FAQ’s – All on 4

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.