All-on-4 or Strategic Implants

What is All-on-4, and how is it different from a strategic implant?

Both methods restore a full mouth, but they anchor in different bone

All-on-4 is the best-known name in full-mouth implant treatment. The difference between it and a strategic implant is not the number of implants but which layer of bone in the jaw the implant anchors in. On this page we set out the thinking behind the two methods side by side. Send us your CBCT scan and we will write and tell you, within one working day, which of them is an option for your jaw.

Short answer

All-on-4 is a way of carrying a fixed bridge on four implants in one jaw; the two back implants are tilted to avoid the sinus and the nerve in the lower jaw. It anchors in the spongy bone inside the jaw, so fusion has to be waited for and the first bridge fitted is temporary. A strategic implant, by contrast, locks mechanically into the hard cortical outer layer; there is no wait for fusion, grafting does not come into it and the final fixed teeth are fitted over three clinic days. The distinction lies not in the number of implants but in the layer of bone they anchor in. A three-dimensional CBCT scan shows which suits you.

Implants in All-on-4: Four per jaw
Where the difference lies: Spongy bone or cortical bone
What decides it: A three-dimensional CBCT scan
Scope: Full mouth and many missing teeth

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-08-31

The thinking behind the two methods, and where they part ways

All-on-4 takes its name straight from its own description: all the teeth in one jaw are replaced by a one-piece fixed bridge that sits on four implants. In the classic approach, six, eight or sometimes more implants are planned to give a jaw fixed teeth. All-on-4 is a placement scheme designed to bring that number down to four; the bridge is not an appliance you can take out and put back in, but a single piece screwed to the implants.

The key idea of the scheme is angled placement. The two front implants go in straight, while the two back implants are tilted so that the end in the bone points forwards. There are two reasons for this: at the back of the upper jaw there is the sinus, and at the back of the lower jaw there is the nerve canal, and the tilt takes the implant in front of these structures; in addition, because the top end of a tilted implant, which carries the bridge, comes out further back, the four implants support the arch over a wider area.

The real question is this: what do these four implants anchor in? All-on-4 is a placement plan within the conventional implant family. The body of the implant sits in the spongy bone inside the jaw, and anchorage is established as the bone around the implant surface fuses with it over time; this fusion is measured in months. For fusion to take place, a certain height and width of bone is needed where the implant will sit. This applies especially at the front of the jaw, because all four implants are gathered there and in the area next to it.

That is why, with All-on-4, the bridge fitted on the first day is temporary; the permanent bridge is made after the implants have fused with the bone, and chewing is restricted throughout this period. It is true that tilted placement reduces the need for a graft, because it bypasses the area at the back where the bone shrinks most. But if there is not enough bone left at the front either, a graft or a sinus lift (sinus floor elevation) is back on the table.

This is exactly where a strategic implant parts ways. Instead of looking for volume in the spongy bone, it targets the hard, dense layer that surrounds the jaw from the outside: the cortical bone. This layer is the load-bearing framework of the jaw and the part most resistant to shrinking; while the spongy bone reduces over the years, it stays in place. The implant is placed so that it reaches that layer, at an angle that locks it mechanically into it. What provides the anchorage is not a fusion that takes months but this locking, which is there from the first day.

In practice, this one difference sets off a chain of consequences. Because there is no wait for fusion, the fixed teeth are fitted directly once the implants have been placed; at the end of three clinic days you leave the clinic with your final fixed teeth. Because anchorage does not depend on the volume of spongy bone, bone graft material, grafting and months of waiting do not come into it. Because the load is not concentrated in one area, more than four implants are placed and spread across the whole jaw; the chewing force is shared along the arch.

Listing what the two have in common keeps the comparison honest. Both use titanium implants, both were designed for a full mouth and for many missing teeth, neither can be planned without a three-dimensional CBCT scan, and neither is carried out while there is active inflammation in the mouth. And with both, getting fixed teeth does not mean that care is over.

The decision comes down to three questions: is the hard outer layer of your jaw suitable for anchorage, is the volume a conventional implant needs still there at the front, and how long are you prepared to wait? If the answer to the first question is yes, a strategic implant is on the table, and grafting and months of waiting drop out of the picture. If the answer to the second question is also yes, All-on-4 is a workable plan. These answers come from an examination and a CBCT scan, not from any sentence on this page.

Who each one is preferred for

The first list describes the situations in which our protocol comes to the fore, the second the situations in which another route is more appropriate. Both become clear after a CBCT scan.

The tooth can be saved

Jaws that have been without teeth for a long time and have shrunkIn a jaw that has worn a denture for years, the spongy bone has reduced markedly, and whether the volume All-on-4 needs is there becomes open to question. The hard outer layer, however, stays in place; a strategic implant anchors in it.
You have been advised to have a graft and do not want oneIf you have been advised to have bone added and to wait for months, a second plan based on your cortical layer is possible. We look at your CBCT scan and tell you in writing whether this step is necessary in your case.
You do not want to waitWith All-on-4, the permanent bridge is made after fusion, and months pass in between. With a strategic implant, the fixed teeth fitted over three clinic days are the final teeth; no new set is made later to replace them. If your schedule is tight, this difference is decisive.
Diabetes that is being monitoredDiabetes is not a barrier, and we use this protocol for people with diabetes. What matters is that your blood sugar is being monitored and that there is no active inflammation in your mouth. We want to see your medicines and your latest test results from the start.

