All-on-4

What Are All-on-4 Dental Implants?

All-on-4 is a full-arch tooth replacement concept in which a fixed prosthesis is supported by strategically positioned dental implants. Instead of replacing every missing tooth with an individual implant, a carefully planned group of implants supports an entire arch of replacement teeth.

The implants are placed into the jawbone, where they provide a foundation for the prosthetic teeth. Depending on your clinical situation and implant stability, a temporary restoration may sometimes be attached during the initial phase of treatment. The definitive restoration is generally completed after appropriate healing.

Although the name “All-on-4” refers to four implants, treatment must be individualized. The appropriate number, position, and type of implants depend on your anatomy, bone quality, bite, and restorative needs.

Who Can Benefit From All-on-4 Dental Implants?

All-on-4 may be considered for adults who have lost most or all of their teeth or whose remaining teeth have a poor long-term prognosis.

You may want to discuss this treatment if you:

• Are missing most or all teeth in one arch
• Have multiple severely damaged or failing teeth
• Wear removable dentures and want greater stability
• Have difficulty chewing because of tooth loss
• Are frustrated by denture movement
• Depend on denture adhesives
• Want to explore a fixed full-arch restoration
• Are considering full-mouth dental implants
• Need comprehensive reconstruction after extensive dental problems

The presence of several compromised teeth does not automatically mean they should be removed. Dr. Shiotsu first evaluates whether maintaining your natural teeth is predictable and appropriate.

Benefits of All-on-4 Dental Implants

For the right patient, All-on-4 can provide important functional and cosmetic benefits.

Improved Stability

Traditional dentures rest primarily on the gums and underlying tissues. Implant-supported teeth receive support from implants anchored within the jaw, providing substantially different stability during everyday function.

A Fixed Full-Arch Restoration

An All-on-4 restoration is designed to remain securely attached rather than being removed by the patient like a conventional denture.

Improved Chewing Function

Replacing unstable or severely compromised teeth with an implant-supported restoration may improve your ability to chew a wider range of foods. Function varies by patient, particularly during the healing period.

Natural-Looking Smile Design

The prosthetic teeth can be designed with attention to tooth shape, color, proportions, bite, and facial appearance.

No Denture Adhesives

Because the restoration is supported by implants, patients do not rely on conventional denture creams or adhesive strips to hold their teeth in position.

Efficient Full-Arch Support

Strategic implant placement can make it possible to support a complete arch without placing an implant for every missing tooth.

Who Is a Good Candidate for All-on-4?

Candidacy is determined through a comprehensive clinical and radiographic evaluation.

Potential candidates typically have:

• Extensive tooth loss or severely compromised teeth
• Sufficient bone in appropriate areas for implant placement
• Healthy or treatable gums
• General health compatible with implant surgery
• Realistic expectations about treatment and recovery
• A commitment to daily oral hygiene
• Willingness to attend ongoing professional maintenance visits

Age alone does not determine candidacy. Your overall health, oral condition, bone anatomy, medications, habits, and ability to heal are more meaningful considerations.

Who May Not Be a Good Candidate?

All-on-4 is not the best solution for everyone.

Treatment may need to be modified, delayed, or avoided for patients with certain circumstances, including:

• Uncontrolled gum disease
• Poor oral hygiene
• Certain uncontrolled medical conditions
• Inadequate bone in necessary implant locations
• Health factors that significantly affect healing
• Heavy smoking or other risk factors
• Inability to maintain an implant-supported restoration
• Unrealistic expectations about treatment
• Natural teeth that can predictably be preserved with more conservative care

A consultation allows Dr. Shiotsu to weigh these considerations and explain suitable alternatives.

Why Jawbone Quality Matters for All-on-4

Dental implants depend on the surrounding jawbone for stability and long-term support.

The amount, shape, density, and location of available bone therefore influence where implants can be placed. Important anatomical structures must also be considered during surgical planning.

At Mercer Island Dental, diagnostic imaging may be used to evaluate these factors before treatment. A CBCT scan, when indicated, provides three-dimensional information that can help with implant planning.

Will I Need Bone Grafting Before All-on-4?

Not necessarily.

One advantage of strategic full-arch implant planning is that available bone may sometimes be used in ways that reduce the need for extensive grafting. However, All-on-4 does not guarantee that bone grafting can be avoided.

If your anatomy requires additional bone support, Dr. Shiotsu may discuss bone grafting or another treatment strategy.

