Real cases from our clinic
Patients of Dr Haim Aseriel, photographed at the clinic and shared with their consent. Drag the line across the photo to compare.
Full-arch restoration on implants
- Real patients of the clinic
- Published with patient consent
- Every result is individual
All on 4: a full arch on four implants
All-on-4 restores a full arch with just four implants, usually with a fixed temporary bridge attached within 24 to 72 hours of surgery.
The concept replaces unstable removable dentures with a fixed bridge. At Dr Haim Aseriel's dental clinic in Jerusalem, treatment combines full mouth rehabilitation planning with the surgical work.
What is the All-on-4 concept, and who is it for?
The All-on-4 concept was developed by Dr Paulo Maló in Portugal and marketed with Nobel Biocare. The protocol relies on four implants: two placed vertically in the incisor area, and two tilted at 30 to 45 degrees in the premolar area. You may also see it called "all on four" or, inaccurately, "4 in 1 implants".
The All-on-4 concept is suited first and foremost to patients with extensive tooth loss, reduced bone or removable dentures that no longer work.
Traditional full mouth dental implants sometimes require 6 to 8 implants and a preliminary bone graft; All-on-4 makes use of the available bone and often avoids a sinus lift.
The All-on-4 implant procedure, step by step
Before any surgical planning, a clinical exam and 3D imaging (CBCT), taken at the clinic with a Planmeca ProMax 3D, are carried out to assess the bone, the position of the sinuses and the jaw nerve.
All-on-4 treatment has four main stages spread over several months.
1. Consultation and digital planning
3D imaging, simulation and precise surgical planning, with a 3D-printed surgical guide when needed.
2. Implant surgery
Four MIS implants are placed in the jaw at the clinic, under local anesthesia; for anxious patients, light oral sedation on prescription can be added. The clinic does not provide general anesthesia.
3. Fixed temporary bridge
Usually within 24 to 72 hours of surgery, allowing you to eat soft foods.
4. Final fixed bridge
After a few months of implant integration (usually 4 to 6), made of a material chosen for the case, for example zirconia.
Each stage is planned in advance, with the aim of a good aesthetic and functional result.
Who performs the surgery
All-on-4 surgery is performed at the clinic itself by Dr Haim Aseriel and Dr Yves Weinberg, head of the Oral and Maxillofacial Surgery Department at Barzilai Medical Center, who operates at the clinic.
Advantages of All-on-4 dental implants
In a long-term study of 245 patients and 980 implants in the lower jaw, the implant-level success rate was 98.1% after 5 years and 94.8% with up to 10 years of follow-up (Maló et al., Journal of the American Dental Association, 2011).
A systematic review of 4,804 implants reported an average survival rate of 99.0 ± 1.0% after 36 months, with an average bone loss of 1.3 ± 0.4 mm; the authors noted that data beyond 5 years are still limited (Patzelt et al., Clinical Implant Dentistry and Related Research, 2014).
98.1%
implant-level success after 5 years (lower jaw)
- Immediate loading: temporary teeth shortly after surgery
- No bone graft in many cases, thanks to the existing bone
- High success rates in long follow-up studies
- Often a lower overall cost, with fewer implants and no graft
All-on-4 vs conventional full-arch implants
The table compares conventional full-arch dental implants with All-on-4: number of implants, need for a bone graft and treatment time.
| Criterion | Conventional implants | All-on-4 |
|---|---|---|
| Implants | Sometimes 6 to 8 implants per arch | Four implants, two of them tilted |
| Bone graft | Often combined with a bone graft or sinus lift | Often avoids a preliminary bone graft |
| Treatment time | Many months, especially when a graft is needed | Immediate loading: temporary bridge within 24 to 72 hours |
Some patients search for "all on 4 denture implants": the All-on-4 bridge is a fixed full-arch prosthesis that only the dentist can remove, not a denture you take out.
Drawbacks and limitations of All-on-4
- Not for every bone structure: the concept needs enough bone in the front of the jaw; when it is lacking, alternatives such as zygomatic implants are considered.
- Reliance on four implants: the whole bridge rests on them, so the failure of one implant may require the entire restoration to be repaired.
- Cleaning under the bridge: the patient cannot remove the bridge, so cleaning underneath it takes daily care and dedicated aids.
- Limited long-term data: most data come from a few years of follow-up, and data beyond 5 years are still limited (Patzelt et al., Clinical Implant Dentistry and Related Research, 2014).
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Why oral hygiene matters with All-on-4 implants
A study of 1,072 patients and 4,288 implants in the upper jaw, followed for up to 13 years, found a biological complication rate of 7.8% at the implant level, and smoking was a significant risk factor for implant failure, with a hazard ratio of 1.94 (Maló et al., Clinical Implant Dentistry and Related Research, 2019).