Saving it is unlikely to hold

One or a few missing teethNeither All-on-4 nor strategic implants are approaches designed for a single gap. When one or two teeth are missing, a conventional implant or, depending on the situation, a bridge is more appropriate.
Jaws in which the hard outer layer is damaged tooA large cyst, previous jaw surgery or severe trauma also damages the cortical layer. Whether a sound surface is left to anchor in is shown by the CBCT scan. In a situation like this, a plan with a graft may be the right route.
Gum inflammation that has not been brought under controlIf there is active inflammation in the mouth, we deal with that first. We do not place implants in inflamed ground, whatever the method. This point changes the order of things; it does not close the door.
An uncontrolled systemic condition and certain medicinesA systemic illness that is not under control, or certain medicines that affect bone metabolism, change the plan. We ask for the full list of the medicines you take at the first consultation; leaving anything out only works against you.

How we decide which one suits you

This sequence is for the decision, not for the treatment. At the end of it you know which of the two methods is an option in your jaw and what that is based on.

1
Send us your scan
If you have a panoramic X-ray or a CBCT scan, send it through the form. The scan is read by the dentist who will carry out the treatment; the first reply is written by the dentist, not an assistant. You do not need to come in; we get back to you within one working day.
2
A three-dimensional CBCT scan
Because the two methods look at different layers, what is measured is different too. All-on-4 asks about the height and width of the bone at the front; a strategic implant asks where the cortical layer is, how thick it is and how sound it is. On the same scan we map the limits of the sinus in the upper jaw and the path of the nerve canal in the lower jaw; these directly determine the angle of the implants.
3
The rest of the mouth
The health of the gums, any teeth and roots that need to come out and the bite of the opposite jaw are part of the plan. A plan built by looking only at bone measurements is an incomplete plan.
4
General health and medicines
We want to see your systemic illnesses, the medicines you take regularly and your latest test results. Diabetes is not a barrier; it affects the planning and the order of the steps.
5
You get the plan in writing
How many implants, in which jaw, at what angle, with what bridgework and whether a graft is needed are set out in writing. If the method that suits you is not ours, we write that just as plainly.
6
Three clinic days
Once we have agreed on the plan, the surgery and the fitting of the fixed teeth are spread over three clinic days. You know what will be done on which day before you arrive.

The routes on the table for a full mouth

All-on-4 and strategic implants are not the only options. None of the routes below is superior to the others in every case; which one is right is decided by the picture in your own jaw.

All-on-4

Four implants per jaw, with the back ones tilted. A one-piece fixed bridge is fitted on the first day as a temporary bridge, and the permanent bridge is made after fusion. A scheme designed for jaws with enough bone volume at the front.

A fixed bridge on six or more implants

The same conventional logic, with more implants. The load is spread over more points and the bridge can be divided into sections. A valid plan if the bone volume allows it; if it does not, it means a graft and waiting.

Strategic implant

Instead of looking for volume in the spongy bone, the implant is placed so that it locks into the hard outer layer. There is no wait for fusion; grafting and months of waiting do not come into it, and the final fixed teeth are fitted over three clinic days. For mouths with a sound cortical layer and many missing teeth.

Removable dentures

A denture held on a small number of implants by stud attachments, or a conventional full denture with no implants at all. These make the surgery smaller or leave it out altogether; on the other hand, the denture comes out of the mouth, chewing does not feel as it does with fixed teeth, and with the option without implants the bone carries no load, so it goes on shrinking.

What you should know when you decide

We write these not to frighten you but so that you can ask the right questions at whichever clinic you go to.

The number of implants is not a measure on its own

"Is four better, or eight?" is the wrong question. What decides it is not how many implants there are but which bone they anchor in and at what angle. The same number of implants gives two different results in two different jaws.

Ask about the second half of "teeth in a day"

In some plans this phrase refers to a temporary bridge, in others to the final bridge; the difference between the two is months. Whichever clinic you go to, ask this: are the teeth fitted on the first day the final teeth, and if not, when is the final bridge made?

A tilted implant is not a flaw in itself

Angled placement is a deliberate solution used to pass in front of anatomical structures. The problem is not the tilt but which scan the planning is based on. An angle drawn on a two-dimensional X-ray does not represent a three-dimensional structure.

An implant can be lost

As with every implant method, there is a chance of failure with this one too, and we say so from the start. Smoking, uncontrolled diabetes and neglected oral hygiene are known to increase the risk.

Fixed teeth do not mean the end of check-ups

The underside of a full-arch fixed bridge needs a different kind of cleaning from the spaces between natural teeth; an interdental brush and a water flosser are part of this treatment. If the gum around an implant is neglected, it becomes inflamed, and if the inflammation progresses, the surrounding bone is lost.

