All-on-4 Procedure: Step-by-Step Guide to Same-Day Implants

The All-on-4 procedure is one of the most significant treatments in modern dentistry.

In a single surgical visit, four dental implants are placed into the jawbone and a full set of fixed teeth is attached on top, restoring an entire arch for patients who have lost most or all of their upper or lower teeth.

Understanding what actually happens during treatment – from the first consultation through to the day you walk out with a new fixed smile – makes the whole process far less intimidating. The surgery itself is carried out under local anaesthetic with optional sedation, and the vast majority of patients report that the hardest part was the decision to go ahead, not the treatment itself.

This guide walks you through every stage of the All-on-4 procedure at Regent Dental in Cambridge: consultation and planning, surgery day, the healing period, and the final teeth. It also covers realistic recovery timelines, who the procedure suits, and the questions patients most commonly ask at each stage.

What Is the All-on-4 Procedure?

All-on-4 is a full-arch dental implant technique where four titanium implants support a complete fixed bridge of twelve to fourteen teeth. The key difference from traditional implant placement is the angle of the rear two implants – they are tilted at around 30 to 45 degrees, which allows them to anchor into denser bone further forward in the jaw. This tilt means most patients can be treated without bone grafting, even after years of bone loss from missing teeth or ill-fitting dentures.

The procedure was developed by Portuguese dental researchers in the 1990s and has been refined over more than three decades of clinical use. Modern All-on-4 treatment combines digital 3D planning, guided surgery, and same-day temporary teeth so that patients rarely leave without a functioning set of teeth in place. The final permanent teeth are fitted a few months later once the implants have fully integrated with the bone.

Step 1: Consultation & Treatment Planning

Every All-on-4 case starts with a thorough consultation. This is where we understand why you are considering implants, assess your current oral health, and take the detailed records we need to plan your surgery safely.

A typical first visit includes a clinical examination of your existing teeth and gums, a full set of X-rays, and a 3D CT scan of your jaw. The CT scan is the most important diagnostic step – it shows the exact density and shape of your bone, the position of nerves and sinuses, and tells us precisely where each of the four implants needs to sit for the strongest, safest result. Without a CT scan, All-on-4 is essentially guesswork.

We also discuss your goals, your medical history (including any medications that could affect healing), and what you want your new smile to look like. Digital smile design software lets you see a preview of your expected result before any treatment begins, so there are no surprises at the final stage.

The consultation is also when you decide whether you want the surgery done under local anaesthetic alone or with IV sedation. Most patients choose sedation for comfort, though neither option affects the clinical outcome.

Step 2: What Happens on Surgery Day?

All-on-4 surgery typically takes between two and four hours per arch. You arrive, settle in, and any sedation is administered. The surgical area is numbed with local anaesthetic, so you feel no pain during the procedure – patients undergoing IV sedation often have little to no memory of the surgery itself.

The first step is removing any remaining teeth that cannot be saved in the treatment area. These are usually extracted carefully to preserve as much surrounding bone as possible. Next, the four implants are placed: two straight implants at the front of the jaw where the bone is densest, and two tilted implants further back to maximise bone contact without hitting the sinuses or nerves. Guided surgery templates ensure each implant goes in exactly where the CT scan mapped out.

Once the implants are stable, a metal framework supporting a temporary set of acrylic teeth is attached the same day. This means you walk out with a full set of fixed teeth – not perfect, not final, but functional, attractive, and firmly in place. These temporary teeth stay in for the healing period.

The surgical appointment ends with post-operative instructions, a review of pain-management medication, and a scheduled follow-up for the next few days.

Step 3: Recovery & Healing Period

The first 48 to 72 hours after All-on-4 surgery are when most patients feel the effects of treatment. Swelling, mild bruising around the jaw, and some discomfort are normal. Pain is usually well controlled with a combination of prescribed pain relief and over-the-counter ibuprofen. Most patients take two or three days off work and are back to normal activities by the end of the first week.

During the healing period – which typically lasts three to six months – the implants undergo a biological process called osseointegration. This is when bone cells grow directly onto the surface of the titanium implant, fusing the implant to the jaw as if it were a natural tooth root. This fusion is what gives All-on-4 its long-term stability and is the reason we wait before attaching the final permanent teeth.

You wear the temporary teeth throughout this period. You can eat, speak, and smile normally, though we recommend avoiding very hard or chewy foods for the first few weeks to protect the healing implants. Regular check-up appointments during this time let us monitor the healing and catch any issues early.

Oral hygiene during healing is simple but important. Gentle brushing around the implants, rinsing with the prescribed antimicrobial mouthwash for the first two weeks, and attending all follow-up appointments are the main things that protect your long-term outcome.

Step 4: Final Teeth – The Permanent Result

Once osseointegration is complete, usually three to six months after surgery, you return for the final restoration appointments. This is when the temporary teeth are removed and replaced with your permanent All-on-4 bridge, made specifically to the colour, shape and character you agreed during planning.

The final teeth are usually made from either high-strength acrylic on a titanium or zirconia framework, or from monolithic zirconia for patients who want the most durable and aesthetic option. Zirconia final teeth are more expensive but resist staining better, last longer, and look closest to natural teeth. Your dentist will recommend the right material based on your bite force, aesthetic goals, and budget.

Fitting the final teeth usually takes two appointments – one for impressions and a try-in, and one for the final fit. By the end of this stage, you have a permanent fixed set of teeth that function almost identically to natural teeth and should last many years with proper care.

