What is the Success Rate for "All on Four" Dental Implants?

The all on four implants replace complete upper teeth with four titanium pins holding them. How can one insure they will not have a negative reaction to the titanium implants?

Doctor Answers 10

Success rate of All on Four and Titanium Allergies

All on 4 technique was created by Dr. Paulo Malo and many research papers have shown an excellent success rate.  The success rate of the prosthesis is close to 100%.  The average implant survival rate is about 95%.  Since the All on 4 uses four or more implants per arch, a loss of one implant does not equate to failure of the restoration.  If an implant fails for various reasons, the implant can be replaced or repositioned to acheive a better final prosthesis.

The titanium used in dental implants are biocompatible.  Titanium is prefered in dental implants due to is ability to osseointergrate and its corosion resistance.  

All on Four Dental Implants or Permanent Teeth-in-1-Day Dental Implants have an incredible success rate!

The average success for dental implants is around 95%, depending on the purpose and location
of the implant. A successful dental implant is one which remains anchored for a minimum of five
years. Typically, the success rate is closer to 100% for tooth implants in the front lower jaw
because the lower jaw bone is denser, and around 85% for tooth implants in the sides and rear
upper jaw.

Dental implant technology has progressed to the point where almost anyone can be a prospect
for dental implants if they are missing one or more teeth. Even those with specific health
conditions who may have been told that they were not a candidate for implants, may benefit
from our extensive expertise in implant procedures. Dental implants give you a healthy, comfortable smile that's both PERMANENT and NATURAL LOOKING AND FEELING! Our patients simple love this life-changing procedure!!!

Charles Botbol, DDS
Toronto Dentist
5.0 out of 5 stars 13 reviews

All on Four is an excellent option for people who suffer with Dentures

The all-on-four technique is an excellent treatment option for someone who suffers with their loose or ill fitting dentures.  It is also a great option for people who have been previously been turned away from dental implants due to insufficient bone height/width/volume.  It gives patients hope and the chance to have a set of teeth which are NOT REMOVABLE.  That in itself is priceless.   Some patients can not afford to have 8-12 implants placed in each jaw to get a set of teeth.  All-on-four gives these patients a chance. 

The success rate is excellent when this procedure is properly executed and the patient is a good candidate for this treatment modality.

Giri Palaniswamy, DDS
Beverly Hills Dentist
5.0 out of 5 stars 3 reviews

You might also like...

"Actual" Success rate for ALL-on-4

I read ALOT. I've also restored ALOT of All-on-4 cases myself. The answer must be based on science!! The doctor that invented the procedure (Dr. Malo) published many papers on longterm followup, with good results. The All-on-4 was originally designed to replace the lower teeth, since lower conventional dentures are very poorly accepted by patients. There is more data on lower All-on-4 treatments...He will have 15 year data on these patients soon. Since there was good results on the lower, they started tracking the upper treatment outcomes, which they only have 5 year followup (soon 10yr). He looked at a couple of different things---

1. Teeth vs. No teeth? Do success rates differ if the patient has teeth currently that need to be extracted, compared to a patient that needs the All-on-4 with no teeth at all?? Or in other words: Does the patient currently have a few missing teeth (partial edentulism) or are they already missing ALL of their teeth (full edentulism)... Does it matter?

2. Upper Arch (Maxilla) vs. Lower arch (Mandible)? Bone is typically more dense in the lower mandible compared to the upper maxilla. Does it matter?

Actual Success Rates for "All-on-4" implants:

Lower Arch: 
5 year followup: 94.8 percent (for people that had the procedure and started with full edentulism; no teeth at all) and 98.1 percent (for partial edentulism)

10 year followup: 93.8 percent (started with full edentulism) and 94.8 percent (for partial edentulism)

Upper Arch:
5 year followup:
93 percent (full edentulism)

Generally speaking, longterm success depends on many factors: patient compliance, hygiene, use of night guards, overall systemic health of patient, grinding of teeth (bruxism), general wear and tear from usage of bridges, trauma, smoking, etc.

Overall, the procedure has some of the highest success rates for ANY dental procedure. However, there is a trend that the lower treatment is slightly more successful than the upper, nonetheless, BOTH are in the ++90%. 

The above information is for educational purposes only. You should have a consultation with your Prosthodontist and Oral Surgeon prior to any treatment.

Ace Jovanovski, DMD
Round Rock Prosthodontist

All-on-4 Implant supported prosthesis

Multiple techniques allow nowadays predictable results with immediate load of the prosthesis for edentulous patients. Depending upon the remaining amount of bone we can place 6-8 implants in cases with minimal bone loss where the prosthesis will have ony "white teeth" without pink porcelian or acrylic. But in patients with extensive bone loss, this type of treatment can become challenging. The most common areas that have limited amount of remaining bone is posterior maxilla and posterior mandible, and sometimes additional bone/soft tissue augmentation can be unpredictable.

