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All-on-Four Dental Implant Procedure -Ramsey Amin DDS Explains Pros and Cons

All-on-four is a dental implant technique specific to people missing all of their teeth and who want to avoid dentures.  Many patients that see me in Burbank ask me about “All on Four.”  Sometimes they call it “All Over Four.”  The all-on-four implant procedure has few advantages, but several disadvantages.

All-on-(or over) four is intended to replace all of your teeth on one arch with only four implants.  [It was popularized by an implant company, Nobel Biocare, that I once taught local Burbank courses for.]

That means that twelve to fourteen teeth are supported by only four implants.  The dental implants in the back of the mouth are purposely placed at a tilted angle to get implants farther towards the back.

Personally, I have surgically placed and made teeth for thousands of dental implants including the all-on-four type.

The biggest advantage, hands down is cost.  The price to do all-on-four is much less than traditional implants that are placed straight up and down in your jaw (not tilted).  Typically the MINIMUM number for FIXED dental implants in the lower jaw is five and the upper jaw is six.  These would be minimum numbers and would apply if your jaw is small, v-shaped, and you only want a few back teeth.  Additionally, some types of bone grafts can be avoided if you have all-on-four dental implants.

Bone grafting can be avoided by purposely tilting the implants away from the sinus (avoid sinus bone grafts) and away from the lower back area where there is a nerve.

Here are two cases I did about 7 years ago:

The biggest disadvantage to the all-on-four dental implant bridge is that it is UNDER-ENGINEERED.  Our natural teeth were created with multiple roots per tooth.  This gives a lot of support for our strong bites. This procedure only gives you four roots!

If you were building your house right now, would you only use four beams to hold up the entire house?

I doubt it!  You would want the foundation to be strong!  What if one of the beams was attacked by termites (gum disease) and you had to remove it?  If you only had four implants you would lose the whole bridge and have to redo it from scratch. If one of the angulated implants is the one that fails, it is going to destroy a lot of bone when I have to remove it. It will hold in the short term, but in a few years, it may have problems, and there are few qualified dental implant specialists in Burbank who can remedy the situation.

The other problem with most all-on-four fixed dental implant bridges is the fact that most dentists give you a bridge with plastic denture teeth as a final bridge!  It is really just a fixed denture made of plastic with teeth that commonly break off, stain, and need to be replaced every few years.  This will cost more in the long term. The rear implants can be in a bad position making your palate feel like it has a big lump on both sides.

My suggestion is that fixed dental implant bridges are made of porcelain.  Please read this post to learn why this is important.  When I do all-on-four, I make porcelain bridges instead, which are much less problematic than hybrid denture types.

All-on-four in my opinion should be used 1-3% of the time and is probably more of a marketing fad than solid, predictable treatment plans that involve a few more implants.  I am not opposed to tilted implants.  I am only opposed to using an absolute minimum number of implants. It is like jumping out of an airplane without a backup parachute.

If you are in need of full mouth dental implants, consider this a last resort.  Although, cost is important, keep in mind you are pricing out body parts.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology/Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, CA

9 thoughts on “All-on-Four Dental Implant Procedure -Ramsey Amin DDS Explains Pros and Cons

  1. Please can you help me. My teeth is keeping me from living the life I need to. My teeth are in such a state that I cannot function any longer. I am not able to afford all on four procedure. Please help me,

    1. If finances are a barrier you should consider some well Made dentures. This will give you the dignity you deserve and you can do implants later.

  2. Dr

    I have only 7 teeth left on the upper jaw. i have had bad teeth my entire life. i have been referred by many dentist to get a fixed bridge or the all on 4 or 6. I can not afford the procedure. I have 2 children and a wife. is there any way to volunteer for this procedure? as in being a teaching patient for other dentists?

    1. Hello Anthony,
      I feel for your situation. You may have good luck at a local dental school. There may be studies that you could take part in.

      You also want to consider long-term maintenance procedures. You will need to be able to afford general maintenance, x-rays on a routine basis to maintain your dental implants. Cleanings on a regular basis are going to be important.

      If the all on 4 procedure that you will be receiving will have acrylic fused to metal teeth, you need to expect this type of bridge to break frequently. This will necessitate repair costs.

      I much prefer the Prettau solid zirconia full arch dental implant bridge because it has a much lower chance of having long-term problems.
      Prettau Dental Implant Full Mouth Bridge

      Be sure to consider the long-term.

      Very respectfully,

      Ramsey A. Amin, D.D.S.

  3. i have gum problem, my doctor told me to do all on 4. with acrylic permanent bridge? i still have 8 teeth. on upper jaw. can i send you CT,and hopefully have different option. thank you

    1. Hi Riri,

      I would really need to see you to help you make those kind of decisions. X-rays alone are only a part of the diagnosis and treatment plan. You can’t use X-rays alone to plan your teeth.

      If you are local, I would be more than happy to see you. 😉

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  4. Very nice article. I am a dentist also
    I agree 100% with you. All on 4 is designed for 2% of the patients with no teeth and marketed to 100% of them.
    I wonder if whoever is so aggressive marketing all on 4 to their patients, really discusses pro and cons with them. Or are they just selling something. Are they extensively trained in dental implants, or did they just take a short course on all on 4, and since then everything and everybody, is treated with this type of prostheses.
    Definitely they did not get the extensive training you have Dr Ramsey.
    I think we will see a lot of those 98% of patients (which were not good candidate for all on 4) coming back with complications.
    I am not surprised that at the “All-on-four-only Centers” they DO NOT want to see you for follow up and maintenance.

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.