All-on-4 dental implants: how they work, and having them done in Vietnam

All-on-4 dental implants replace every tooth in one jaw with a fixed bridge held by four implants. The two front implants usually go in straight and the two back ones are tilted. Most clinics fit a temporary fixed bridge within about a day of surgery, then replace it with the final bridge once you've healed. Because there are two stages, a trip to Vietnam for All-on-4 usually means at least two visits.

All-on-4 is one of several ways to replace a full arch. If you're still comparing options, read our guide to full mouth dental implants first, and get a CBCT scan reviewed before you plan anything else.

How All-on-4 works

All-on-4 was developed as a way to give people a fixed set of teeth on the day of surgery, using a small number of implants. A study of the method describes the basic plan: four implants per jaw, with angled connectors on the tilted back implants, and a fixed bridge attached the same day.

Tilting the back implants does two things, according to the same study. It lets the surgeon place a longer implant than would fit straight up, and it shortens the part of the bridge that sticks out behind the last implant, which is better for the bite.

The bridge is screwed to the implants. You can't take it out at home, and you clean it in your mouth like natural teeth, with extra attention around the implants.

Stage	What happens	When
Planning	Exam, X-rays and a CBCT scan, medical history, treatment plan	Before or at the start of trip 1
Surgery	Any remaining teeth removed, four implants placed	Trip 1
Temporary bridge	A fixed temporary bridge is attached	Within about a day of surgery
Healing	The bone grows around the implants	Months. One study allowed 3 months
Final bridge	The temporary bridge is replaced with the final one	Trip 2
Maintenance	Check-ups and professional cleaning	For as long as you have the bridge

The American Dental Association explains that the bone grows around an implant and holds it in place, a process that can take up to several months before the final teeth go on.

What the studies show

Most of the long-term evidence for All-on-4 comes from large clinic studies that look back at past patients, so the results reflect experienced teams.

• Japan, up to 17 years. A study of 561 jaws and 2,364 implants found implant-level survival of 97.4% in the upper jaw and 98.9% in the lower jaw. The upper jaw was the biggest risk factor for failure, and most upper-jaw failures happened in the first 24 months.
• Temporary or final bridge on day one. A study of 126 patients found implant survival of 98.2%. The most common problem in the first 3 months was chipped or broken teeth on the bridge, which happened with both temporary and final bridges.
• Four or six implants. A Lisbon study of 943 patients found similar survival with four or six implants, 98.4% and 98.7% at 5 years. The authors note it came from one clinic and one experienced surgeon.

These are good numbers, but they come from specialist centres. Ask your clinic how many full-arch cases its surgeon has done, and what happens if an implant fails.

Who All-on-4 suits

All-on-4 is usually considered for people who have lost most or all of the teeth in a jaw, or whose remaining teeth can't be saved. The ADA says good general health matters more than age, and that chronic illnesses such as diabetes or leukaemia may interfere with healing. Tobacco use can slow healing too.

Tell the surgeon about every medical condition and medicine. Some patients need a check by their own doctor before surgery. Older patients should read our guide to dental implants for seniors, which covers medicines and health conditions.

Planning All-on-4 in Vietnam

Send your records first. A recent panoramic X-ray or CBCT scan lets the clinic say whether All-on-4 is suitable and how many trips you'll need. Our guide to dental X-rays and scans explains which files to ask for.

Plan two trips. The first trip covers the exam, scan, extractions, implant surgery and temporary bridge. The second trip, months later, is for the final bridge. Planning your visits shows how an implant trip is usually laid out day by day, and the trip planner builds a sample schedule.

Leave time to recover before you fly. Full-arch surgery is a bigger operation than a single implant. Read flying after dental treatment and ask the surgeon when it's safe to fly.

Eat soft food. The ADA suggests soft foods, cold foods and warm soup while you heal. Your temporary bridge also needs care, as chipping was a common early problem in the research. What to eat after dental surgery lists soft Vietnamese dishes.

Questions to ask the clinic

• Who will place the implants, and how many full-arch cases have they done?
• Which implant system do you use? Can dentists in my home country service it?
• What is the temporary bridge made of, and what is the final bridge made of?
• When will you fit the final bridge, and how long should the second trip be?
• Do I need extractions, bone grafts or other procedures first?
• What does the warranty cover, and what happens if an implant fails after I'm home?
• Which records will I take home: scans, implant details and treatment notes?

Every clinic listed on VietDentalTrip has had its licence, lead dentist and address checked. See how we verify clinics, and ask for a written plan and itemised quote before you book.