How Long Is the All-on-4 Recovery Timeline?

Here is a realistic week-by-week recovery overview so you know what to expect at each stage:

This timeline varies patient to patient. Smokers and people with certain medical conditions may need longer healing. Your surgeon will give you a personalised timeline at the consultation.

Expert Tip: The biggest factor in All-on-4 success is following the post-surgery instructions carefully in the first two weeks. Soft diet, gentle hygiene, no smoking, and attending every follow-up appointment is what turns a good surgical result into a lifetime restoration.

Is All-on-4 Right for You?

All-on-4 is not suitable for everyone. The procedure works best for adults who have lost most or all of the teeth in one or both arches, or whose remaining teeth are failing and need extraction. It is particularly effective for patients who have been wearing ill-fitting dentures for years and want a fixed, stable alternative.

You may be a good candidate if you have enough bone in the front of your jaw to support the four implants, reasonable general health, and commit to the aftercare regime. Patients with uncontrolled diabetes, active gum disease that has not been treated, or heavy smokers face higher complication rates – though these are often manageable with prior treatment rather than absolute barriers.

The CT scan at the consultation gives the definitive answer. If your bone volume is insufficient even for All-on-4, alternatives such as zygomatic implants or staged bone grafting may be offered. We would rather tell you honestly that you are not a candidate than push ahead with a compromised result.

Frequently Asked Questions – All-on-4 Procedure

Below are the questions patients ask most often about what All-on-4 actually involves. If your specific question is not covered here, we can address it in detail at the consultation.

How long does the All-on-4 procedure take?
The surgery itself takes two to four hours per arch. Total time in the clinic on surgery day, including preparation, anaesthetic, placement and fitting the temporary teeth, is usually between four and six hours.

Does All-on-4 surgery hurt?
You feel no pain during the surgery because the area is fully numbed with local anaesthetic, and most patients opt for IV sedation for extra comfort. Post-surgery discomfort is usually manageable with standard pain relief for two to three days.

Can I eat normally straight after All-on-4?
You can eat the same day, but only soft foods for the first two weeks – soups, yoghurts, well-cooked pasta, soft fish. Gradually return to normal textures over the following weeks. Hard and chewy foods should be avoided until after the final teeth are fitted.

Do I need bone grafting for All-on-4?
Most patients do not. The 30 to 45 degree angle of the rear two implants is specifically designed to avoid bone grafting by using the naturally denser bone further forward in the jaw. The CT scan confirms whether grafting is needed in your specific case.

How long do All-on-4 implants last?
The implants themselves can last 20 years or more with proper care. The final teeth fixed on top may need replacement after 10 to 15 years depending on the material and your bite. For the full cost breakdown across implant types, see our full mouth dental implants cost guide.

Is All-on-4 done under general anaesthetic?
No, All-on-4 is almost always done under local anaesthetic, with optional IV sedation. General anaesthetic is rarely used except in hospital-based cases with specific medical indications.

What happens if one of the four implants fails?
Implant failure rates are low (around 2-3% long term) but when it does happen, the implant can usually be removed and replaced with minimal disruption to the rest of the arch. Regular check-ups catch early warning signs.

All-on-4 at Regent Dental, Cambridge

Regent Dental in Cambridge offers All-on-4 treatment from £15,000 per arch, with 3D CT-guided surgery, in-house planning, and a choice of acrylic or zirconia final teeth. Every case begins with a full consultation including a CT scan so we can give you a realistic clinical assessment and a firm quote before any treatment is planned.

We also offer interest-free finance to spread the cost of All-on-4 across 12 or 24 months. For patients travelling from outside Cambridge, treatment can usually be completed across fewer, longer visits to reduce the number of trips.

Book your All-on-4 consultation today

All-on-4 Procedure: What to Remember

All-on-4 is one of the most life-changing treatments in dentistry, and understanding the process stage by stage removes most of the anxiety that patients initially feel. The surgery is carried out under local anaesthetic with optional sedation, most patients leave the same day with fixed temporary teeth, and the final permanent result is fitted once the implants have fully integrated with the bone.

What makes the All-on-4 technique so practical is the angle of the rear implants, which eliminates the need for bone grafting in most cases. Combined with modern 3D digital planning and guided surgery, this is why same-day fixed teeth have become the standard rather than the exception.

Here are the essential points every patient should remember:

• Consultation matters most – a proper CT scan determines whether you are a candidate and how treatment is planned
• Surgery is usually 2 to 4 hours per arch under local anaesthetic, with optional IV sedation
• Same-day fixed temporary teeth mean you leave the clinic with a functioning smile on the day of surgery
• Healing takes 3 to 6 months before the final permanent teeth are fitted
• Bone grafting is rarely needed thanks to the tilted rear implants
• Long-term results depend on aftercare – oral hygiene, check-ups, and not smoking

Taking the time to understand each stage before committing to treatment is the best investment you can make in the final outcome. A consultation at Regent Dental gives you a realistic clinical assessment, a digital preview of your expected result, and a transparent quote with no pressure to proceed on the day.

If you have been told your teeth are beyond saving, All-on-4 often gives patients a way forward that was not available even ten years ago – a permanent, fixed, natural-looking set of teeth after a single surgical visit.

Information Sources

All-on-Four Treatment Concept: Systematic Review (PMC)
Axial & Tilted Implants in All-on-Four: Survival Review (PubMed)
Dental Implants Clinical Overview (Guy’s & St Thomas’ NHS Trust)