All on 4 Implants

The basic mechanism of the system is as follows:

Implant placement

The system works on the principle of placing four implants at specific angles and positions:

• Two implants are placed vertically (axially) in the front of the jaw.
• The other two implants are placed at an angle of up to 45 degrees in the rear area.

Why are implants placed at an angle? (Biomechanical advantages)

The angled positioning of implants at the back is the most important part of how the system works:

• Angled placement increases the implant's contact surface with the bone, providing optimized support even with minimal bone volume.
• This inclination allows utilization of existing bone without damaging vital structures such as the sinus cavities in the upper jaw or the mandibular nerve in the lower jaw.
• The implants attach crosswise to the bone in the front region, where the jawbone is generally denser and of higher quality.
• This spreading of the implants allows the prosthesis placed on top to distribute the chewing load evenly along the bone.

Eliminates the need for bone grafting

Traditional methods require surgical procedures such as bone grafting or sinus lifting when there is bone deficiency in the posterior regions; the All-on-4 technique uses the existing bone by placing the implants at an angle, eliminating the need for these difficult and costly procedures.

The role of system components

Three main components come together for the system to function:

• Titanium screws (implants): These are placed in the jawbone and act as artificial tooth roots.
• Multi-unit abutments: These are intermediate pieces attached to the implants that correct the angle and enable the prosthesis to be screwed onto the implants.
• Fixed prosthesis: This is the artificial dental arch screwed onto the implants that enables the patient to chew and speak.

Teeth in a day

The All-on-4 protocol works by screwing a temporary fixed bridge onto the implants immediately after they are placed (provided the implants have reached sufficient tightness). After a healing (osseointegration) period of approximately 4 to 6 months, this temporary structure is replaced with a permanent and more durable final prosthesis.

The main differences between the All-on-4 and All-on-6 treatment concepts are as follows:

• Number of implants: The most fundamental difference is the number of supporting implants. In the All-on-4 method, a full dental arch is placed on just four implants, while the All-on-6 method uses six implants.
• Support and stability: Both methods are used to support a full set of teeth (arch). However, All-on-6 provides more support points for the dental bridge because it uses more implants.
• Bone structure and selection: Which method is used depends on the volume and density of the patient's jawbone. Dentists use CBCT (computed tomography) scans and X-ray images to determine whether the bone mass provides sufficient ‘diameter’ (support) for the implants.
• Application technique: In the All-on-4 technique, implants in the rear region are placed at a specific angle (up to 45 degrees) to maximize the use of existing bone and increase surface area. The procedure is generally the same for All-on-6; titanium posts are placed in the jawbone to act as roots for new teeth.
• Cost and efficiency: Both All-on-4 and All-on-6 are less invasive and more cost-effective options compared to traditional treatments requiring 8 to 10 implants. All-on-4 generally offers a cost advantage as it requires fewer implants.

The All-on-4 treatment concept is a good option for many patients in modern dentistry, but the patient must meet specific requirements for the procedure to work. The best people for this treatment and the conditions that need to be met are as follows:

Overall oral health

Total tooth loss (Edentulous):

This treatment is best for people who have lost all of their teeth in either the upper or lower jaw.

Soon to be toothless

This is the best way to help those whose teeth are already loose, can't be saved, or need to be pulled soon.

Several missing teeth:

This method may be chosen by patients with several missing teeth who want a fixed solution instead of detachable dentures.

The size and shape of the bones

The All-on-4 method is meant to make the most of the bone that is already there. But there are some minimal measurements that must be met for implants to be safely placed:

Upper jaw (maxilla):

From the canine region to the canine region, the bone must be at least 5 mm wide and 10 mm high.

Lower jaw (mandible):

There should be at least 5 mm of bone breadth and 8 mm of bone height between the mental foramen, which are the nerve exit locations.

Low bone density exception:

If a patient has very low bone density in the upper jaw, zygomatic implants supported by the cheekbone may be a better option than regular All-on-4.

Clinical and functional needs

Primary stability:

When the implant is put in, it must be tightened to a minimum torque (tightening force) value of 35 Ncm. If this level of stability can't be reached, it's best to wait for the normal healing process instead of putting in temporary teeth on the same day.

Habits that aren't good for you

Not having habits that put too much stress on the implants, like extreme teeth clenching or grinding (bruxism), makes success more likely.

