All on 4 FAQ’s

No, it is not experimental, the All-on-4 procedure (AO4) has been successfully performed in Europe for more than two decades and here in the U.S. from 2004. Approximately 14 years ago one of the world’s largest dental implant manufacturers, Nobel Biocare, began to study computer simulation and bio-mechanics and collected large amounts of data about this use of implants for the edentulous patient (most or all of the natural teeth missing). Dentists in USA have since studied with the developers of the AO4 procedure through AO4 seminars. Recent studies of large numbers of patients treated with this procedure show a success rate of nearly 99%.


For upper jaw, I will in 90% of cases place 4 implants ( because of bone quality and quantity, depending on the sizes of implants used, 8% of cases get 5 implants, and 2% get 6 implants ). For lower jaw, 98% of my cases get 4 implants as above; but in rare case 6 implants. Research studies have shown that if the back two implants are tilted slightly          ( usually 30 degree ), and the two front implants are straight or tilted 17 degree. This would render enough retention and support as multiple implants.

An implant-supported bridge attaches to these four specifically placed implants and is just as effective as being supported by many more implants using a non-AO4 technique. Think of this analogy: your teeth as a table that needs for legs ( implants ) to be stable. The results are less cost, less chair time, less healing time, hardly any bone graft, and most of all, no painful temporary stage with dentures needed.

Most dental clinicians do not have experience in the AO4 procedures and protocols and continue to use too many implants per jaw, increasing the cost to the patient, more trauma  and more treatment time. At Extreme Smile Makeover, dr. A, Shojania recommends the most cost effective denture replacement procedure that is customized and appropriate for you.

At Extreme Smile Makeover, after the initial examination, Dr. Shojania with his on site Lab takes total of about 5-6 hours, all in one day. Basically, Dr. Shojania takes about 2.5 hours to pull out all the teeth in one jaw ( if patient has teeth ), and place 4 – 6 ( mostly 4 ) implants, and close the gum; Then the lab person will take 2.5  hours to fabricate the temporary implant-supported bridge; lastly Dr. Shojania will take about ½ hour to srew the bridge to the implants, and adjust the bite. Patients will not need any bone graft procedure with the  ALL ON 4 procedure. Then patient will be walking away with a new smile. And new outlook on life. Patient can start eating food right away ( soft diet only ). We wait about 3-6 months; then we take a new mold of the implants in order to make the final permanent bridge; which not only has more teeth added in the back; but also has stronger base for the bridge to be attached to your implants. No temporary painful stages with dentures anymore; no waiting for the bone to be hardened around the implants.

Keep in mind that before the invention of  ALL ON 4  technique, using the traditional implants normally involved 6-8 implants per arch, risky and expensive and timely bone graft procedures ( usually involving the sinus ), several visits to different specialists in different locations, would normally took between 8 months to 2 years with patient being without teeth and temporary denture.

Knowledge is power. When I heard about this technique, I was skeptic also. But through hours of research, seminars, and post implantology courses, and seeing the results on live patients seminars, I can assure you that in rare cases, two things can go wrong:

1-     In the early stage, one of the implants might fail; which the problem can be resolved right away by:  a) replacing the failed implant with a larger diameter or longer implant     at the same location. b) replacing the failed implant with another implant in a different location, but close to the failed implant. In either case, I will modify your temporary implant-supported fixed bridge, so you can continue to have a fixed bridge until the new implant heals.

2-     Late failures,

We’ve heard this statement often, and can assure you it is not accurate. In fact there are even reports with pretty good results using only 3 implants. We don’t recommend this approach, for a variety of reasons, but it shows how silly the statements insulting the 4 implant design can be. We have met with and discussed the All-on-4 technique with some of these skeptical dentists and surprisingly these very dentists now understand the AO4 and how it can instantly give relief to their dentally exhausted patients. Even still, some of these same dentists are now resolute advocates of the AO4, advising their patients to see us for a complimentary consultation. We are experienced and will care for you. And we mean it.

When only 4 implants are inserted into each jaw ( optimal ), 20 year study shows that the All on 4 for the lower jaw is 98% successful; and for the upper jaw All on 4 is 98.2% successful. These success rates does not change if there are more implants ( 5,6 or more ) in the jaw bone. If in rare cases an implant fails, which will happen in the first 2 months, we will replace that implant, and fit it into the bridge accordingly.

There are different dentists practicing:

1-     Some dentists do not no how to do simple implant procedures, and unfortunately they would rather offer partials or dentures to their patients instead of losing their patients to a dentist that does implants and All on 4 procedures.

