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All-on-4® is a treatment approach that replaces an entire arch of missing teeth with a prosthesis anchored on four strategically placed dental implants. Rather than fitting individual implants for each tooth, this method uses implant positioning and a fixed bridge to restore function and appearance in a streamlined way. For many patients, the most noticeable advantage is the ability to leave the office with a stable, natural-looking set of provisional teeth on the day of surgery.
That same-day provisional allows patients to speak, eat certain foods, and smile with confidence while the implants integrate with the jawbone. The initial prosthesis is designed to be functional and aesthetic; once healing is complete, the provisional is replaced by a final prosthesis that reflects long-term fit and polish. This staged process balances immediate improvement with predictable, durable outcomes.
Because implant-supported restorations behave more like natural teeth than traditional removable dentures, they can significantly improve chewing efficiency and daily comfort. Our team places emphasis on careful planning and precise execution so patients experience a smooth transition from tooth loss to a restored, practical smile.
Successful All-on-4® treatment starts with comprehensive planning. Modern imaging — typically cone beam CT scans and digital x-rays — lets the clinician evaluate bone volume, nerve location, and sinus anatomy. This three-dimensional information guides implant angulation and position so that each implant supports the prosthesis optimally while avoiding vital structures.
Implants used in the All-on-4® concept are positioned in areas of the jaw where bone is naturally stronger. Two implants near the front are often placed more vertically, while two toward the back are angled to maximize support. This approach can reduce the need for extensive bone grafting in suitable candidates and creates a secure foundation for a full-arch prosthesis.
Following placement, a provisional prosthesis is attached to the implants to provide immediate function. Over the subsequent months the implants osseointegrate — a biological process where bone bonds to the implant surface — after which the provisional can be replaced with a final, precisely crafted restoration. Throughout, clinicians prioritize accurate impressions, occlusal balance, and esthetic contouring so the final result blends comfortably with the patient’s facial dynamics.
Every step of the process is coordinated with the goal of predictable healing and a reliable long-term result. Communication among surgical and restorative team members ensures that the eventual fixed bridge meets both functional and cosmetic objectives.
Before arriving for surgery, patients undergo diagnostic appointments to map out the treatment sequence and to address any existing dental issues that could affect implant success. This may include treatment of gum disease, extractions of non-restorable teeth, and a review of medical history to ensure safe care. A clear timeline and preoperative instructions are provided to set expectations and to prepare patients physically and mentally for the procedure.
On the day of implant placement, care is taken to provide a comfortable experience. Local anesthesia is used, and sedation options are discussed when appropriate to reduce anxiety. The surgical phase involves placing the implants and securing the provisional prosthesis. The procedure can be efficient because of the restorative-driven planning that guides implant positions from the outset.
After surgery, patients receive specific guidelines for short-term care: managing discomfort, protecting the provisional prosthesis, and following dietary recommendations tailored to the early healing phase. Follow-up visits are scheduled to monitor healing, adjust the prosthesis as needed, and verify that integration is progressing as expected. Good oral hygiene and regular professional care are essential during the healing period to support long-term success.
Once the implants have integrated and the mouth is stable, the provisional is replaced with a final prosthesis designed for durability and ease of maintenance. The final restoration restores chewing function and facial support while delivering a comfortable, natural appearance.
All-on-4® is often recommended for patients who have lost most or all teeth in an arch, or for those who face unstable dentures and want a fixed alternative. Candidacy depends on several factors, including overall health, oral hygiene, the condition of gum tissues, and bone quality. A thorough clinical exam and 3D imaging help determine whether this approach is appropriate or if additional procedures are needed first.
Patients with controlled systemic conditions can still be candidates, but medical history is reviewed closely to manage any risk factors. Smoking and unmanaged periodontal disease can affect healing and implant longevity, so those issues are discussed openly and addressed before moving forward. When bone volume is limited, the All-on-4® design can sometimes avoid grafting, but cases are assessed individually and treatment is tailored to the patient’s anatomy.
