all of their teeth) are eligible for this treatment, too. Patients who already have dentures but are dissatisfied with them are another group that might benefit from All-on-4 treatment.

At the Center for Oral Surgery & Dental Implants, we perform a thorough evaluation on each prospective patient to determine whether he or she is eligible for All-on-4 treatment. The evaluation consists of:

  • Medical history, including any conditions that might affect the treatment outcome or the patient’s ability to have oral surgery, such as conditions or habits that could interfere with healing (diabetes, smoking).
  • Dental history, including periodontal disease and habits such as clenching and bruxing that can impact long-term outcome.
  • Radiographic analysis, initially with a panoramic radiograph usually followed by a full-mouth periapical series, a CT scan or a cone beam CT analysis.
  • Intra- and extraoral examination, to evaluate the remaining teeth and the soft tissue.

 “The preoperative evaluation assesses the whole patient including their fitness for surgery,” says Dr. Richard Panek, a surgeon at the Center For Oral Surgery & Dental Implants. “Most reasonably healthy patients are excellent candidates for this treatment.”


1 Malo P, de Araujo Nobre M, Lopes A, et al. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res. 2019;21(4):565-577.

2 Malo P, de Araujo Nobre M, Lopes A, et al. The All-on-4 concept for full-arch rehabilitation of the edentulous maxillae: a longitudinal study with 5-13 years of follow-up. Clin Implant Dent Relat Res. 2019;21(4):538-549.

3 iData Research U.S. and European Markets for Overdentures, 2014.