All-on-4 Dental Implants

When four implants are considered

• No teeth left in the jaw, or the remaining teeth cannot be saved (advanced decay, root fractures, advanced gum disease)
• Enough bone in the front of the jaw to carry four implants
• Bone loss further back; tilted implants may reduce the need for grafting in some patients
• People who cannot manage or do not want a removable full denture
• General health that allows surgery and healing

When four may not be enough, or a fixed bridge may not suit

The points below are clinical reasoning; the evidence does not pick a number. The reasoning should always be explained to you on your own scan.

• The amount or quality of bone in the front of the jaw is not enough to carry four implants
• The back end of the bridge would extend a long way behind the last implants
• You clench or grind your teeth
• The opposing jaw also has a fixed implant bridge
• There is too little vertical space for the bridge, or the line where the bridge meets the gum would show when you smile
• Your lip needs support from the gum-coloured part of a removable denture
• You would not be able to clean under the bridge yourself every day

The first four points concern the number and position of the implants: more implants, a different bridge design or a bone graft may be considered. The last three concern the fixed bridge itself, and more implants do not solve them; a removable implant-retained denture may suit better. A separate question is whether the implants hold firmly enough at placement to carry a provisional bridge straight away. If they do not, the provisional bridge is postponed; the number of implants is not increased for that reason.

What is associated with higher risk

The figures below are pooled results of observational studies. They show an association, not proven cause and effect.

• Smoking. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant¹ as in non-smokers. Per patient it was about 4 times as likely. A separate review of 32 studies looked at early failure. In its implant-level analysis of 21 cohorts the odds ratio was about 2.6². An odds ratio compares odds, not risk, so this does not mean 2.6 times as likely. No number of cigarettes a day has been shown to carry no extra risk.
• A history of periodontitis. Periodontitis is gum disease that has damaged the tissues and bone supporting the teeth. Across 14 prospective studies the rate of implant loss over follow-up was about 1.75 times higher³ (a hazard ratio). Peri-implantitis, inflammation around an implant with loss of the supporting bone, was about 3 times more common. For inflammation of the soft tissue alone, no significant difference was found. These were treated patients; implants are not placed while the disease is active.
• Clenching or grinding. A review of 27 studies compared people judged likely to clench or grind their teeth with people who do not. The odds of implant failure were about 2.2 times higher⁴ in the first group (an odds ratio). Whether a night guard prevents this was not tested in these studies.
• Diabetes. The findings are mixed. Two of three reviews found no significant difference in implant failure (2021 review⁵; 2016 review⁶), and one found a higher rate⁷. The 2021 review, in type 2 diabetes, ties its result to strictly maintained oral hygiene. All three found more bone loss around implants in people with diabetes.
• Bone-strengthening medicines (bisphosphonates, denosumab). The risk depends on why, at what dose and for how long the medicine is taken. Whether it is given by drip, by injection or by mouth does not on its own decide it. At the high doses used in cancer treatment, implants are usually not appropriate, and the decision is made with your oncology team. Doses used for osteoporosis are assessed separately. With these medicines the main concern is not implant loss but osteonecrosis of the jaw. In this condition an area of jaw bone dies and does not heal. A 21-study review found that in people taking bisphosphonates, implant loss was about 1.7 times more likely per implant⁸. Osteonecrosis of the jaw was about 3.5 times more likely per patient. The per-patient analysis of implant loss found no significant difference. These figures are for bisphosphonates and cannot be generalised to denosumab; the certainty of the evidence is very low. Tell us about every medicine you take, and do not stop one without asking the doctor who prescribed it.
• Radiotherapy to the head and neck. Implants fail more often in irradiated bone. There is also a risk of wounds that do not heal and of bone death (osteoradionecrosis). Planning is done together with your oncology team.

Where another step comes first

• Active infection, untreated gum disease, uncontrolled medical conditions: these are treated first.
• Very little bone in the upper jaw: bone grafting, a sinus lift or zygomatic implants may be considered; zygomatic implants are explained at the consultation.
• A jaw that is still growing: in young patients implants wait until growth is complete.

Suitability is decided by an examination, a 3D scan and your medical history. An assessment made from photographs or X-rays you send is preliminary, not a treatment plan.

The evidence does not pick a side. A 2026 review pooled 55 studies of All-on-4 and All-on-6. At five years and beyond, about 98 in 100 All-on-4 implants and about 97 to 98 in 100 All-on-6 implants⁹ were still in place. The numbers do not all point one way. All-on-4 had slightly higher pooled survival in the medium and long term. All-on-6 had higher survival in the first year and less bone loss at five years (0.94 mm versus 1.28 mm). An umbrella review of seven systematic reviews found that the number of implants did not significantly affect implant or bridge survival¹⁰. The consensus of the International Team for Implantology (ITI) states that the literature supports different implant numbers¹¹ for full-arch fixed bridges.