The All-on-4 Dental Implant Process at Mercer Island Dental

Every full-mouth reconstruction is different. Your treatment sequence will be based on your current teeth, bone, health, and restorative goals.

Step 1: Comprehensive Implant Consultation

Treatment begins with a detailed evaluation.

Dr. Shiotsu will review your dental and medical history, examine your teeth and gums, assess your bite, discuss your concerns, and determine what you hope to achieve.

This is also an opportunity to compare All-on-4 with other tooth replacement options rather than assuming a single treatment is right for everyone.

Step 2: Diagnostic Imaging and Treatment Planning

Successful implant dentistry requires planning both the surgical and restorative aspects of treatment.

Diagnostic records may include photographs, scans, impressions, X-rays, or three-dimensional imaging. These records help evaluate your bone, existing teeth, bite, implant locations, and anticipated final restoration.

Step 3: Preparing Your Mouth for Treatment

Teeth that cannot predictably be restored may need to be removed before or during implant treatment.

When necessary, tooth extractions are incorporated into the overall treatment plan rather than considered separately from your final restoration.

Any required bone or gum treatment will also be considered during this stage.

Step 4: Implant Placement

The dental implants are surgically positioned within the jawbone according to your treatment plan.

Their placement is carefully coordinated with the anticipated position of the replacement teeth. This restorative-driven approach is particularly important in full-arch implant treatment because implant position can influence function, hygiene access, and the design of the final prosthesis.

Step 5: Temporary Teeth When Appropriate

Some patients may qualify for a temporary fixed restoration soon after implant placement.

This is sometimes associated with terms such as “Teeth in a Day,” but immediate loading is not appropriate for every patient.

Adequate implant stability, bone quality, bite considerations, and other clinical factors must be present. Any teeth provided during this early phase are typically temporary and should not be confused with the definitive restoration.

Step 6: Healing and Osseointegration

The implants need time to integrate with the surrounding jawbone.

This biological process is called osseointegration and generally occurs over several months. During this period, following dietary, hygiene, and postoperative instructions is important.

Dr. Shiotsu will monitor healing and implant stability at appropriate follow-up visits.

Step 7: Your Final Full-Arch Restoration

After adequate healing, the definitive restoration can be completed.

Attention is given to:

• Fit
• Bite
• Tooth position
• Smile appearance
• Speech
• Comfort
• Cleaning access
• Long-term function

The objective is not simply to replace missing teeth, but to create a restoration planned around your overall oral function and appearance.

How Long Does All-on-4 Treatment Take?

The surgical placement of implants represents only one stage of treatment. The complete All-on-4 process typically extends over several months because the implants require time to integrate with the jawbone before the definitive restoration is completed.

Your individual timeline can depend on:

• Whether teeth require extraction
• Available bone
• Need for grafting
• Implant stability
• Healing response
• Medical conditions
• Complexity of the restoration
• Whether temporary teeth can be placed immediately

After evaluating your specific case, Dr. Shiotsu can provide a more meaningful treatment timeline.

Can I Get Teeth in a Day With All-on-4?

Some patients may be able to receive temporary replacement teeth on or near the day their implants are placed.

However, same-day teeth are not guaranteed.

Immediate loading depends on obtaining adequate implant stability and meeting other clinical requirements. The temporary prosthesis also needs to be protected while the implants heal.

The final restoration is generally made after implant integration and healing are sufficiently complete.

What Is Recovery Like After All-on-4 Surgery?

Recovery varies based on the extent of surgery, whether extractions or grafting were performed, your general health, and your body's healing response.

Temporary swelling, tenderness, bruising, and minor bleeding can occur following implant surgery.

You will receive instructions regarding:

• Oral hygiene
• Diet
• Medications when prescribed
• Activity
• Cleaning around the surgical areas
• Protecting temporary teeth
• Follow-up appointments

Following these instructions closely helps support healing.

What Can I Eat With All-on-4 Dental Implants?

Dietary restrictions are particularly important during early implant healing.

Even when temporary teeth feel stable, the implants underneath are still integrating with the jawbone. Excessive chewing forces during this period can interfere with healing.

Patients are commonly advised to follow a softer diet initially and gradually transition based on their progress and Dr. Shiotsu's recommendations.

After successful healing and completion of the final restoration, many patients experience significantly improved chewing compared with unstable conventional dentures. Individual results vary.