Mouth opening:

Because the implants are placed at an angle in the back of the mouth, the patient needs to be able to open their mouth wide enough for the surgical tools to fit.

Expectations for quality of life and appearance

Complaints about removable dentures:

The best candidates are those who say their existing dentures move, hurt, or make it hard to chew, and who want a more comfortable and fixed option.

Expectation of speedy results:

This treatment is great for people who don't want to remain without teeth while they heal and want to have their new teeth the same day.

Evaluation and digital planning

Before therapy starts, a lot of planning is done:

• Clinical examination: The dentist checks your teeth, gums, and overall oral health. • Imaging: X-rays and CBCT (cone beam computed tomography) scans are used to look at the jawbone's volume, density, and anatomical structures (sinuses, nerves) in three dimensions.
• Computer-assisted planning: The dentist uses digitized information from CT scans to figure out the best angles and placements for the implants in a computer setting.

The surgery

Most of the time, the surgical stage is done with local anesthesia, although sometimes it is done with general anesthesia or sedation.

• Preparation: Any teeth that are loose or can be pulled out are pulled out. If necessary, the jawbone is sculpted to make sure the prosthetic fits well and to hide the area where the prosthesis meets the jawbone.
• Implant placement: Two implants are put in the front of the jaw vertically, and two implants are put in the back at an angle of up to 45 degrees. This angle gives more support to the bone while staying away from important tissues like the jaw nerve or sinus.
• Check for stability: The implants must be tight enough (at least 35 Ncm torque) to hold the teeth in place the same day. If this stability can't be reached, the normal healing time is followed.

Putting on the temporary prosthesis (same day)

The prosthetic phase starts right after the implants are put in:

• Abutment connection: Multi-unit abutments, which are intermediate parts that will hold up the prosthesis, are joined to the implants and screwed on.
• Temporary bridge: The abutments are bolted into place on a temporary fixed bridge made of acrylic. This means that the patient can leave the clinic with teeth that look good and work well within a few hours after the surgery.

The healing process (osseointegration)

The implants need four to six months to biologically integrate with the bone. There are two primary parts to the All-on-4 therapy procedure: the acute phase, which lasts for the first few days after surgery, and the long-term healing process (osseointegration), which is when the implants fuse with the bone.

The day of the procedure and the first few days after it

With the All-on-4 idea, patients can get fitted with temporary teeth on the same day as the surgery. Here is how recovery goes just after the surgery: • Same day: A temporary acrylic bridge is fastened onto the implants soon after they are put in. • The first few days: It's typical for the gums to be red, swollen, and a little painful; this normally goes away within two days. • Taking care of your mouth: For the first few days, it is better to use special mouthwashes and saltwater rinses instead of brushing. • Speech adaptation: At first, patients may have a minor lisp, but their tongues rapidly get used to the new teeth, and their speech goes back to normal in a few days.

Recovery in a short amount of time (1–2 weeks)

During this time, surgical incisions shut and gums heal:

• Dietary Restrictions: Patients must eat a soft diet and stay away from hard foods so that the implants can integrate well into the bone.
• Cleanliness: The dentist should tell you to start brushing and cleaning your teeth gently as the gums heal.

The time it takes for the bone to mend (3 to 6 months)

This is the time it takes for implants to fully integrate into the jawbone (osseointegration):

• Use of temporary prostheses: Patients keep using their prosthetic teeth for about 3 to 6 months, or until the bone has healed completely.
• Check-ups: The dentist keeps an eye on how well the bones are healing and how well the wounds are healing during this time.

The last restoration (starting in the fourth month)

After enough time for healing, the last step of the treatment is putting in permanent teeth:

• Final bridge: The temporary acrylic bridge is taken down and replaced with a stronger porcelain or zirconium final bridge about four to six months following the surgery.

• Brushing and flossing every day: Even though prosthetic teeth don't decay, you should nevertheless brush and floss them every day to get rid of food particles and keep the surfaces clean.
• Avoiding gum disease: Taking care of your teeth isn't just for looks; the danger of getting gum disease stays high even after implant surgery. Cleaning your teeth regularly can help keep these problems from happening, which can lead to losing an implant.
• Stopping bad breath: Food that gets stuck under and around the prosthesis can make your breath smell foul. Good cleanliness takes care of this problem.
• Regular appointments: Your dentist will normally tell you to come in for check-ups once or twice a year to check on the health of your implants and the tissues in your mouth.