The practice coordinates care across specialties when necessary. Periodontal concerns, orthodontic needs, or more complex restorative requirements are evaluated by the team so that each phase of treatment is integrated and efficient. At the office of David M. Goldberg, DDS in Bellerose we prioritize a thoughtful, patient-centered evaluation to help determine the safest and most predictable path to a restored arch.
Maintaining an All-on-4® restoration requires a combination of daily home care and periodic professional visits. Patients are instructed in effective cleaning techniques around the prosthesis and implants, including the use of interdental brushes, floss designed for implants, and antimicrobial rinses when appropriate. Consistent hygiene reduces the risk of inflammation around the implants and supports longevity.
Regular checkups allow the dental team to monitor soft tissue health, occlusion, and the condition of the prosthesis. Minor adjustments can be made to improve comfort or function, and professional cleanings help control biofilm buildup that could threaten implant health. Any concerns such as unusual mobility, discomfort, or persistent inflammation should be reported promptly so they can be evaluated.
With proper care, implant-supported restorations can provide many years of reliable service. Patients benefit from a maintenance schedule individualized to their oral health needs, which helps protect the investment of time and treatment required to achieve a fixed full-arch solution.
1All-on-4 is a registered trademark of Nobel Biocare.
To learn more about how All-on-4® may restore your smile and improve daily function, contact us for additional information. Our team is available to answer your questions and guide you through the evaluation process.
All-on-4® is a treatment concept that replaces an entire dental arch with a fixed prosthesis supported by four strategically positioned implants. The system uses a combination of vertical and angled implants to create a stable foundation that can often support a provisional bridge on the day of surgery. This approach is designed to restore chewing function, facial support, and a natural appearance in a streamlined manner.
The immediate provisional allows patients to speak and eat with greater confidence while implants integrate with the jawbone. After a healing period the temporary restoration is replaced with a final prosthesis designed for long-term fit and esthetics. Clinicians plan each case to balance immediate improvement with predictable, durable outcomes.
Unlike removable dentures that sit on the gums, an All-on-4® restoration is fixed to implants and behaves more like natural teeth. Fixed implant-supported prostheses improve chewing efficiency, reduce slippage, and provide more consistent facial support than conventional removable appliances. Because the prosthesis is attached to implants, patients typically experience improved comfort and function in daily activities.
All-on-4® can also reduce the need for extensive bone grafting in select cases by using angled posterior implants to maximize available bone. Removable dentures may require adhesives and frequent adjustment, whereas implant-supported bridges are maintained through hygiene and periodic professional care. Treatment selection depends on oral anatomy, functional needs, and clinical goals.
Good candidates generally include people who have lost most or all teeth in an arch, those with failing dentition, or patients who are dissatisfied with unstable removable dentures. Candidacy depends on overall health, gum condition, oral hygiene habits, and bone quality rather than age alone. A careful medical and dental evaluation helps determine whether All-on-4® is appropriate or if preparatory treatment is required.
Controlled systemic conditions can be compatible with implant treatment when managed in consultation with medical providers, while smoking and active periodontal disease may compromise outcomes and are addressed before proceeding. Three-dimensional imaging and clinical exams evaluate bone volume, nerve position, and sinus anatomy so the team can plan the safest, most predictable approach. At the office of David M. Goldberg, DDS in Bellerose we prioritize a comprehensive evaluation to match treatment to each patient’s needs.
Planning begins with a thorough diagnostic workup that typically includes cone beam CT imaging and digital x-rays to visualize bone structure and vital anatomy in three dimensions. This information guides implant angulation and position so implants support the final prosthesis while avoiding nerves and sinuses. Surgical planning is restorative-driven, meaning the desired tooth position informs implant placement for predictable esthetic and functional results.
During the procedure two anterior implants are often placed more vertically while two posterior implants are angled to maximize support and available bone. A provisional prosthesis is attached to provide immediate function while osseointegration occurs. Throughout placement and restoration, the team focuses on accurate impressions, occlusal balance, and esthetic contouring so the final bridge integrates with the patient’s facial dynamics.