How Long Do All-on-4 Dental Implants Last?

Dental implants are designed as a long-term tooth replacement solution, but it is important to distinguish between the implants and the prosthetic teeth attached to them.

Implants can function for many years when they remain healthy and integrated with the bone. The full-arch prosthesis and its components experience normal wear and may eventually require adjustment, repair, maintenance, or replacement.

Long-term success is influenced by:

• Daily oral hygiene
• Gum and bone health
• Smoking
• Medical conditions
• Bite forces
• Grinding or clenching
• Professional maintenance
• Prosthesis care

No responsible implant treatment should be presented as a guaranteed lifetime restoration.

What Are the Risks and Limitations of All-on-4?

All-on-4 can be transformative for appropriate patients, but it is still a surgical and prosthetic treatment with potential limitations.

Possible considerations include:

• Infection
• Implant failure
• Delayed healing
• Bone loss around an implant
• Gum inflammation
• Prosthetic tooth wear
• Chipping or fracture of prosthetic materials
• Component loosening or wear
• Speech or bite adaptation
• Need for repair or future replacement
• Ongoing professional maintenance

Smoking, uncontrolled health conditions, poor hygiene, and excessive bite forces may increase certain risks.

Dr. Shiotsu will discuss benefits, limitations, and reasonable alternatives based on your individual circumstances.

How Much Do All-on-4 Dental Implants Cost in Mercer Island?

There is no single fee that accurately represents every All-on-4 case because full-arch implant treatment is highly individualized.

Your total investment can be affected by:

• One arch versus both arches
• Number and condition of remaining teeth
• Extractions
• Bone grafting
• Diagnostic imaging
• Number and type of implants
• Surgical complexity
• Temporary restoration
• Final prosthetic materials
• Laboratory procedures
• Additional treatment required

A comprehensive implant consultation provides a more accurate estimate based on your actual treatment plan.

For patients who want to understand payment options, Mercer Island Dental also provides information about dental financing.

All-on-4 vs. Traditional Dentures

Both treatments can replace a complete arch of missing teeth, but they work very differently.

All-on-4 Dental Implants

All-on-4 uses implants within the jaw to support a fixed prosthesis. This provides increased stability and eliminates the need for conventional denture adhesives.

Treatment involves surgery, healing, a higher initial investment, and ongoing implant maintenance.

Traditional Dentures

Traditional dentures are removable appliances that replace missing teeth without implant surgery.

They may be appropriate for patients who prefer a removable solution or who are not candidates for implant surgery. However, conventional dentures can move during chewing or speaking and may require adjustments as the mouth changes.

Neither option is automatically better for every patient. Your health, anatomy, expectations, budget, and preferences should guide the decision.

All-on-4 vs. Individual Dental Implants

Individual implants are commonly used to replace one or several missing teeth. All-on-4 is intended for a much larger problem: replacing an entire arch of teeth.

Placing an implant for every missing tooth is generally unnecessary in full-arch rehabilitation. Instead, strategically positioned implants can support a connected prosthesis.

If only a few teeth are missing, an individual implant or another localized restoration may be more conservative.

All-on-4 vs. Fixed Implant Bridges

Full-arch All-on-4 treatment and fixed implant bridges both use dental implants for support, but the appropriate design depends on how many teeth are missing, available bone, implant positions, and restorative goals.

A detailed evaluation allows Dr. Shiotsu to determine which implant configuration is appropriate rather than selecting treatment solely by its name.

Alternatives to All-on-4 Dental Implants

All-on-4 is one option within a broader range of restorative treatments.

Depending on your condition, alternatives may include:

• Preserving and restoring natural teeth
• Individual dental implants
• Implant-supported bridges
• Different full-arch implant configurations
• Removable dentures
• Bone reconstruction followed by another implant approach

The most conservative predictable option should be considered before removing restorable natural teeth.

Caring for All-on-4 Dental Implants

Implant-supported teeth cannot develop cavities in the same way natural teeth do, but the tissues and bone around the implants still require excellent care.

Plaque accumulation around implants can contribute to inflammation and disease around the supporting tissues.

Long-term maintenance may include:

• Daily brushing
• Cleaning underneath the prosthesis
• Specialized floss or interdental tools
• Water irrigation when recommended
• Professional dental cleanings
• Routine implant examinations
• Periodic imaging when appropriate
• Bite evaluation
• Monitoring prosthetic components

Your dental team can demonstrate techniques appropriate for the design of your restoration.