• There is a minimum age requirement for All-on-4 treatment. This is the time when the jawbone has finished growing, which is commonly between the ages of 18 and 20. But there is no upper age limit as long as the patient doesn't have a major systemic ailment that would keep them from getting general or local anesthesia.
• The patient's general health and the condition of their jawbone are more important than their age when it comes to treatment. For the treatment to work, the jawbone must be wide enough (at least 5 mm) and tall enough (10 mm in the upper jaw and 8 mm in the lower jaw) to hold the implants.
• The All-on-4 technique gets rid of long, difficult surgeries like bone grafting (adding bone powder), making it a more pleasant and faster option for older patients who may not be able to handle these kinds of surgeries.

The All-on-4 treatment approach has several important benefits from both a surgical and prosthetic point of view. However, it also has some drawbacks and hazards that patients and dentists should be aware of.

Advantages of the All-on-4 system

• Teeth that are fixed the same day (immediate function): The best thing about this procedure is that patients can get a fixed, temporary prosthesis on the same day the implants are put in. This lets the patient leave the clinic with teeth that look good and work well right after surgery.
• No need for bone grafting: The implants can be placed at an angle of up to 45 degrees in the back, which makes the best use of the bone that is already there. This reduces or gets rid of the need for bone grafting, which is sometimes painful, expensive, and takes a long time to heal.
• Full restoration with fewer implants: The All-on-4 system only needs four implants to support the whole dental arch, while other procedures may need 8 to 10 implants per jaw. This lowers both the trauma of surgery and the total expense.
• High success rates: Clinical tests have shown that this idea works very well, with a success rate of 98.3% in the lower jaw and about 98% in the upper jaw. • Keeping the shape of the face and bones: When you chew, implants stimulate the bone, which stops bone loss that happens when you lose teeth. This keeps the lips from falling in and the lower area of the face from getting shorter, which makes the patient look younger.
• Comfort and naturalness: They don't cover the palate like removable dentures do, so speech, taste, and chewing may all happen as naturally as possible.

The All-on-4 system has some disadvantages and limits.

• The area where the surgery was done may be red, swollen, and a little painful for the first few days after the surgery. Patients could also have a slight lisp for a few days at first. Why the prosthetic teeth don't rot, but the danger of gum disease (peri-implantitis) around the implant stays the same. So, patients need to take very good care of their teeth by using special dental floss and interdental brushes and going to the dentist for frequent check-ups.
• If the patient's smile line is particularly high and the place where the denture meets the gums is visible, the surgeon may need to shave a little bit of the jawbone to hide this "transition zone."
• The All-on-4 treatment is less expensive than 8-10 implant systems, but it needs a lot of skill and particular parts, so the beginning cost is a big investment.
• Patients must eat soft foods during the first 4 to 6 months of healing, when the implants are fusing with the bone, to avoid putting too much stress on the implants.

There are three basic types of prosthesis that are used:Acrylic prostheses: These are usually only used as temporary prostheses. They are cheap, but they are also more delicate and may change color over time.

Hybrid prostheses are permanent prostheses that are strong and look good. They have acrylic teeth on a metal foundation.

Zirconium dentures are the most attractive and biocompatible type of denture since they don't have any metal in them. They are the most expensive choice and are very resistant to gum recession.

Why should I choose Turkey for All-on-4 treatment?

Turkey is different from Western countries since it is 60–70% cheaper, has expert doctors trained to European standards, clinics with the latest equipment, and full dental tourism packages. You can also combine your treatment with a vacation in destinations like Antalya and Istanbul. For further information regarding your treatment and vacation alternatives, you can get in touch with Isın Dental Clinic.

What is the price of All-on-4 in Turkey?

Prices for All-on-4 therapy in Turkey vary based on the brand of implant used, the type of prosthesis, and any other operations that need to be done. For one jaw, they start at about €3,500 to €6,500. It can cost between €6,500 and €11,000 for procedures on both jaws (upper and lower). Most of the time, these rates cover implants, temporary teeth, lodging, and transportation.

What makes All-on-4 less expensive in Turkey?

The low prices in Turkey don't come from cheap materials or workers. This is because the costs of running clinics, labs, and hiring staff are lower than they are in Western countries. Also, several clinics provide package deals that cover the cost of travel, lodging, and the whole therapy.