On the day of surgery you will undergo implant placement under local anesthesia, and sedation options are discussed in advance to help manage anxiety. The procedure is typically efficient because of careful preoperative planning, and a provisional prosthesis is often attached the same day so you leave with functional teeth. The clinical team will give specific instructions about activity, diet, and wound care before you go home.
Short-term discomfort, swelling, and minor bleeding are common and manageable with prescribed or recommended medications and cold compresses. You will receive guidance on protecting the provisional prosthesis and following a soft or modified diet for the initial healing phase. Scheduled follow-up visits ensure the restoration is functioning well and that integration is progressing as expected.
The recovery period includes a healing phase called osseointegration, during which bone bonds to the implant surface; this typically takes several months. During this time patients should follow dietary recommendations, oral hygiene instructions, and avoid habits that could stress the provisional restoration. Regular follow-up appointments allow the clinician to monitor healing, adjust the temporary prosthesis if needed, and identify any early issues.
Most patients can return to normal light activities within a few days, but strenuous exercise is usually limited for a short period to support healing. Maintaining excellent oral hygiene and attending professional cleanings are essential to protect soft tissues and implant health. When integration and soft tissues are stable, the provisional is replaced with a final prosthesis optimized for fit, function, and esthetics.
Long-term maintenance combines thorough daily home care with regular professional visits to monitor tissue health and prosthesis condition. Patients are instructed in cleaning techniques around the implants, including use of interdental brushes, floss designed for implant prostheses, and antimicrobial rinses when appropriate. Consistent hygiene reduces the risk of peri-implant inflammation and helps preserve the supporting bone and gum tissues.
Periodic checkups allow the dental team to assess occlusion, make minor adjustments, and professionally clean areas that are difficult to reach at home. The practice will personalize a maintenance schedule based on your oral health status and functional needs. Prompt reporting of unusual mobility, persistent discomfort, or changes in the soft tissue helps ensure timely evaluation and care.
As with any surgical procedure, All-on-4® carries risks such as infection, delayed healing, or implant failure, although careful planning and proper care reduce these chances. Nerve injury, sinus complications, and prosthetic issues are potential concerns that clinicians evaluate and mitigate through imaging and technique. Smoking and uncontrolled systemic conditions can increase complication risk and are managed proactively as part of the treatment plan.
Early detection and intervention are important if complications arise, which is why follow-up visits and attentive home care are emphasized. If a problem develops, the restorative and surgical teams work together to determine the appropriate corrective steps. Transparent communication about risks and realistic expectations supports safer, more predictable outcomes.
Alternatives include removable complete dentures, implant-retained overdentures, and full-arch restorations supported by more than four implants or by individual implants and bridges. Each option has distinct surgical and restorative requirements, differences in stability, and varying maintenance needs. The choice depends on anatomy, functional goals, esthetic priorities, and the overall treatment plan developed with the dental team.
Bone grafting, staged implant placement, or hybrid prosthetic designs may be recommended in cases where anatomy or long-term goals favor a different approach. A thorough consultation with imaging and clinical assessment helps compare options so patients can make an informed decision. The dental team coordinates care across specialties when needed to deliver the most appropriate, individualized solution.
The office emphasizes a team-based, restorative-driven approach that integrates diagnostic imaging, surgical planning, and prosthetic design to achieve coordinated results. Periodontal, surgical, and restorative aspects of care are communicated among providers so each phase proceeds smoothly and aligns with the overall treatment goals. Clear preoperative instructions and scheduled follow-up visits help ensure continuity and predictable healing.
Patients receive a personalized plan that addresses preparatory needs such as extractions or periodontal therapy and outlines the expected clinical sequence. The team at the practice supports patients through each step, focusing on comfort, safety, and functional outcomes. If you have questions about whether All-on-4® is right for you, the practice can arrange a consultation to review your diagnostic findings and treatment options.