2-     Some dentists know how to do implants; but they haven’t gone through all the All on 4 classes and seminars to be able to do the All on 4 cases.

3-     Some dentists know how to do implants; and have taken some All on 4 courses; but because it is hard for them to do, they do not like to try it, and mess up someone’s jaw; and consequently, pay the price for it.

Fortunately, there are a few local general dentists that are highly educated, and have seen the benefits of All on 4 specially for edentulous patients with full or partial dentures, put the patient’s health a priority. These dentists frequently refer patients to us for single, a few implants; or full mouth ( All on 4 ) Implants. In our office, we do A-Z; meaning from pulling the tooth, bone graft, implant, and the restorative part which is implant crown, implant bridge; or All on 4 for the whole jaw.

Even though most patients are great candidates for All on 4 procedure, it is contraindicated if the patient has an uncontrolled medical condition like diabetic, severe immune deficiency, cancer, organ failures, etc. But even with above diseases, if it is controlled, the All on 4 treatment is acceptable. We will collaborate with the patient’s medical doctor to insure the patient’s safety.

Age is not an issue with the All on 4 treatment. The patient can be as old as 100 years, and still he/she is a good candidate for All on 4. Bone quality does not change much with age.


Temporary bridge is screwed on the 4 implants on the same day that the implants are placed; so the patient can leave the office with a beautiful smile. It is made of acrylic, and composite resin. They are strong enough for patients to have a normal life before the final bridge is made. Because the implants are not fully integrated with the bone for about 4 months, the patient will be instructed to go on a soft diet for 3-5 months. Soft diet does not mean liquid diet; the patient can chew anything that the side of the fork can cut through. No chewy food like bread, steak, and pizza. No sharp, sticky, and hard food like peanut butter, popcorn, dried fruits & nuts, candy, chewing gum, seeds, spicy foods. Temporary bridge is made to last 6-12 months max, and then it will start to deteriorate and fracture. Temporary All on 4 bridge normally has no molars, to reduce the pressure exerted on the implants in the healing period.

 Final bridge is made after 3-5 months after the temporary bridge is made. It usually takes 3-4 appointments. It has a hard titanium framework for support, and has couple more teeth ( molars ) added to the All on 4 bridge. It is made with acrylic, composite or porcelain. Even though It is durable, and made to last long term, be extra careful the first 2 months, so the bone gets stimulated, and the bite totally adjusted. Before the final All on 4 bridge is made, the patient has a chance to change the shade, shape, and size of the teeth. Also, if there is some bone loss under the temporary bridge that food traps in there, we close it to avoid food collection under the All on 4 bridge. The final bridge will give you a great smile, and functions like your natural teeth. No more cavities, root canal. The only trip to the dental office is for keeping the gum healthy, and making sure that the patient is keeping the bridge clean.

1.      Get a good night’s rest the night before treatment.

2.      Eat a light, nutritious breakfast or lunch, but avoid coffee or other beverages that may increase your need to use the restroom during your procedure. No caffeine.

3.      Do not exercise or lift heavy objects for 2-3 days after the surgery.

4.      Take prescribed mediation as recommended by your physician, especially heart, blood pressure, or diabetic medication.

5.      Avoid aspirin 3 days prior to treatment.  If you take Coumadin, or any other blood thinners, you must be off the medication for at least three days prior to treatment.  Please check with your physician prior to discontinuing any medication.

6.      Have cold, soft foods in your home prior to your appointment so that they are available to you the day of your surgery.

7.      If you would like to listen to music during your treatment, please feel free to bring your own personal music and headphones.

8.      If you tend to become cool easily, please dress warmly.

Day of surgery:  for the first 24 hours, your diet should consist of cold, soft foods and drinks such as:

Iced tea                        Malts or Milk Shakes                              Chilled Canned Fruits

Fruit Juices                 Ice Cream or Frozen Yogurt              Milk

Cottage Cheese           Any Nutritional Drink                         Ensure Drink

Potato Salad               Apple sauce                                             Carnation Drink

After the first 24 hours you can return to a warmer diet such as:

Soups                                  Cooked Cereals                                        Eggs

Fish                                     Ground Beef, pork, Lamb or Turkey   Plenty of Fluids

Steamed Vegetables         Spaghetti                                                  Ensure Drink Mashed potato                                                                                                                                                                                      

While you are healing, you should only eat foods that you are able to cut it with the side of the fork; also no chewy, sharp or sticky foods; therefore AVOID:

Popcorn                             Candy, Chewing Gum                           Spicy Foods

Peanut Butter                   Sunflower or Sesame Seeds                 Pizza

Dried Fruits & Nuts        hard Crusted Breads                              Chips