All-on-4 is a fixed bridge for a whole jaw on four implants, and for most people without teeth it is a good solution. Like any procedure, it has limits that are worth knowing in advance: four implants leave no reserve if one is lost, it costs more than a denture, and the final bridge comes three to four months later. At TB Dent in Trebinje we do around 60 All-on-4 procedures a year, and before each one we assess what is best for you: four, five or six implants, or a different solution.
What happens if one implant is lost?
With All-on-4, the whole jaw rests on four supports. If one implant is lost, a fixed bridge cannot be made on the remaining three, so the patient moves to some form of denture. With six implants, losing one still leaves five, and the fixed bridge stays.
That is why at TB Dent, whenever there is enough bone and you want it, we suggest six implants. Work on six is also more stable, because the chewing force is spread over more supports. The difference is €1,534 (3,000 KM) per jaw. How we choose between four and six is explained in All-on-4 or All-on-6.
Can it be five implants?
Yes. The number does not have to be four or six. When the bone allows five but not six, we place five. You get the plan after a CBCT scan, before the surgery.
What is life like with All-on-4?
In everyday life, All-on-4 is close to having your own teeth. The fixed bridge does not come out and you can eat everything. It does not affect speech or taste, and 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.
Unlike a denture, which over time stops holding because the bone shrinks where teeth are missing, a bridge on implants stays firmly in place.
How much does All-on-4 cost compared with dentures?
At TB Dent, All-on-4 costs from €5,110 (10,000 KM) per jaw with Neodent implants, and a full denture €205 to €256. Over ten years, with new dentures, relining and repairs, a denture costs around €767. The difference is large, but for it you get fixed teeth that do not come out.
If you choose a denture now, you can still move to All-on-4 later, but the longer you wait, the less bone there is. Payment is in two parts: the surgical part on the first visit, the rest when the final bridge is ready. We do not ask for payment in advance, and both jaws at once bring a 10 percent discount.
What are the surgery and recovery like?
All-on-4 surgery is done in one visit, under local anaesthetic: any remaining teeth are removed and the four implants placed straight away. It takes about an hour per jaw. You feel no pain in the chair; pain afterwards varies, and most patients have none. We do not offer sedation, and general anaesthesia is only possible in a hospital.
After the surgery you spend one night without teeth, because a dental technician makes the temporary bridge from a scan. You get it the next day.
How long do swelling and bruising last?
Swelling lasts a few days and is usually mild, because we give a dexamethasone injection during surgery. Bruising is common and fades on its own. We prescribe painkillers and antibiotics, and for the first few days cold compresses and soft food are a must. We usually operate on Saturday mornings, and you can fly home two days after surgery; how to plan the flights is covered in Flying after dental implants.
Why does All-on-4 take several months?
All-on-4 takes several months because the implants have to fuse with the bone: about four months in the lower jaw, three to four in the upper. During that time you wear a temporary fixed bridge. Treatment has five visits over two trips, seven working days in Trebinje in total.
About 30 percent of our All-on patients come from overseas. If you can travel only once a year, you can get the temporary bridge on one trip and the final bridge on the next. Entry rules, accommodation and transfers are covered in our guide to dental tourism in Bosnia and Herzegovina.
When is All-on-4 not the right choice?
All-on-4 is not right for everyone, and we assess that before surgery. At TB Dent we do not do it with uncontrolled diabetes, osteoporosis or bisphosphonate therapy, bone density below 150 HU (type D5), in people under 18, during pregnancy, or for oncology patients. Smoking is not an absolute barrier, but we discuss it before treatment.
When All-on-4 is not the best choice, the surgeon suggests another solution: six or five implants, bone grafting, or a denture on two implants. Most patients do not need bone grafting, because the back implants are placed at an angle. When grafting is needed, it costs €102 (200 KM) per gram of bone.
How does TB Dent assess what is best for you?
Assessment at TB Dent starts with a CBCT scan, which shows how much bone you have and how dense it is. Based on it, Dr Darijo Pandžić, a specialist in oral surgery, suggests the number of implants and gives you the exact price before surgery. If you have health problems, we also ask for a letter from your physician.
The consultation can be done remotely: you send your scan on WhatsApp and get the plan before you travel. It is free, in English, and led by the surgeon who will do your treatment.
After treatment you get a written warranty: ten years on the implants and five on the bridge, with a check-up one month after the final bridge and then every six months. If something needs fixing once you are home, we see you straight away, without waiting for an appointment; the trip is at your own cost. With your implant passport, a dentist at home can also repair the work. This article is also available in German.
Questions patients ask about the downsides of All-on-4
What happens if one of my All-on-4 implants fails?
A fixed bridge cannot be made on the remaining three, so you move to some form of denture. That is why, when the bone allows it, we suggest six implants.
Is All-on-4 better than dentures?
All-on-4 is a fixed bridge that does not come out and lets you eat everything, while a denture stops holding over time. All-on-4 costs from €5,110 per jaw, a full denture €205 to €256.
Can I get teeth the same day?
You get the temporary fixed bridge the next day, because the technician makes it from a scan. You spend one night without teeth.
Can All-on-4 be finished in one trip?
No. The implants need three to four months to fuse with the bone, so treatment takes two trips to Trebinje, seven working days in total.
Can I have All-on-4 if I smoke or have diabetes?
Smoking is not an absolute barrier, but we discuss it before treatment. With controlled diabetes we assess each case; with uncontrolled diabetes we do not do All-on-4.
How do I know if All-on-4 is right for me?
Send your CBCT scan on WhatsApp. The surgeon who does the treatment will suggest the number of implants or another solution and give you the exact price before you travel.
