Why look at the downsides first?
Because All-on-4 changes a whole jaw and is hard to undo. For many people it ends years of loose dentures or failing teeth, and they would choose it again. But it is a surgical treatment with a long timeline and ongoing care, and the right decision comes from knowing the trade-offs, not only the after photos.
Below are the downsides we explain to every patient before treatment, and what can be done about each.
Does it mean losing the remaining teeth?
Usually, yes, in the jaw being treated. All-on-4 replaces a full arch, so teeth that remain are often removed, either because they are failing or because a full bridge cannot be built around them. Sometimes a few strong teeth can be kept and a different plan made, for example individual implants and bridges.
That is why the decision starts with an honest look at each remaining tooth. If teeth can be kept with reasonable effort, the doctor tells you, and explains the alternatives with their own pros and cons.
How demanding are the surgery and healing?
Implant placement and any extractions are done in one session under local anaesthetic, with sedation available. Most people describe it as more tiring than painful. Swelling and bruising peak on the second or third day. For the first weeks you eat soft food while the implants heal, and the fixed temporary teeth are designed for that period, not for full chewing.
The full treatment takes two trips, three to six months apart. Our guide on one trip or two explains the timeline.
Is cleaning harder than with natural teeth?
Yes, it takes more care. Food and plaque can collect under the bridge where it meets the gum. You clean there every day with special floss, small brushes or a water flosser, and the technique is shown to you before you leave. Professional cleaning, during which the bridge may be unscrewed, is advised at regular intervals.
Poor cleaning is the main cause of inflammation around implants, which over time can cost bone. This is the part of All-on-4 that depends most on you.
What happens if one implant fails?
With four implants carrying a whole bridge, losing one affects the bridge, which may need to be adapted and a new implant placed. This is uncommon once implants have healed, but it is more likely in smokers, with poorly controlled diabetes, or with poor cleaning. All-on-6 spreads the load over six implants and leaves a reserve, which is one reason it is chosen when there is enough bone.
Are there downsides in speech, feel and appearance?
Many people adapt within days to weeks, but at first speech can sound slightly different, especially “s” sounds, and the bridge can feel bulky. The bridge usually includes a pink part that replaces lost gum, which looks natural when designed well but shows if the lip line is very high. The try-in on the second trip is where shape, length and the visible gum are checked and adjusted with you.
What maintenance and costs come later?
| Item | What to expect |
|---|---|
| Check-ups | At least once a year, often more in the first year |
| Professional cleaning | Regularly, sometimes with the bridge removed |
| Screws and small repairs | Screws can loosen; teeth on the bridge can chip and be repaired |
| Night guard | Advised if you grind or clench |
| Renewal of the bridge | After many years of wear, depending on material and use |
These are part of owning a full-arch bridge, wherever it is made. Your dentist at home can do most of them with your records and implant details. What our aftercare covers is set out in the aftercare terms.
Who is All-on-4 not right for?
It may not suit people who still have several healthy teeth that can be kept, people who cannot clean under a bridge every day, heavy smokers who will not stop, or people with medical conditions that affect healing until these are under control. Bone that is too thin even for tilted implants may need grafting or a different plan; our guide on bone grafts explains this.
How does it compare with a denture?
A denture avoids surgery and costs less, but moves, covers the palate and does not stop the bone from shrinking. All-on-4 is fixed and stable, but needs surgery and care. Our guide on All-on-4 or dentures compares them side by side, including the middle option of an implant-retained denture.
What is the first step?
Send a few photos and, if you have one, a recent X-ray or 3D scan. A doctor tells you whether All-on-4, All-on-6 or another option suits you, with the downsides that apply to your case, before you decide anything. The All-on-4 page shows the plan day by day.