Technique All-On-4 gives the chance to the patients with severe bone loss to get fixed prosthesis at the time of the implant surgery when other conventional techniques will fail. Not every patient should be a candidate for this type of treatment however it is becoming more popular due to it`s availability. The amount of bone loss is evaluated with CT scan (CBCT) to identify the areas where the implant will get good bone support and excellent prognosis. Usually the overall treatment plan involves multiple appointments: diagnostic impressions for immediate prosthesis, implant surgery with immediate placement of the prosthesis, fabrication of the final prosthesis. The surgical part is performed by oral surgeon and prosthetic part is done by a prosthodontist, specialists who are additionally trained to work with this particular method. The treatment is performed in sterile operating room setting under intra-venous sedation when patient is asleep. Not every implant dentist has an experience to perform this procedure.

This type of treatment helped many patients with extreme bone loss, trauma, after cancer rehabilitation, in cases with previously failed implants, in cases where none of the conventional methods can be used. This method is utilizing Nobel Biocare implants and has strong underlying research. All modern implants have the same type of titanium alloy which is a standard for every implant company. It has high biocomatibilty with biological tissue and none recorded case of allergy according to the research.

if you consider this type of tretament you should discover the options with ClearChoice centers which specialize with Al-On-4 treatment.

All-on-Four implant approach

First the answer to your question regarding reaction to implants: All implants are made of titanium which is very bone and tissue friendly and does not cause any reaction or rejection. Infection or inflammation is the only factor that can cause implants 'not take'.

As for All-on-Four implant approach, it's important to know that it is not for everyone and only selected patients may be appropriate for it. Also, it requires close collaboration between surgeon and the restorative dentist or prosthodontist to make it work. Also, the outcome and long term results are unknown as there is are not enough studies or long term evaluation in the literature yet. There are other approaches that are more predictable and perhaps even more successful in long term than All-on-Four technique.

The bottom line is it's risky, technique sensitive, and have potentially higher chances of failure than other more routine techniques.

H. Ryan Kazemi, DMD
Bethesda Oral & Maxillofacial Surgeon
5.0 out of 5 stars 5 reviews

Implants have high success rates.

All on four can work depending on your age and the density of your bone structure. A bone density test can reveal that and a panorex or CT scan. I would do more implants than 4 tho or at least get a second opionion from someone that does NOT do the all on four treatment.

Michael J. Thomas, DDS
Los Angeles Dentist
1.0 out of 5 stars 1 review

Implant success is very predictable

All on four has shown some great success in cases where conventional wisdom would suggest that all-on-four was pushing the limits of our experience.  While it is usually considered to have some very narrow applications and believed that it cannot be used for EVERY case, this approach is becoming more common.  For the cases that are appropriate, success is good.  Depending on type of final restoration, quality of bone, bite forces and other factors, "all on four" may work for you.

As far as insuring no adverse reaction, nothing is 100%.  Titanium is not recognized by the body as foreign, so there is no rejection of the material.  However, if infection is present at the time of placement or during the healing phase, then success rates go down.

If all on four is not appropriate, more implants and additional augmentive surgeries will increase chances for success.

The titanium aspect of implants is very predicatable.

However, the "all on 4" concept has very poor predictability.  The biology of the bone, the extend of the prosthesis are only 2 of the crucial players in this restoration.  Most cases have been tried in university settings only, the ones in private practice have had little overall long term success.  They do work in carefully treatment planned cases, with very qualified specialists. 


Anca Bazile, DDS, MSD, New York City

Anca Bazile, DDS
New York Dentist

High Success, But Common Complications

Great question. The answer, however, is not so simple. 

The All-on-Four procedure (aka permanent dentures, fixed dentures) consists of two main components: surgical and prosthetic. Both components have widely documented success rates in the high 90%'s over 5-10 years. This treatment is very successful and it can make a tremendous difference in a patient's quality of life. 

However, it would not be fair to promise that your permanent dentures are going to be "problem-free." I don't mean to scare you, but you should know exactly what you are getting into. Everything in dentistry eventually breaks and has to be repaired--including permanent dentures. Similar to a car, permanent dentures need to undergo regular check-ups and some maintenance.

Over time, the prosthetic teeth may wear or chip and will need to be replaced. The rate of this wear depends on many things. There are several different materials that can be used to make permanent denture including: acrylic & titanium or zirconium & porcelain. These materials have different implications for the cosmetic outcome and durability of the prosthesis. 

With regard to allergies, it is very rare that a titanium implant would cause an allergic reaction--but it is possible and it is reported in the literature. Patients that have other metal allergies may be particularly susceptible. In these cases it may be recommendable for the patient to see a physician who specializes in Allergy & Immunology to do a "patch" test for titanium allergy. 

Ask your dentist:

1. What material is used and how does it affect cosmetics/durability?

2. Do they ever have problems with wear/breakage on permanent dentures?

(If they say they don't, it probably means that they are fairly new to this procedure.)
3. How many appointments does it take?

4.  Do they have a guarantee on permanent dentures?

(Some dentists do. My personal guarantee is that if the patient comes for routine check-ups, I will only charge for minimum laboratory fees for any maintenance required.)

I hope this helps!


Ivan Chicchon, DDS
Stockton Dentist
5.0 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.