The All-on-4 Procedure,
Step by Step

It means the implants and a fixed arch of teeth go in at the same appointment, so you walk out with a full set of teeth rather than a gap or a denture. It is the fourth of the six all on 4 procedure steps above, and it is the stage everybody asks about first. What it does not mean is that your treatment is finished that afternoon.

The clinical name for it is immediate loading. Ordinarily an implant is left undisturbed beneath the gum for months while bone grows onto its surface, and only then is a tooth attached to it. Immediate load dental implants are given their job straight away. That works with All-on-4 because the four implants are joined by one rigid arch: the arch spreads the forces of speaking and light chewing across all four, so no single implant is rocked loose while it is fusing, and the two tilted back implants engage a long run of solid bone, which is what makes them firm enough to be loaded on the day.

There is a condition attached, and it is worth knowing before you come in. Immediate loading depends on every implant being tight the moment it is placed, which is measured on the day rather than assumed from the scan. Occasionally bone turns out to be softer than the images suggested and an implant will not hold firmly enough to be trusted with an arch straight away. When that happens we tell you at the time and let the implants heal covered over before the arch goes on. That is a delay of a few months, not a failure, and we would far rather have the conversation than load an implant that is not ready. It is an uncommon but genuine outcome of same day teeth implants, and any practice offering the treatment should mention it before you book.

The arch you leave with is fixed. It is screwed to the implants, you cannot take it out, it stays in overnight and it needs no adhesive and no soaking. It is not, however, the arch you will keep. The temporary is made of acrylic, built to look right and to let you speak normally from the first day, and deliberately not built for heavy chewing.

The final arch waits because your mouth is still changing. Swelling settles, extraction sockets fill in, and the gum shrinks back onto a ridge that is remodelling around four new implants. An arch made in the first week would fit a mouth that has stopped existing by the time the implants have integrated. Waiting also gives you several months of wearing a full-size trial: if the teeth look too long, the shade is not what you pictured, or the bite feels wrong, it gets changed before the permanent arch is made rather than after.

Most people are back to their ordinary routine within a week, and the full all on 4 recovery time — through to the day your final arch is fitted — is three to six months. The first week is about swelling going down. Everything after that is bone quietly fusing to the implants while you get on with your life.

Days one to three are the low point and are best planned for. Rest, use ice on the outside of the face on the first day, sleep propped up, and start warm salt-water rinses the day after surgery rather than the same evening. Keep off cigarettes and alcohol, avoid drinking through a straw, and leave the gym alone. Eat cool and soft: yoghurt, smoothies taken with a spoon, scrambled egg, mashed potato, soup once it has cooled. Do not skip meals because chewing feels like an effort — healing runs on food.

Days four to seven are when it turns. Swelling drops away, bruising comes to the surface and starts fading, and most people with desk jobs are back at work around day three or four; a physically demanding job is closer to a week. Move on to soft food you can chew gently: flaked fish, pasta, minced meat, well-cooked vegetables. Cut everything small and chew on the back teeth on both sides. Nothing that needs a front-tooth bite — tearing at food with the front of the arch puts a lever on the implants at exactly the wrong moment.

Weeks two to six feel close to normal. Soreness has gone, the gum tightens and firms around the arch, and any lisp settles within a fortnight, faster if you read aloud for ten minutes a day. Exercise can go back to normal at around two weeks. You can eat most things, but the temporary arch is acrylic and will crack under a hard bite, so keep away from crusty bread, nuts, boiled sweets, toffee, ice and whole apples until the final arch is in.

Months three to six are the part you barely notice. The implants integrate with the bone, and there is nothing you have to do beyond cleaning well and coming to your reviews, where we check the arch, the screws and the gum, and take radiographs when they are useful. Once integration is confirmed we take final impressions and fit your permanent arch. Give yourself a fortnight to settle into it: a new bite feels strange before it feels like yours. After that, most people eat normally.

These are typical figures rather than a schedule you are obliged to keep to. Heavy smokers, anyone whose diabetes is not well controlled, and people who needed a lot of extractions on the day all tend to heal more slowly, and we will say so at the planning stage rather than leave you wondering why your second week is not like the one described here.