All-on-4 suits patients who want a fast, fixed full-arch smile with minimal bone.
Usually, patients bring a lot of worries with them and a lot of questions when they come to Lema Dental Clinic in Istanbul. It is quite common that they have been hearing from their dentists in their home countries either that without enough bone they cannot get dental implants or that they have gotten themselves into a vicious circle of wearing loose dentures which are uncomfortable and getting new ones over and over again.
Actually, the All-on-4 technique was precisely invented to deal with such complicated situations. However, this method is not a solution for everyone. As a senior medical partner working with Professor Doctor Coşkun Yıldız, I basically realized that the key to success was patient selection. Here, we will take away the marketing stuff and talk about the clinical facts just to understand who would be the right candidate for this therapy.
The “Low Bone Volume” Patient
Most of the time, the patient that we meet in Turkey is the one who are suffering from a serious dental bone loss. One may compare a jawbone to the foundation on which the whole house stands. When teeth are lost, the jawbone is no longer stimulated and gradually melts away. From a traditional implantologist’s standpoint, the treatment of a declining bone foundation means that one is going to have to undergo bone grafting – this kind of treatment can be so time-consuming that it is not uncommon for the whole period to be extended by 6 months or even more.
All-on-4 protocol, however, is a completely different story. When dental implants in the back are angled at 45 degrees, this way, lower-density bone areas can be bypassed and the screw can be fixed in the back where the bone quality is better without sacrificing any bone. In fact, it is like a hiker who, to get a better hold of his tent, is angling the pegs more in the direction of the wind. If you have been advised to have a sinus lift or a lot of grafting, then the procedure described here is probably most suitable for you.
The “Denture Fatigue” Sufferer
Removable dentures are still the most common solution to the problem even though for decades people have known how inconvenient and uncomfortable they can be both on the psychological and physical levels.
Dentist Polen Akkılıç who manages her clinic together with the team, the clinic clinic often encounters patients who are so fed up with the slipping and clicking of their dentures that they are at the end of their rope. Additionally, the taste disorder caused by the palate covering the roof of the mouth with acrylic is the last straw for many patients. The kind of patient for the All-on-4 treatment is the one who is willing to give up removable dentures and therefore the inconveniences attached to it.
The “Immediate Need” Professional
In the first place, time is money, especially for our international patients who have to get to Turkey by plane among other non-traveling expenditures. Traditional implants, which are usually placed following a “heal-then-load” protocol, can mean having to put up with a gap or a temporary tooth for months.
Firstly, the person who is a perfect match for the All-on-4 procedure is the one who needs “Immediate Function” as IT is also called. Dental implants are fitted with the prosthetic arch, so the force applied is evenly distributed across the dental implants. This stability from one side of the arch within the other is exactly what allows Professor Doctor Coşkun Yıldız to let you have a tattoo-fixed set of teeth on the day of the surgery or on the very day of it if there are no unexpected complications. If you need teeth in a matter of days and not months, this protocol is reliant on you.
Comparing Your Options: The Clinical Breakdown
This is how, at the clinic, we visualize trade-offs with the patient.
| Feature | All-on-4 Implants | Traditional Implants (Full Arch) | Removable Dentures |
| Bone Requirements | Low to moderate. Utilizes available bone via angulation. | High. Often requires grafting or sinus lifts. | None. Relies on gum suction or adhesive. |
| Treatment Time | Fast. Often “teeth in a day” or 3–5 days in Turkey. | Long. 6–10 months including graft healing time. | Fast. 2–4 weeks for fabrication. |
| Stability | High. Fixed, non-removable. | High. Fixed, non-removable. | Low. Can slip or click and often needs adhesive. |
| Palate Coverage | None. Upper palate remains open, improving taste and comfort. | None. Upper palate remains open. | Full. Covers the roof of the mouth. |
| Cost Efficiency | High. Fewer implants and no grafting reduce the total cost. | Moderate. Higher cost due to more implants and grafting. | Low. Cheapest upfront, but ongoing maintenance adds cost. |
Are There Red Flags? (Contraindications)
We can’t help but mention who the contraindications are for. There are only a few, and these conditions are systemic ones that could pose significant risks. Diabetes mellitus prevents wound healing and accordingly, as an example, acts as the rust and corrosion on the biological machinery that is the main ingredient for the process of bone fusion to the dental implant.
It is also not recommended that heavy smokers be rejected as a matter of principle. Smoking causes blood vessels to restrict; therefore the gums which basically get oxygen from the blood have practically been suffocated as a result of the short supply. Lema Dental Clinic is not a place that compulsorily turns its back on smokers, but we still talk openly and frankly with the patients about the higher risk of failure.
Frequently Asked Questions (Doctor-to-Patient)
Definitely not. It is the main worry that we always address first, but once the technique has been explained in detail, it becomes clear that there is nothing to worry about. The very moment you leave the operating chair, as a rule, you get your teeth that are temporarily fixed, so you can smile when you come out. We never leave the patients without teeth during the phase of healing.
That is something that we discuss every day. During the operation, under deep sedation or general anesthesia, you do not feel anything; the process is so fast that you will find it exactly like blinking and realizing that the treatment is finished. After surgery, there will be some swelling and bruising, which is quite normal after wisdom teeth are taken out, but the majority of patients easily manage this with painkillers.
Imagine a stool. If its four legs are placed in quite the right spots, it will be perfectly stable. If the rear implants are tilted, then the beard area of the titanium and the bone is indirectly increased through the contact area. It’s like a truss support structure; the bigger the contact area is, the stronger it becomes. When there’s a heavy biter involved, then perhaps All-on-6 might be suggested, but this is rarely the case since four is the gold standard for a reason.
Typically, after the All-on-4 procedure is done, the patient is expected to stay 5 to 7 days before returning home. Therefore, during that period, Dentist Polen Akkılıç and the staff will have made the temporary teeth in the lab and will have completed all surgical procedures. You will return after a few months for your permanent zirconia prosthesis.
After your zirconia set is affixed and the bone has fused, mostly done after 3-6 months, you are nearly free to eat anything that you like. However, during the initial healing stage when you are still on temporary teeth, a “fork-tender” diet (pasta, fish, eggs) is what you will be asked not to rock the implants while they settle.
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- Patzelt, S. B. M., & Bahat, O. (2020). The All-on-4 Treatment Concept: A Systematic Review. International Journal of Oral & Maxillofacial Implants, 35(2).
- Soto-Penaloza, D., Zaragozí-Alonso, R., Penarrocha-Diago, M., & Penarrocha-Oltra, D. (2017). The All-on-4 Treatment Concept: Systematic Review. Journal of Clinical and Experimental Dentistry, 9(3), e474.
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