Single arch All-on-4 price comparison by country

Why dental tourism is good in Antalya

Holiday and therapy together:

• Antalya is a great place to rest and explore after treatment because it has beautiful beaches, a lot of history, and high-end hotels. Antalya has a lot of interesting historical and cultural sites to see.
• Kaleiçi (Old Town) sits in the center of the city and is like a time machine. Its small alleyways are lined with structures from the Roman, Seljuk, and Ottoman eras, as well as boutique hotels. You can see the area's rich history at ancient cities like Perge, Aspendos, and Termessos, which are not far from the city center. Aspendos Theatre, in particular, is one of the best-preserved Roman theaters in the world and still hosts festivals.
• Antalya's cultural experience goes beyond only learning about the past. It also includes traditional art courses and local foods.

Advanced clinical infrastructure:

Many clinics in Antalya use cutting-edge technology (such as 3D tomography and digital planning) and are accredited by international organizations.

Full package services:

To make things easier for patients, clinics often provide packages that include things like airport shuttles, a place to stay, and a personal patient coordinator.

The all-on-4 treatment approach at Isın Dental Clinic for tourists is as follows:

Before the treatment:

• Make sure your passport is still valid.
• Plan your travel around your treatment schedule.
• A VIP car will pick you up at the airport and take you to the hotel.
• A thorough checkup at the clinic, a 3D tomography scan, and the final treatment plan's approval.
• Making the treatment program and length of stay clear.

Treatment phase (First visit - 7-10 days)

• Days 1-2: Comprehensive examination and planning.
• Day 3: Implant surgery (2-3 hours per jaw).
• Day 4: Check-up and fitting of temporary fixed teeth. You can now smile with your teeth!
• Days 5-7: Healing process, check-ups, necessary adjustments, and bite tests.

Recovery process at home (3-6 months)

• The implants are expected to fuse with the jawbone (osseointegration).
• Remote communication with the clinic is maintained, and recovery is monitored.

Second visit for permanent prosthesis (3-5 days)

• Second trip to Antalya after recovery is complete.
• Taking measurements and fitting for the permanent prosthesis (zirconium or hybrid).
• Delivery of the new teeth and final checks.
• You now have your permanent, aesthetic, and functional teeth that you will use for life.

What is All-on-4?

All-on-4 is a treatment protocol in which four dental implants are strategically placed to replace all teeth in the upper or lower jaw. These implants serve as support for a fixed temporary denture that is screwed in place on the same day.

Is the All-on-4 procedure painful?

The procedure is performed under local anesthesia, so no pain is felt. Mild swelling and discomfort after the procedure are normal and can be easily managed with painkillers recommended by your dentist.

How long does All-on-4 treatment take?

The treatment process consists of two main stages:

Surgical stage: The placement of the implants and fitting of the temporary denture usually takes 2-3 hours.

Total treatment time: Including the healing process (3-6 months), the time until the permanent denture is delivered can take approximately 6-9 months.

Will I experience speech impairment after All-on-4?

Unlike removable dentures, speech impairment does not occur with All-on-4 because the palate is not covered. In fact, patients speak much more comfortably after getting used to their dentures. There may be a slight adjustment period during the first few days after the temporary dentures are fitted, but this resolves quickly.

Can All-on-4 be performed on patients with gum disease (periodontitis)?

Yes, but first, the existing infection and gum disease must be treated. All-on-4 is a treatment method often recommended for patients who have lost their teeth due to periodontal disease. After all teeth are extracted, the implants are placed in healthy bone.

Can diabetic patients undergo All-on-4 treatment?

Treatment is not recommended for diabetic patients with uncontrolled diabetes (high HbA1c value) due to the high risk of healing problems and infection. However, All-on-4 treatment can be performed on diabetic patients with regular and controlled blood sugar levels, provided that the necessary precautions are taken.

Are All-on-4 dentures removed at night?

No, All-on-4 dentures are fixed dentures. They can only be removed by a dentist using special tools. Therefore, they do not need to be removed at night by the patient; they remain in the mouth just like natural teeth.

Can removable denture users switch to All-on-4?

Yes. All-on-4 is an excellent alternative for removable denture users. Since the palate is not covered, the sense of taste improves, the gag reflex disappears, and the patient feels much safer and more comfortable thanks to the fixed teeth.