The comparisons in these reviews rest mostly on pooled results from different groups of patients. They do not prove that one design is better than, or equivalent to, the other. The reviews cited here do not measure what happens to the bridge when one implant is lost, out of four or out of six. That is the practical argument for six: if an implant is lost, the bridge may be easier to rescue. The practical argument for four is of the same kind: fewer surgical sites, and the chance to proceed at the back without a graft. Both are clinical reasoning, not a measured advantage.

What decides the number:

• The amount and position of bone
• The shape of the jaw, and whether it is the upper or the lower jaw
• What is in the opposing jaw
• Clenching habits
• The length of the bridge

If you are told "four is enough" or "six is safer", ask for the reasoning on your own scan. The six-implant version is explained on the All-on-6 page.

• Doing nothing. Having no teeth affects chewing and diet, and the jaw bone continues to shrink. It is still not an urgent decision; you can take time to think. Pain, swelling or infection in the remaining teeth still needs prompt treatment, whatever you decide about replacing them.
• Saving the remaining teeth. If teeth can be saved, gum treatment, root canal treatment, individual implants or a conventional bridge are smaller interventions. An extraction cannot be undone.
• A removable full denture. It needs no surgery and can be reversed. Grip, speech and chewing may stay limited.
• An implant-retained removable denture. It clips onto implants: often two in the lower jaw, usually at least four in the upper. Compared with a full denture, grip improves clearly. In the lower jaw it often needs fewer implants than a fixed bridge; in the upper jaw the number can be the same. You take the denture out to clean it.
• A fixed bridge (All-on-4 or All-on-6). It is screwed onto implants and only the dentist removes it. It needs surgery, regular maintenance and reviews.

These options are compared for the whole mouth on the full-mouth dental implants page. Before you decide, you can also ask a dentist in the UK for an independent opinion. Ask which option suits you, what they think of the plan you are given, and whether to have the treatment in the UK instead.

This is the usual sequence at our clinic. Times vary from patient to patient, and your plan is given in writing. How these stages fit into visits to Antalya is explained in "Visits to Antalya, and the time between them" below. If you are considering sedation, see sedation and anaesthesia.

Risks

The figures below come from published studies, not from our own patient records.

• Implant loss. In studies about 2 in 100 All-on-4 implants⁹ were lost at five years and beyond. Smoking, a history of periodontitis, clenching and some medicines are associated with this risk. Replacing a lost implant and keeping the existing bridge is not always possible; further surgery, a new bridge or a removable denture may be needed.
• Steps that cannot be undone. Extracting the remaining teeth, and removing part of the jaw bone where that is planned, cannot be reversed. Bone is removed to make room for the bridge and to hide the junction line. If it is in your plan, ask about its extent, the reason and the alternatives before surgery.
• The back extension of the bridge. With four implants, the back end of the bridge usually extends behind the last implants. The reviews cited on this page contain no comparison measuring how the length of this extension affects the outcome. That is why the design decision is discussed with its reasoning.
• Inflammation around implants. Peri-implant mucositis is inflammation of the soft tissue around an implant. Peri-implantitis is that inflammation with loss of the supporting bone. Its treatment may need surgery, and if it progresses the implant can be lost. A 57-study review of implant patients in general found it in about 20 in 100 patients¹². The rate depends on the definition used and the time in function.
• Bone loss. Around All-on-4 implants, an average bone loss of 1.28 mm per implant at five years⁹ has been reported, against 0.94 mm with six implants. "No bone loss" is not true.
• Technical problems with the bridge. Reviews report screw loosening and fracture of the bridge's framework¹⁰, and chipping of the porcelain layer on zirconia bridges (veneered zirconia). In these reviews, bridges of solid (monolithic) zirconia chipped less than veneered ones and had fewer technical problems. Loose screws can be tightened and chipped porcelain repaired. Some bridges have to be remade, which counts as losing the original bridge.
• Surgical risks. Bleeding, swelling, bruising and infection. In the lower jaw, the nerve canal is close: the lip and chin may feel numb for a while and, rarely, permanently. In the upper jaw, the sinus is close: its membrane may tear, and sinusitis or an opening between the mouth and the sinus may follow. The 3D scan shows where the nerve and the sinus are, so the implants can be planned around them; these complications can still happen.
• Immediate loading. Provisional teeth on the same day or within a few days (immediate loading) can work well in selected patients. A review of 39 randomised trials found slightly lower implant survival¹³ with immediate loading; the Cochrane review¹⁴ found no convincing difference within one year. Placing an implant straight into the socket of an extracted tooth is a separate question. There, survival was lower than in healed bone, 95.2 versus 98.4 per cent¹⁵. These rates are not specific to All-on-4. Nobody is promised same-day teeth.
• Speech and adaptation. Speech and chewing habits change in the first weeks. The junction of the bridge and the gum is the hardest place to keep clean.