Careful oral hygiene is the main factor in the long-term success of All-on-4 implants.
The team gives each patient personalized hygiene instructions, including special floss for implants, interdental brushes and mouth rinses as the dentist advises. Regular maintenance visits, including gum treatment when needed, play an important role in preventing peri-implantitis.
Recovery after All-on-4 implants
74% of All-on-4 implant failures occur within the first 12 months, according to a systematic review of 4,804 implants (Patzelt et al., Clinical Implant Dentistry and Related Research, 2014).
In the first week, a soft diet and rest from physical exertion are recommended. Most patients report moderate discomfort rather than the severe pain they feared; the pain reliever and dose are decided with the dentist or pharmacist.
74%
- of implant failures occur in the first 12 months
4,804
- implants reviewed in a systematic review
Aftercare and follow-up after All-on-4
After surgery, the dentist explains the exact instructions for each stage: typically a soft diet at first, then a gradual return to normal chewing as healing progresses.
Case from the clinic
A 55-year-old man who had just completed the implant stage ate only soft, mashed food for the first two weeks, as instructed. By the sixth week, he was back to almost full function.
Full recovery after All-on-4 implants includes follow-up at set points: one week, one month, three months and six months after surgery.
A small prospective study of 16 patients and 64 implants in the lower jaw (12 of whom reached the 7-year check-up) showed 100% implant survival, with no statistical difference between straight and tilted implants in stability or marginal bone loss (Ayub et al., International Journal of Oral & Maxillofacial Implants, 2017).
How much do All-on-4 dental implants cost?
Every patient arrives with a different bone situation, different aesthetic needs and a different general health picture, so there is no single price that applies to everyone.
The cost of All-on-4 dental implants is set only after full treatment planning, including 3D imaging and planning of the restoration.
At the end of a thorough consultation you receive a detailed written quote listing each stage separately, and the clinic provides itemized receipts you can submit to your insurer (reimbursement depends on your policy). For the factors that affect the price, see dental implant cost.
All-on-4 dental implants in Jerusalem: consultation at Dr Haim Aseriel's clinic
A systematic review of studies with more than 24 months of follow-up found a survival rate of 99.8%, but the authors noted limitations in study quality and follow-up length (Soto-Penaloza et al., Journal of Clinical and Experimental Dentistry, 2017).
The clinic's approach rests on one guiding principle: every natural tooth that can be saved is preferable. When a full restoration cannot be avoided, All-on-4 provides a fixed, natural-looking solution. At a consultation with Dr Haim Aseriel (DDS, NYU College of Dentistry), held in English if you wish, your mouth is fully assessed and your suitability for the concept checked. The clinic is at 12 HaTnufa Street in Talpiot, south Jerusalem, open Sun 8:00–19:00 · Mon 9:00–19:00 · Tue–Wed 9:00–21:00 · Thu 8:30–21:00 · Fri 8:00–14:00. You can also read patient reviews.
All-on-4 dental implants: frequently asked questions
All-on-4 dental implants restore a complete arch of teeth on four implants: two placed vertically in the front, and two tilted at 30 to 45 degrees in the premolar area. The concept was developed by Dr Paulo Maló in Portugal, with Nobel Biocare, and is mainly suited to patients with extensive tooth loss, reduced bone or removable dentures that no longer work.
A conventional full-arch implant restoration sometimes needs 6 to 8 implants per arch, often combined with a bone graft or sinus lift, in a process that can take many months. All-on-4 uses four implants, with the back two tilted, and usually allows immediate loading: a temporary bridge within 24 to 72 hours of surgery.
All-on-4 implants have high success rates: in a long-term study of 980 implants in the lower jaw, the implant-level success rate was 98.1% after 5 years and 94.8% with up to 10 years of follow-up. A systematic review found about 99% survival after 3 years, but noted that long-term data are still limited.
After All-on-4 implant surgery, a soft diet and rest from physical exertion are recommended in the first week. After a few months of implant integration (usually four to six), the temporary bridge is replaced with the final bridge, for example in zirconia.
The cost of All-on-4 dental implants is set only after full treatment planning, including 3D imaging and planning of the restoration. At the end of the consultation, a detailed written quote lists each stage separately.
Sources
- Maló P et al., Journal of the American Dental Association, 2011 – Link to study
- Patzelt SB et al., Clinical Implant Dentistry and Related Research, 2014 – Link to study
- Maló P et al., Clinical Implant Dentistry and Related Research, 2019 – Link to study
- Soto-Penaloza D et al., Journal of Clinical and Experimental Dentistry, 2017 – Link to study
- Ayub KV et al., International Journal of Oral & Maxillofacial Implants, 2017 – Link to study