Why Choose Dr. Goichi Shiotsu for Full-Mouth Dental Implants?

Full-arch implant treatment requires careful coordination between surgery and prosthetic reconstruction.

Dr. Goichi Shiotsu has advanced education directly relevant to complex implant and restorative dentistry.

After earning his dental degree from the University of California, San Francisco, Dr. Shiotsu completed a two-year postgraduate Advanced Education in General Dentistry program. He subsequently pursued postgraduate training in Prosthodontics and Implant Dentistry at Loma Linda University.

His training encompasses both the surgical and restorative aspects of implant dentistry, allowing treatment planning to consider not only where implants can be placed, but also how they will support the final teeth.

Dr. Shiotsu has also:

• Served as President of the Washington State Society of Prosthodontists
• Maintained membership in the Academy of Osseointegration
• Lectured nationally on implant and esthetic dentistry
• Authored material related to his areas of expertise
• Received Seattle Metropolitan Magazine Top Dentist recognition every year since 2011
• Completed training and certification in microscope-enhanced dentistry

This background is particularly relevant for patients with complex dental conditions requiring comprehensive reconstruction.

Advanced Implant Planning at Mercer Island Dental

Full-mouth implant dentistry involves more than implant placement alone.

The final teeth, bite, bone anatomy, implant positions, aesthetics, hygiene access, and long-term maintenance should be considered together from the beginning.

Mercer Island Dental uses advanced diagnostic and restorative technology to support this planning process. Digital records can help create an accurate representation of your teeth and oral structures and assist with communication throughout treatment.

This combination of surgical planning and prosthodontic perspective is especially valuable for complex full-arch rehabilitation.

All-on-4 Dental Implants in Mercer Island and the Eastside

Mercer Island Dental provides implant and restorative care from our office at:

2825 80th Ave SE, Suite 3
Mercer Island, WA 98040

Our location serves patients from Mercer Island and surrounding Eastside communities, as well as patients traveling from nearby Bellevue and Seattle for complex restorative and implant care.

If extensive tooth loss, failing teeth, or unstable dentures are affecting your daily life, a comprehensive consultation can help you understand your options without committing you to a specific treatment.

Frequently Asked Questions About All-on-4 Dental Implants

What are All-on-4 dental implants?

All-on-4 uses strategically positioned dental implants to support a full arch of replacement teeth. It may be considered for patients who are missing most or all of their teeth or have severely compromised teeth.

How much do All-on-4 dental implants cost?

Cost varies according to the number of arches, extractions, bone needs, implant placement, temporary teeth, final materials, and complexity of treatment. A consultation is needed for an individualized estimate.

How long do All-on-4 implants last?

Implants can function for many years with healthy tissues and proper maintenance. The attached prosthesis may require adjustments, repairs, or replacement over time.

Is All-on-4 better than dentures?

All-on-4 provides fixed implant support and greater stability, while traditional dentures are removable and do not require implant surgery. The better option depends on your health, anatomy, goals, and preferences.

Can I get teeth the same day?

Some patients qualify for temporary teeth soon after implant placement. Same-day loading depends on implant stability, bone quality, bite, and other clinical factors.

How long does All-on-4 treatment take?

Although implant placement may occur in one surgical visit, complete treatment generally takes several months because the implants need time to integrate before the final restoration is completed.

Will I need bone grafting?

Not everyone needs bone grafting. Your bone anatomy and planned implant positions determine whether grafting or another preparatory procedure is necessary.

What are the downsides of All-on-4?

Treatment requires surgery, healing, ongoing hygiene, and professional maintenance. Implant failure, infection, bone loss, and prosthetic wear or damage are also possible.

Can I eat normally with All-on-4 implants?

Diet is usually restricted during early healing. After successful integration and completion of the final restoration, many patients experience improved chewing function.

Schedule an All-on-4 Consultation in Mercer Island, WA

If you are considering All-on-4 dental implants in Mercer Island, the first step is finding out whether full-arch implant treatment is appropriate for your specific condition.

At Mercer Island Dental, Dr. Goichi Shiotsu will evaluate your remaining teeth, gums, jawbone, bite, health history, and restorative goals. You will have an opportunity to understand All-on-4, alternative implant configurations, and non-implant options before deciding how to proceed.

Call (206) 736-3397 or schedule an implant consultation today.