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Treatment concept · Full arch

The All-on-4® treatment concept: fixed teeth on four implants

A whole jaw of fixed teeth on four implants

The All-on-4® treatment concept replaces all the teeth in one jaw with a fixed bridge on four implants. The two front implants are straight; the two back implants are tilted to avoid the sinus or nerve and to use the bone that is there. A fixed temporary bridge is often fitted within days, when the implants are stable enough.12

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Educational jaw model with four implants, the back two tilted, next to a full-arch bridge (not a Nobel Biocare product image)
In short
  • A treatment concept, not an implant brand or a product. It was developed and documented by a clinic in Lisbon with Nobel Biocare implants.1
  • Long-term studies from that clinic: 93% implant survival up to 18 years (lower jaw) and 94.7% up to 13 years (upper jaw).12
  • Across many clinics and brands, a 2026 review found similar survival for four- and six-implant bridges.3
  • Smoking and past gum or implant infections raise the risk of failure.21

How it works, step by step

  1. 3D x-ray and scans; planning of the teeth and the four implant positions.
  2. Removal of any remaining failing teeth and placement of four implants, usually in one surgery.
  3. If the implants are stable enough, a fixed temporary bridge is attached, often within 24–72 hours.
  4. Healing for several months while the implants fuse with the bone.
  5. A stronger final bridge is made and fitted.
  6. Professional cleaning and check-ups for life.
Jaw model with four implants
Educational model: two straight front implants, two tilted back implants, and a full-arch bridge. Not a Nobel Biocare product image.
Multi-unit Abutments (the angled connectors)Treatment timeline

What the long-term research shows

Independent clinical study

In 471 patients treated with the All-on-4® treatment concept in the lower jaw at one clinic in Lisbon, prosthesis survival was 98.8% and implant survival 93% over up to 18 years. 1

Single-centre study from the clinic that developed the concept; 31.6% of patients were lost to follow-up, which can make results look better than they are.

Independent clinical study

In 1,072 patients treated with the All-on-4® treatment concept in the upper jaw at the same clinic, prosthesis success was 99.2% and implant survival 94.7% over up to 13 years. Smoking was associated with implant failure. 2

Single-centre retrospective series; 20.4% of patients were lost to follow-up.

Systematic review

A 2026 systematic review of 55 studies found similar implant survival for four-implant and six-implant full-arch bridges, with long-term (≥5 years) pooled survival of about 98% for both. 3

Pooled data from many clinics and implant brands; not specific to one manufacturer.

Systematic review

A meta-analysis of 44 publications found no overall difference in failure rates between tilted and straight (axial) implants, although in studies of the upper jaw only, tilted implants failed more often. 4

These are good results, but they come mostly from experienced teams and from patients who attended their check-ups. Results in your case depend on your health, your bone, your hygiene and the team.

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Who it may suit, and who not

  • People who have lost, or are about to lose, most teeth in a jaw and want fixed teeth instead of a denture.
  • People with some bone loss who want to avoid major bone grafting, if the plan allows.
  • Not everyone: very severe bone loss may need zygomatic implants or grafting; uncontrolled diabetes, heavy smoking or poor hygiene raise risks.
Four vs six implants is a clinical decision. Ask the surgeon why they chose the number of implants in your plan.
All-on-4® treatment concept vs six implantsAll-on-4® treatment concept vs zygomatic implants

Risks and maintenance

  • Bridge or screw problems (chipping, loosening) are the most common issues and are usually repairable.3
  • Inflammation around implants (peri-implantitis) if cleaning and check-ups are neglected.5
  • If one implant fails, the bridge may need adjustment and a new implant.
Consensus / guideline

The EFP S3 clinical guideline on peri-implant diseases centres prevention on oral hygiene, regular supportive care and managing risk factors such as smoking. 5

Maintenance after implantsPeri-implantitis explained

The name: why we write "All-on-4® treatment concept"

The term "All-on-4® treatment concept" contains a registered trademark of Nobel Biocare. The owner asks that it is written as "All-on-4® treatment concept". Other clinics use generic terms such as "full arch on four implants". A clinic using the name does not guarantee it uses Nobel Biocare implants: ask which implants and parts will be used, and ask for the implant passport.6

Frequently asked questions

Is All-on-4 a type of implant?
No. It is a treatment concept: a way of placing four implants and attaching a fixed bridge. Different implants can be used within it.
Do I get teeth the same day?
Often a fixed temporary bridge is fitted within a few days, but only if the implants are stable enough at surgery. It cannot be promised in advance.1
How long does All-on-4 last?
Studies from the developer clinic report 93–95% implant survival over 13–18 years, with regular maintenance.12 The bridge may need repairs or replacement over time.
How much does it cost?
It varies widely by country and by what is included (temporary and final bridge, extractions, sedation, follow-up). See the cost guide.
Clinical review pending. Facts on this page are checked against the sources listed below (regulatory records, manufacturer documents, peer-reviewed research). A named clinician will review it before we call it medically reviewed.
Last updated 28 Sep 2026 · How we review

Sources

  1. Independent clinical studyMaló P et al. The All-on-4 treatment concept in the edentulous mandible: longitudinal study with 10–18 years of follow-up. Clin Implant Dent Relat Res 2019 — Clin Implant Dent Relat Res, 2019. Accessed 28 Sep 2026.
  2. Independent clinical studyMaló P et al. The All-on-4 concept for the edentulous maxilla: longitudinal study with 5–13 years of follow-up. Clin Implant Dent Relat Res 2019 — Clin Implant Dent Relat Res, 2019. Accessed 28 Sep 2026.
  3. Systematic reviewShao WH et al. All-on-4 and All-on-6 implant-supported fixed prostheses: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2026 — Int J Oral Maxillofac Surg, 2026. Accessed 28 Sep 2026.
  4. Systematic reviewChrcanovic BR et al. Tilted versus axially placed dental implants: a meta-analysis. J Dent 2015 — J Dent, 2015. Accessed 28 Sep 2026.
  5. Consensus / guidelineHerrera D et al. Prevention and treatment of peri-implant diseases — EFP S3 level clinical practice guideline — J Clin Periodontol, 2023. Accessed 28 Sep 2026.
  6. Manufacturer documentationNobel Biocare — Trademarks and trademark usage guidelines — Nobel Biocare Services AG, 2026-09-28. Accessed 28 Sep 2026.

Educational information only. The choice of implant system depends on your anatomy, restorative plan, bone quality and the clinician's assessment. This website does not recommend a specific implant for you.

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