All-on-4 dental implants: fixed full-arch teeth, planned properly

All-on-4 dental implants replace every tooth in one jaw with a fixed bridge held on four implants. It is often described as "teeth in a day", and that phrase is partly true: most patients leave on the day of surgery with a fixed provisional set. But the full treatment runs over several months, and the quality of the result is decided long before any implant is placed. This guide explains how All-on-4 works, who it suits, how it compares with the alternatives, what the process involves and what full arch implants cost at Dental & Wellness London.

What All-on-4 dental implants are

All-on-4 is a way of supporting a complete arch of teeth, upper or lower, on four implants rather than one implant per tooth. Two implants are placed upright towards the front of the jaw. The two at the back are placed at an angle, so that they engage the denser bone at the front of the jaw and avoid structures such as the sinuses in the upper jaw and the nerve in the lower jaw.

That angulation is the point of the technique. It allows a long, stable bridge to be supported with fewer implants, and in many patients it reduces or removes the need for bone grafting for dental implants at the back of the mouth, where bone is often thinnest after years of tooth loss.

The finished restoration is a single fixed bridge, screwed to the four implants. It is not removed at home. It is cleaned in place, and removed by the dental team at maintenance visits when needed.

How it differs from single implants

Where only one or two teeth are missing, a single implant with a crown is usually the right answer, and our dental implants page covers that in detail. All-on-4 belongs at the other end of the scale: when most or all of the teeth in a jaw are missing, failing or already replaced by a denture.

Who All-on-4 suits, and who it does not

We see two groups of patients ask about full arch implants. The first have worn dentures for years and are tired of the movement, the adhesive and the foods they have quietly stopped eating. The second have a failing set of natural teeth: teeth loosening from gum disease, repeated fractures, or a history of patching one tooth at a time that no longer works.

Often a good fit

• A full arch of missing or failing teeth, upper or lower.
• A loose or uncomfortable complete denture, particularly in the lower jaw.
• Advanced gum disease that has left several teeth unsavable, once the disease is under control.
• Good general health and a willingness to keep up daily cleaning and regular maintenance.

Needs care, preparation or a different answer

• Several healthy teeth remaining. Removing sound teeth to fit a full arch is rarely justified. Smaller implant bridges or a partial denture may serve better.
• Active gum disease. This is treated first; see gum disease and bleeding gums.
• Very limited bone, even at the front of the jaw. Some cases need grafting first or a different surgical approach, and a few are referred on.
• Smoking and poorly controlled diabetes, both of which raise the risk of implant failure and gum problems around implants.
• Certain medicines and treatments, including some bone medicines and previous radiotherapy to the jaws, which need discussion with your doctor first.

We say no to All-on-4, or stage it differently, more often than the phrase "teeth in a day" might suggest. An honest no at assessment is better than a complication later.

Full arch options compared

All-on-4 is one of several ways to replace a full arch. Our tooth replacement guide sets out the wider range; for a complete arch, the main choices are these.

• Complete denture. The simplest and least expensive option, with no surgery. It rests on the gum, so it can move, particularly on the lower jaw, and it does nothing to slow bone loss. See removable dentures.
• Implant-retained overdenture. Two to four implants with a denture that clips on and off. Much more secure than a conventional denture, easier to clean, and usually less costly than a fixed bridge.
• All-on-4 fixed bridge. Four implants and a fixed bridge that stays in. It feels closer to natural teeth than any removable option and covers less of the palate.
• Fixed bridge on five or six implants. Where bone allows, extra implants spread the load further. This can suit patients with a strong bite or heavy grinding.

The right choice depends on your bone, your bite, how you clean, your priorities and your budget. We explain each option against your scan rather than leading with one technique.

The All-on-4 process, step by step

1. Consultation and 3D imaging. Dr Rishil Patel examines your mouth, gums, bite and general health and reviews a 3D (CBCT) scan of the jaws. Nothing is promised before the scan is read. You leave with a written plan and an itemised cost.
2. Planning. The implant positions are planned against the scan, and the provisional bridge is designed in advance so that it can be fitted on the day of surgery.
3. Surgery day. Any remaining teeth in the arch are removed, four implants are placed under local anaesthetic, and a fixed provisional bridge is attached, usually the same day.
4. Healing, three to six months. The implants fuse with the bone. You eat a softer diet at first and attend review appointments to check healing, comfort and your bite.
5. The final bridge. Once the implants are integrated, the definitive bridge is made, stronger and refined in shape and shade, and fitted. This is the set you keep.
6. Maintenance. Regular hygiene and review visits, with the bridge removed and cleaned by the team when needed.

Results, longevity and aftercare

A well-planned full arch on implants can restore comfortable chewing, clear speech and a natural-looking smile. The implants themselves can last for many years, often decades, when they are looked after. The bridge on top is a working part: it may need repair, a new set of teeth or replacement over time, depending on the material, your bite and whether you grind. Results vary between patients, and we will not promise a lifespan.

Long-term success depends mostly on what happens after the final bridge is fitted.