What to expect afterwards

The course below applies to patients treated with strategic implants. With a plan that waits for fusion, such as All-on-4, or when a graft has been done, the timeline is longer.

Three clinic days
Once the examination and planning are complete, the surgery and the fitting of the fixed teeth are spread over these days. You leave the clinic with your fixed teeth. Some swelling and tenderness over these days is normal.
The first week
The swelling goes down. We ask you to eat soft food, to stay away from hard and hot food and to brush the area gently. If there are stitches, they are removed according to the clinic's follow-up plan.
The first weeks
We increase the chewing load step by step. Habits such as eating hard-shelled foods and chewing ice are put off during this period. Over these weeks the gum settles into its new shape.
Check-ups and the long term
We give you the check-up schedule and the care routine for the bridgework in writing. Interdental cleaning, regular professional cleaning and yearly imaging are a permanent part of the plan.

Message us right away if

Swelling increases after the third day. Swelling goes down as healing progresses. If it is increasing, we need to assess it.
You have a fever. A fever is a warning sign of infection. Call us without waiting.
Numbness does not wear off. Tell us about any numbness that persists in your lip, chin or tongue.
You feel movement in the bridge. A fixed bridge does not move. If you feel even the slightest movement when you bite, do not try to deal with it yourself; call us.

What sets the cost

We give no figures on this page, because the right figure can only be given once the CBCT scan has been seen. Send us your scan and we will set out the scope in writing, item by item. These are the items that set the total:

Number of implants and which jaw: One jaw or both, how many implants are planned and in which areas they will be placed set the total directly. All-on-4 and a plan with more implants do not come under the same item.
Whether extra surgery is needed: If a graft or a sinus lift is needed, the scope widens. When this item does not come into it, both the timeline and the total get smaller; we tell you whether it applies to you after the CBCT scan.
Preparing the mouth: If there are teeth that have to come out, gum inflammation that has to be treated or roots that have to be removed, these are added to the plan and affect the timetable too.
Bridgework, and how many bridges are made: The material of the fixed teeth and the laboratory work affect the total directly. Plans that wait for fusion also involve making two bridges: first a temporary bridge, then the permanent bridge months later. We tell you the brand of the material we use in writing from the start.

Frequently asked questions

Is All-on-4 a bad method?

No. All-on-4 is an established way of giving a full mouth fixed teeth, and in the right jaw it works well. The distinction we draw is not one of quality but of mechanism: All-on-4 waits for fusion with the spongy bone, while a strategic implant locks into the hard outer layer from the first day. If the bone at the front of your jaw is still there, All-on-4 is a workable plan; if it has shrunk, a strategic implant comes into play.

Are four implants enough to carry a whole jaw?

If the placement is right and there is enough bone, yes; that is exactly what the scheme was designed for. But four implants narrow the margin for error: if one of the implants is lost, the number of points the bridge rests on drops by a quarter. That is why we prefer to share the load across more implants spread over the whole jaw.

People say All-on-4 does not need a graft either, so what is the difference?

That is true: tilted placement bypasses the area at the back where the bone shrinks most. But all four implants are gathered at the front, so a volume of spongy bone is still essential there. If that volume has shrunk, a graft comes back into an All-on-4 plan. Because a strategic implant looks for a hard surface rather than volume, it does not depend on this condition.

What is the difference between teeth fitted on the first day and teeth fitted three days later?

In an All-on-4 plan, the bridge fitted on the first day is temporary; the permanent bridge is made over the following months, after the implants have fused with the bone. In our protocol, on the first and second days you have try-in teeth in your mouth, used to settle the final design; the teeth fixed in place at the end of the third day are your final teeth. You do not leave the clinic without teeth, and you are not waiting for a second bridge to be made afterwards.

I have worn a full denture for years and my jaw has shrunk badly. I was told I cannot have All-on-4.

That answer tells you that the bone volume a conventional implant needs is no longer there, and within its own method it is correct. What it does not tell you is whether your hard outer layer is still there; because conventional planning does not target that layer, it has no need to measure it either. Send us your CBCT scan and let us take that measurement.

I have diabetes. Can I have full-mouth implants?

Diabetes is not a barrier, and we use this protocol for people with diabetes. What matters is whether your blood sugar is being monitored and whether there is active inflammation in your mouth. If your blood sugar is poorly controlled, we get it under control first; skipping that step does nobody any favours.

I have a panoramic X-ray. Do I really need a CBCT scan?

It is enough for a preliminary assessment; we look at it and write and tell you which possibilities are on the table. It is not enough for a treatment decision. A panoramic X-ray is two-dimensional; it does not show the thickness of the bone, the real position of the sinus and the nerve canal, or the condition of the hard outer layer. The placement plan for both methods is based on this information.

Sources

Send your X-ray and we will tell you which option is realistic for your tooth.

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Next step

Send your X-ray and we will talk through the options.

Share your CBCT or panoramic X-ray. We will write back within 24 hours on which option is realistic for your tooth.

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