All-on-4 is a fixed bridge for a whole jaw on four implants. At TB Dent in Trebinje, any remaining teeth are removed and the implants placed in one appointment under local anaesthetic. The next day you get a temporary fixed bridge. The final bridge follows after three to four months of healing. In total it takes five appointments over two trips. Below is every step, what to expect in the first days and what life with All-on-4 is like.
What are All-on-4 dental implants?
With All-on-4, a screw-retained bridge carries all the teeth of one jaw on just four implants, instead of replacing each tooth separately. The two front implants are placed straight and the two back implants at an angle. That way they avoid the areas where bone is often missing, which is why a bone graft is rarely needed with All-on-4.
Unlike a denture, the bridge does not come out. It stays fixed, you clean it in your mouth and you can eat everything with it.
Is it always four implants?
No. If the bone allows it and you want it, we place six implants at TB Dent, sometimes five. Six give you a reserve if one implant is lost. When we recommend four and when six is explained in All-on-4 vs All-on-6. If there isn't enough bone, Dental implants with bone loss explains what can be done.
How does the All-on-4 procedure work?
All-on-4 at TB Dent takes five appointments over two trips, seven working days in Trebinje in total. Between the trips there are three to four months while the implants fuse with the bone.
What happens before you travel?
Before you travel, you send us your CBCT scan, a 3D X-ray of the jaw. On it the surgeon sees how much bone you have and suggests the number of implants. You get the plan and the exact price before you book flights. Bring the CBCT scan with you and, if you have health problems, a written clearance from your physician. You fill in a questionnaire at the clinic.
What happens on the day of surgery?
On the first day all remaining teeth are removed and the implants placed straight away, in one appointment and under the same anaesthetic. We then take a scan of your mouth for the temporary bridge. The surgery takes about an hour per jaw for All-on-4 and about an hour and a half for All-on-6.
We use local anaesthetic with articaine. We don't offer sedation, and general anaesthesia is only possible in hospital. Surgery is usually on a Saturday morning.
What happens on the second trip?
Three to four months later we remove the temporary bridge and scan for the final one. Three days after that we try in the new bridge, and two days later it is fitted for good. This trip therefore takes about a working week.
Do you get teeth in a day with All-on-4?
At TB Dent you don't get your fixed teeth on the same day, but the next. After surgery the dental technician makes the temporary bridge from the scan, and that takes about 24 hours. So you spend one night without teeth.
We would rather say this up front, because "teeth in a day" often sounds as if you walk out of the clinic with new teeth. Every patient gets the temporary fixed bridge, and it is included in the price. You wear it until the final bridge is ready.
What is recovery like after All-on-4?
For most patients, the first days after All-on-4 are easier than they expect. You feel no pain in the chair, and most people have none afterwards either.
We prescribe painkillers and antibiotics, and cold compresses are a must for the first days. Bruising is common and fades on its own. How to plan the flight home is in Flying after dental implants.
How long does healing take?
About four months in the lower jaw and three to four months in the upper jaw. That is how long the implants need to fuse firmly with the bone, and it cannot be sped up. During that time you wear the temporary fixed bridge.
What if I can only come once a year?
Then you get the temporary bridge on one stay and the final bridge on the next. The temporary bridge lasts up to twelve months. For July and August, book your appointment at least 30 days ahead and your accommodation two months ahead.
What is life like with All-on-4?
With the final bridge, life is close to having your own teeth. It doesn't come out, you can eat everything, and speech and taste stay the same. Getting used to it takes a few days.
You clean it with a toothbrush and toothpaste, and a water flosser or superfloss is a must. The first check-up is one month after the final bridge, then every six months. We give a ten-year warranty on the implants and five years on the bridge, valid with regular check-ups. On the day of surgery you receive your implant passport.
What All-on-4 can't do and who it doesn't suit is in Does All-on-4 have disadvantages?
Who places the implants at TB Dent?
All-on-4 at TB Dent is done by Dr Darijo Pandžić, a specialist in oral surgery, and Dr Nikola Krnojelac, an oral surgery resident. We do around 60 All-on-4 cases a year. The bridges are made by our partner laboratory in Mostar, and the CBCT scan is taken at a partner imaging centre next to the clinic.
All-on-4 costs from €5,110 per jaw with us, both bridges included. What exactly the price covers and what costs extra is in All-on-4 cost. Travel and entry rules are in Dental tourism in Bosnia and Herzegovina. If you only need single implants, read Dental implant procedure.
Send us your CBCT scan on WhatsApp; all our doctors speak English. This article is also available in German.
Questions patients ask about All-on-4 dental implants
What are All-on-4 dental implants?
A fixed bridge for a whole jaw on four implants. The two back implants are placed at an angle, which is why a bone graft is rarely needed.
Do I get teeth in a day with All-on-4?
At TB Dent, the next day. The technician makes the temporary fixed bridge from a scan, which takes about 24 hours. You spend one night without teeth.
How long does it take to place four implants?
About an hour per jaw, including removing the remaining teeth, in one appointment under local anaesthetic.
Does All-on-4 hurt?
Not during the surgery, because it is done under local anaesthetic. Pain afterwards varies, and most patients have none. Swelling is usually mild.
How long does All-on-4 take to heal?
About four months in the lower jaw and three to four in the upper. During that time you wear a temporary fixed bridge.
How many trips to Trebinje does All-on-4 take?
Two: one for surgery and the temporary bridge, and one three to four months later for the final bridge. Seven working days in total.