• Daily cleaning under and around the bridge, using interdental brushes, a water flosser or floss threaders, as shown at your fit appointment.
• Regular hygiene visits. Our dental hygienist appointments are 30 minutes, and implant patients are usually seen more often than average.
• A night guard if you clench or grind, to protect the bridge.
• Not smoking, which is the single most important thing you can do for the implants.

For the first days after surgery, our guide to dental implant aftercare covers swelling, diet and cleaning in practical detail.

Risks, and how we reduce them

All-on-4 is a surgical procedure, and every patient should understand the risks before consenting.

• Implant failure. An implant may fail to integrate or may be lost later. Careful planning, sterile technique and managing smoking and gum health reduce the risk; a failed implant can often be replaced.
• Peri-implantitis. Inflammation and bone loss around implants, closely linked to cleaning and smoking. Regular maintenance is the main protection.
• Nerve and sinus complications. Rare when the implants are planned against a 3D scan, which is why we do not proceed without one.
• Fracture of the provisional or final bridge. More likely with heavy grinding, and reduced with a night guard and sensible food choices in the healing phase.
• Swelling, bruising and discomfort in the first week, which are expected and usually managed with ordinary pain relief.

All-on-4 cost in London

We do not publish a single headline price for All-on-4, because the cost of full arch implants depends on the number of extractions, the bone available, whether grafting is needed, and the material of the final bridge. Instead, the cost is quoted in writing after assessment, itemised so that you can see what is included: surgery, implants, the provisional bridge, the final bridge and follow-up.

• Implant consultation: £120.
• Single implant for comparison: from £2,200, including the crown.
• Bone grafting, if needed: quoted in writing after assessment.
• Finance: 0% APR finance over 12 months via Tabeo, subject to status.

When comparing All-on-4 cost between clinics in London, ask whether the quotation includes the final bridge as well as the provisional, which material the final bridge is made from, and what maintenance is included. Our article on full mouth dental implants explains what drives the cost in more detail.

Why choose Dental & Wellness London for All-on-4

All-on-4 cases are assessed, planned and placed by Dr Rishil Patel, BDS (Hons) King's College London (2008), MClinDent in Implantology, MJDF, GDC 154292. His postgraduate training is in implant dentistry, and he follows each case from the first scan to the final bridge.

The practice was founded in 2009 by Dr Vishal Patel, BDS (Liverpool), MSc Aesthetic & Restorative Dentistry (Manchester), GDC 103127, and has been on Essex Road since. We are a private practice, rated 4.7 stars from more than 300 Google reviews. Our approach is proportionate: we choose the simplest plan that gives a stable, lasting result, and we tell you plainly when a full arch is not the right answer. Patients from the surrounding area may also find our dental implants Islington page useful.

Questions patients ask about All-on-4

Is All-on-4 really teeth in a day?

Partly. In most cases a fixed provisional bridge is fitted on the day the implants are placed, so you do not leave without teeth. The final bridge follows three to six months later, once the implants have fused with the bone. The full treatment therefore spans several months, with planning beforehand and maintenance afterwards.

How much do All-on-4 dental implants cost in London?

The cost depends on extractions, bone, any grafting and the material of the final bridge, so we quote it in writing after assessment rather than publishing a single figure. The implant consultation is £120, and 0% APR finance over 12 months via Tabeo is available, subject to status.

Can I have All-on-4 if I have been told I do not have enough bone?

Often, yes. The angled back implants are designed to use the denser bone at the front of the jaw, which can avoid grafting in areas where bone is thin. A 3D scan settles the question. Some patients still need a graft first, and a small number are better served by a different approach.

Does All-on-4 hurt?

The surgery is carried out under local anaesthetic, so you should feel pressure rather than pain. Swelling, bruising and soreness are common for several days and usually respond to ordinary pain relief. Most patients are on a soft diet for the first weeks and return to light work within a few days.

How long do full arch implants last?

With good cleaning, regular maintenance and no smoking, the implants can last for many years, often decades. The bridge may need repair or replacement during that time, particularly if you grind. Results vary between patients, which is why long-term maintenance is part of every plan.

If you are weighing full arch implants against a denture, our article on All-on-4 dental implants is a useful companion read before your consultation.

Further reading

• Dental Implants UK Cost: A Comprehensive Guide to Expenses and Fees
• Types of Dental Implants: A Complete Guide

Getting here

We are at 222 Essex Road, Islington, London N1 3AP, in the same building since the practice was founded in 2009. We are open Monday to Friday, 8am to 7pm, by appointment only; we are closed at weekends and do not take walk-ins.

• By train: Essex Road station (Great Northern) is about two minutes on foot. Highbury & Islington is one stop north, and Old Street and Moorgate are a short ride south.
• By bus: the 38, 56, 73, 341 and 476 all stop on Essex Road close to the door.
• On foot from Angel: allow 15–20 minutes' walk from Angel station along Essex Road. Our Angel page has the route.
• By bike: many patients cycle or use Lime and Forest e-bikes. From Dalston it is about ten minutes by bike; see also our Highbury and Canonbury pages.
• By car: street parking on Essex Road is metered and controlled during the day. For most visits, the train, bus or bike is simpler.