📅 15th May 2026
📍 Pure Smiles
All-on-4 is a full-arch implant technique that replaces every tooth in a jaw using just four titanium implants supporting a fixed bridge. The back two implants are tilted at 30–45° to anchor into denser bone, avoiding the sinus and the inferior alveolar nerve. In most cases a fixed temporary bridge is fitted the same day.
The All-on-4 concept was developed in the 1990s by Portuguese implantologist Paulo Maló in collaboration with Nobel Biocare. The principle: instead of placing 6–8 vertical implants (which often requires bone grafting), you place four — two vertical at the front, two tilted at the back.
All-on-4 is a fixed solution screwed permanently to four implants. It is not a removable denture that snaps on and off — you brush it like natural teeth.
The tilted back implants engage dense cortical bone in the front of the jaw, where bone resorbs more slowly after tooth loss. According to the Clinical Oral Implants Research journal, 10-year survival rates for All-on-4 implants exceed 94% in published cohorts of over 1,000 patients.
| Component | Budget clinic | Pure Smiles (Fulham) | Premium / Harley Street |
|---|---|---|---|
| Single arch (upper or lower) | £10,000–£14,000 | £16,500–£19,500 | £22,000–£28,000 |
| Both arches (full mouth) | £18,000–£26,000 | £30,000–£36,000 | £40,000–£55,000 |
| Implant brand | Korean/Israeli | Straumann / Nobel | Nobel Biocare |
| Bridge material | Acrylic on bar | Zirconia or PMMA | Full zirconia |
The price typically includes implants, the same-day temporary bridge, the final permanent bridge, all surgical and restorative appointments, and 12 months of reviews. Sedation (£400–£800) and bone grafting (rarely needed in All-on-4) are usually charged separately.
For a single missing tooth, see how much do dental implants cost in London 2026.
According to the standard Maló protocol used at Pure Smiles:
| Option | Cost per arch | Removable? | Bite strength | Bone grafting needed? |
|---|---|---|---|---|
| Conventional denture | £800–£2,500 | Yes | 20–25% of natural | No |
| Implant-retained denture (2 implants) | £6,000–£9,500 | Yes (snap-on) | 50–60% | Sometimes |
| All-on-4 | £14,000–£22,000 | No (fixed) | 85–95% | Rarely |
| All-on-6 | £18,000–£28,000 | No (fixed) | 95–100% | Sometimes |
All-on-6 is the more conservative option for patients with heavy bite forces or bruxism. All-on-4 is not inferior — it’s the right tool for the right anatomy, particularly when bone in the back of the jaw is already compromised.
Ideal candidates have:
Relative contraindications include uncontrolled diabetes (HbA1c above 8.0), active periodontal disease (treat first — see periodontist vs general dentist), heavy smoking (>10/day reduces success by 10–15%), and bisphosphonate therapy.
Aftercare is simpler than natural teeth in some ways: there’s no decay risk because the bridge is non-vital ceramic. But peri-implantitis — gum disease around implants — is the leading cause of late failure.
Daily maintenance: electric toothbrush, water flosser, interdental brushes around each implant abutment. Hygiene appointment every 3–4 months with a hygienist trained in implant maintenance (we have specialist hygienists at Pure Smiles).
For a single-tooth alternative, compare with dental implants vs bridges. Book an All-on-4 consultation in Fulham to receive a personalised CBCT-based treatment plan.
All-on-4 costs £14,000–£22,000 per arch in London in 2026. Pure Smiles cases start at £16,500 using Straumann implants and a temporary same-day bridge.
Studies show implant survival above 94% at 10 years. The implants themselves typically last 20+ years; the prosthetic bridge is usually refurbished or replaced after 10–15.
Yes. The All-on-4 protocol is designed for immediate loading — a fixed temporary bridge is fitted the same day as surgery.
All-on-6 distributes forces over more implants and gives redundancy if one fails. All-on-4 is more cost-effective and usually avoids bone grafting. Both have strong long-term data.
Most patients with extensive tooth loss are candidates. Uncontrolled diabetes, active gum disease and heavy smoking reduce success rates and may need addressing first.