Benefits

• A fixed bridge can improve grip and chewing comfort, and the palate stays uncovered. Sensation, speech and the feel of the teeth are not the same as natural teeth; the result varies by person and design.
• Where the anatomy allows, tilted back implants can reduce the need for a graft; for patients who need no graft, treatment is shorter.
• Four implants mean fewer surgical sites than six. Whether that changes healing or the outcome has not been measured.
• The dentist can remove the bridge, so there is access for cleaning and repair.

The first days

• Swelling and bruising usually increase over the first two to three days, then settle; use cold packs and the medicines prescribed.
• Eat soft, lukewarm food in the first weeks. While the provisional bridge is in place, that is until healing is complete, do not chew hard or sticky food.
• If you had sedation, do not drive or operate machinery for as long as the sedation team tells you. The UK national standard for conscious sedation in dentistry requires an escort. This applies to every form of sedation other than inhalation sedation in adults¹⁶. A responsible adult takes you back to where you are staying and stays with you as instructed. If an escort cannot be arranged, treatment under sedation is not carried out. Before you leave the clinic after surgery, you and your escort should have written aftercare instructions. You should also know how to reach the clinic, including out of hours.
• Smoking is associated with poorer healing and with implant loss (see "Who it suits" above). At the very least, do not smoke during the healing period.

Daily care

• In the first days, follow your written aftercare instructions on cleaning around the wounds, and ask when to start cleaning under the bridge.
• Once you have been shown how, clean under the bridge every day with bridge floss, interdental brushes or a water flosser. Your dentist shows you which works in your mouth.
• Brush twice a day with a soft brush and fluoride toothpaste, paying particular attention to the line where the bridge meets the gum.
• If you clench, a night guard may be advised to protect the bridge. It has not been shown to prevent implant loss, and we hold no study showing how well it protects the bridge.
• When the bridge is completed, an X-ray and probing measurements are taken as a baseline¹⁷. These records allow later changes to be compared reliably. Without a baseline, assessment relies on other diagnostic criteria. Your review interval is set by your risk.

After surgery, or at any time later, contact us and see a dentist near you in these cases.

• Pain or swelling increases after the third day, or bleeding does not stop
• A high temperature, or swelling of the face that keeps growing
• Numbness of the lip or chin lasts longer than you were told to expect
• The bridge moves, a screw feels loose, or a piece cracks or breaks
• Bleeding, a bad smell, discharge or receding gum around the bridge
• Pain on biting, or a bite that feels high
• Nasal discharge, blockage or sinus pain (upper jaw)

Before you fly home. If any of these starts while you are still in Turkey, tell us before you travel.

Once you are home. Contact us through the route written in your plan. See a dentist near you as well if bleeding does not stop, numbness persists, pain or swelling keeps increasing, or the bridge moves. Do not wait for our reply. In England, the NHS says to call 111 or get help from 111 online¹⁸ if you do not have a dentist. The same applies if you cannot get an emergency appointment. They can tell you where to get help. You may have to pay for the appointment. Elsewhere in the UK, check the local arrangements.

Emergencies. In the UK, call 999 or go to A&E¹⁸ if you have any of the signs below. Do not wait for our reply. In Turkey, call 112.

• It is hard to breathe, speak or swallow
• There is a lot of swelling in your mouth, or it is hard to open your mouth
• Your eye is swollen or painful, or your eyesight changes suddenly
• Your neck is swollen¹⁹

The figures below are results from published studies, not from our own records, and they are not promises. Staying in place does not mean trouble-free. What happens in your case depends on your bone, your habits and your care; no treatment lasts for life.

• Implants. In the 55-study review, about 98 in 100 All-on-4 implants⁹ were still in place at five years and beyond (per implant).
• Bridge. In the umbrella review of seven systematic reviews, bridge survival over 5 to 15 years was about 90 to 97 per cent¹⁰. That is as given in the review abstract; whether it counts bridges or patients could not be checked in the full text. A 2012 review looked at full-arch fixed bridges on four to six implants. In the upper jaw, about 97 in 100 bridges were in use at five years and 95 at ten²⁰. In the lower jaw the figures were 98 and 96.
• Maintenance. Being in use does not mean no repair was needed. Over the years screws may need tightening and porcelain repairing. Some bridges have to be remade, which counts as losing the original bridge. Before you start, ask what these cost and who will carry them out once you are back in the UK.

We have found no good research comparing implant treatment compressed into a few days with treatment staged over months. So the questions are practical ones. How is healing checked? Who do you contact if something goes wrong? Which aftercare does the plan include? Ask for the answers in writing before you book.

First visit: surgery and the provisional bridge

The examination, 3D scan, extractions, implants and provisional bridge take place on the first visit. If your examination and 3D scan are on the same visit, you can still decide not to go ahead. You can say no, or ask to stop, at any stage; once a tooth has been extracted, that step cannot be undone. You can take the plan home for a second opinion. How many days the visit needs depends on your plan, and is stated in writing before you book travel. Ask whether the wound and the provisional bridge are checked before you fly home. The examination in Antalya may show that All-on-4 does not suit you, and a different plan or no treatment may be advised. Ask before you travel what you would pay in that case.

A 2023 narrative review suggests waiting at least 72 hours²¹ after implant placement before flying. After a sinus lift it suggests at least two and ideally six weeks. These intervals assume no pain, swelling or bleeding at the treated site²¹. The authors note that the research is limited and drawn mainly from military aviation. Treat these intervals as a starting point for a conversation with the dentist who treated you, not as clearance to fly. Your dates are planned around them.

At home: healing before the final bridge

The implants need time to fuse with the bone before the final bridge is made. How long depends on the bone, whether a graft was done and how you heal; you are told after the examination. You spend this time at home with a fixed provisional bridge. If the implants were not firm enough for a fixed one, you wear a removable temporary denture. Which one you will have is decided during surgery, so ask before you book what happens in each case. Soft food and daily cleaning under the bridge protect the healing. The final bridge waits until healing is confirmed; do not shorten this period to fit travel plans.

The NHS suggests you discuss your plans with a GP²² before making final decisions about travel or treatment. Tell your own dentist as well, and ask whether they will see you between the visits and afterwards. If you do not have a regular dentist, find one, NHS or private, before you travel. A check with a dentist in the UK between the visits can be written into your plan. Some dentists may not want to take on treatment that is in progress. So the plan also says where to turn if a problem arises in between.

Second visit: the final bridge

After healing, new impressions are taken and the shape and shade are agreed at try-ins. The final bridge is then screwed in and the bite adjusted. Some plans need a further visit, for example when a try-in shows that a change is needed. You leave with your records and a written review interval.

Once you are back in the UK, the first person to see a problem may be a dentist near you rather than us. Plan for that before you travel.

• A loose screw or chipped porcelain. These are the usual technical problems (see "Risks and benefits" above). Contact us through the route in your plan, and see a dentist near you with your records. Whether the repair is done in the UK or on another visit to Antalya depends on the problem.
• An implant that fails. Replacing a lost implant and keeping the existing bridge is not always possible. Further surgery, a new bridge or a removable denture may be needed, and that may mean another visit to Antalya.
• Who pays. The GDC suggests asking whether work is guaranteed and for how long; it does not set a minimum period itself. Our written remake terms state who pays for further treatment and travel (see "Is the work guaranteed?" below).
• Check-ups. Once the bridge is in use, the European Federation of Periodontology calls for a structured programme with periodic checks of the tissue around the implants²³. Much of that care will be with a dentist near your home. Take your baseline X-ray and measurements home with you. Check-ups can be done in Antalya or, where your plan says so, with a dentist in the UK. Ask who will do yours and who pays for them.

What the NHS does and does not do

NHS guidance for dentists in England and Wales says a patient treated abroad is dealt with like any patient previously treated by another provider. If an NHS practice accepts you, it provides the clinically necessary treatment its NHS contract covers, with your consent. But some entitlements do not apply where another provider did the original work. These are further treatment within two months, free repair or replacement, and a replacement appliance under Regulation 11²⁴. That guidance does not say an implant bridge will be repaired or remade on the NHS. It covers England and Wales. Scotland and Northern Ireland have their own NHS rules, which this page does not cover; ask the practice you plan to use. The NHS also states that it is not liable for negligence or failure of treatment²² you receive abroad.

Travel insurance

The NHS warns that most travel insurance policies will not cover you for planned treatment abroad²², so you may need specialist cover. Ask your insurer, in writing, before you book.

The UK General Dental Council lists thirteen questions²⁵ to ask before dental treatment abroad, and the NHS has its own checklist. Below are the ones that matter most for All-on-4, each with our answer. Where our answer is a commitment rather than something you can check today, it says so. Ask us the full list, and ask for the answers in writing.

Who will treat me, and how can I check their registration?

We name the dentist who will treat you, in writing, before you commit. In Turkey a dentist in private practice must register with the local dental chamber²⁶ within a month of starting, and cannot practise privately without it. The Turkish Dental Association's website offers a search of registered dentists by name and province²⁷. Ask us for the treating dentist's registration details. Registration in Turkey is separate from the UK register: the GDC states that only people registered with it can legally practise dentistry in the UK²⁸.

How often do you do this, and what are your complication rates?

The GDC suggests asking how many times the procedure has been carried out, and the success, complication and infection rates²⁵. The figures on this page come from published reviews, not from our own patient records. Ask us for our own All-on-4 figures, how complications were defined and over what period.

Is the clinic licensed and regulated?

In Turkey a dental clinic cannot open without a licence or treat patients without an operating permit. It is inspected at least once a year²⁹. To treat international patients, a facility also needs an authorisation certificate from the Ministry of Health³⁰. The Ministry publishes a register of authorised facilities³¹ that you can check yourself. We give you our authorisation details before you commit. A licence or authorisation is a legal minimum, not a statement about the result of your treatment. The GDC itself cannot guarantee that a regulator like it exists in another country²⁵.

Will I get the plan in writing?

Yes. The GDC says you should be assessed by a qualified dentist before being given a treatment plan and cost estimate²⁵. Your written plan states the number of implants and why, the alternatives, what it covers and does not cover, and how many visits are needed. A plan made from photographs or X-rays you send is preliminary. It is confirmed after the examination and 3D scan, and we tell you before anything in it changes.

Is the work guaranteed?

The GDC suggests asking whether the work is guaranteed and for how long²⁵. It also suggests asking whether further treatment is included if there are complications, and who pays for extra flights, hotel and remedial work²⁵. Before you commit, we give you our complication route and remake terms in writing. They state what is covered, for how long and what is excluded. They also state what you must do to keep the cover, such as attending reviews, and who pays for further treatment and travel. Read that document before you decide, rather than relying on the word "guarantee" on any web page.

Is there insurance if something goes wrong?

The GDC list also asks about insurance²⁵. In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre³⁰. That does not by itself tell you whether your implant surgery is covered, so ask which procedures in your plan fall under it. Ask us too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, and what it covers. Travel insurance is covered under "If an implant fails or the bridge breaks after you are home" above.

Who do I contact after treatment?

Your written plan names the contact route for questions and problems once you are home, and your review interval. For urgent symptoms, get emergency care where you are first (see "When to contact a dentist" above).

What records will I take home?

The NHS lists exchanging medical records and arranging aftercare back home²² among the things to consider. In Turkey you are entitled to an itemised bill, and on request to free copies of the records of materials, tests and imaging³⁰. You may also examine your file and take a copy³². At the end of treatment we give you your records in a form a UK dentist can use. They include the plan, X-rays and scan, the implant system and parts used, and the baseline measurements. Before you go, ask us which implant system we use, and ask your UK dentist whether they can work with it.

What if I am unhappy, and where can I complain?

We give you our written complaints procedure before treatment. A complaint goes to the clinic first; private dental polyclinics, centres and hospitals in Turkey must have a patient rights unit²⁹. If the clinic does not resolve it, you can apply in writing to the provincial health directorate's Patient Rights Board³². The Board decides within thirty days, but it does not assess allegations of medical error. The dental chamber can also open disciplinary proceedings²⁶ against a dentist. Do not expect the UK regulator to settle it. The GDC states that it cannot resolve complaints or help with refunds²⁸; its investigations are about whether dental professionals are fit to practise.

Will the team speak English?

The GDC suggests asking whether the team speaks your language and, if not, whether a translator is provided²⁵. We confirm in writing, before you commit, who will explain the plan, the consent form and the aftercare instructions to you in English.

Warning signs, including for us

The NHS checklist names five signs to think twice about before booking. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare³³. Apply them to us too. If you feel pushed to decide quickly, wait.

No prices are shown on this page. The main factors are the number of extractions and any bone reduction, and the number and type of implants. Then come the provisional bridge and the material of the final bridge (monolithic zirconia, veneered zirconia, acrylic on titanium). Sedation, the number of visits, the review programme and the remake terms also count. Ask, in writing, what the plan includes, and who pays for further treatment and extra travel if there is a complication. Add your own travel for every visit, and reviews with a dentist in the UK, to see the whole cost.