All on 4
All-on-4 recovery — what New Zealand patients experience after full-arch surgery
All-on-4 recovery: swelling peaks at 48 hours, soft diet for 8–12 weeks, 3–6 months osseointegration in NZ. Most patients fly home 5–7 days after surgery with their provisional bridge.
All-on-4 recovery at Picasso Dental Clinic involves 3–5 days of significant swelling that peaks at 48 hours, a soft diet for 8–12 weeks while the provisional bridge is in place, and an osseointegration period of 3–6 months before the final high-strength prosthesis is fitted on trip two.
All-on-4 is a full surgical event and the recovery reflects that. Four implants are placed, remaining teeth are extracted in the same session for most patients, and a full-arch provisional bridge is fitted before you leave the clinic. This is a significant procedure by any measure — and the recovery is more demanding than a single implant in both duration and intensity.
What surprises most patients is that it remains manageable. The discomfort is real but it is contained within a predictable protocol, and the result on the other side of recovery — a fixed full arch of teeth — is a meaningful change for people who have been without stable teeth for years.
Day of surgery — what happens in the chair
A full All-on-4 session under local anaesthetic takes approximately 3–5 hours. The sequence is:
- Full clinical review and final CBCT confirmation on arrival
- Local anaesthetic administered across the full arch being treated
- Extraction of remaining teeth if any are still present
- Four implant fixtures placed — two in the front of the arch and two at an angle in the posterior (the angled placement avoids major sinus structures and allows use of available bone)
- Abutments placed on all four fixtures
- A pre-fabricated provisional full-arch bridge adjusted and secured to the abutments
- Bite checked and refined before you leave the chair
You leave the clinic with a complete arch of teeth. The provisional bridge is fixed — it does not come out for cleaning. You are given written post-operative instructions, prescribed medication, and our contact details before you leave.
First 48 hours — the swelling peak
Significant facial swelling is expected after All-on-4. This is the body’s response to the surgical trauma of multiple implant placements and extractions, and it is normal. Do not be alarmed by the level of swelling in the first two days — it looks worse than it feels for most patients.
Ice protocol: cold compress to the outside of the face — 20 minutes on, 20 minutes off — continuously during waking hours for the first 24–48 hours. This is the single most effective tool for limiting swelling.
Position: keep your head elevated when resting. Lying flat increases blood flow to the face and worsens swelling. Use two or three pillows.
Diet: blended and pureed only. Yoghurt, smoothies (no straw — suction pressure can disturb surgical sites), soup that has been blended, soft mashed food. Nothing that requires any chewing force.
Pain management: paracetamol 500mg every 4–6 hours, alternating with ibuprofen 400mg every 6–8 hours. Take consistently on schedule rather than waiting for discomfort to peak. We provide a written dosing schedule.
No rinsing for the first 24 hours. From day 2: warm saltwater rinses, gently swirled and released — do not spit forcefully.
Days 3–7 — swelling resolves, discomfort is manageable
From day 3 the swelling begins to visibly reduce. Most patients describe this phase as “sore but bearable” — the acute intensity of the first two days is past, and they are functional at a moderate level of discomfort.
- Resume light activity from day 3 — walking, light movement
- Continue the soft diet
- Warm saltwater rinses twice daily from day 2 onwards
- Continue analgesics as needed — most patients reduce frequency by day 4–5
- The gum tissue around the implant sites will be tender and swollen — this is normal
By day 5–7, most patients are well enough to fly home and feel comfortable doing so.
Flying home — when is it safe?
We recommend a minimum of 4–5 days after All-on-4 surgery before flying for uncomplicated cases. In practice, we advise patients to allow 5–7 days in Vietnam to include:
- The initial post-operative review (day 2–3)
- A follow-up bite adjustment appointment if the provisional bridge requires refinement
- A buffer day before the return flight
Before you fly, we provide a full clinical summary for you to share with any New Zealand dental professional involved in your ongoing care, including the implant specifications, post-operative instructions, and our contact details.
On the flight: take your prescribed analgesic before departure, avoid alcohol, request an aisle seat, and carry your written post-operative instructions in your hand luggage.
Patients who had a simultaneous lateral sinus lift should wait a minimum of 7 days before flying. Discuss the specific timing with us at your post-operative review.
The provisional bridge phase — months 1–6 in New Zealand
The provisional bridge is in place for the entire 3–6 month osseointegration period. It is fixed, functional, and aesthetically reasonable — most patients are comfortable being seen in public and returning to work within 1–2 weeks of surgery, once the swelling has substantially resolved.
What the provisional bridge is:
- A full-arch resin prosthesis, attached to the four implants with screws through the abutments
- Designed for function during the healing phase — not a permanent solution
- Adjustable — if the bite changes or a specific point causes discomfort, we can advise your NZ dentist on adjustments, or you can address minor issues via video consultation with us
What the provisional bridge is not:
- As strong or durable as the final prosthesis
- Suitable for the same bite forces as natural teeth during the healing phase
- Something you can bite ice or very hard objects with
Diet progression during the provisional phase
A clear dietary progression is one of the most important things we provide after All-on-4. The force transmitted to the implants through the provisional bridge affects osseointegration — loading the implants too heavily before integration is complete increases the risk of failure.
| Phase | What to eat |
|---|---|
| Weeks 1–4 | Pureed and blended only: yoghurt, smooth soups, smoothies (no straw), mashed potato, soft scrambled eggs |
| Weeks 4–8 | Soft foods: soft fish, soft pasta, soft cooked vegetables, tofu, eggs in all forms, soft bread without crusts |
| Weeks 8–12 | Most normal foods: avoiding hard, crunchy, or very chewy items — raw carrots, hard nuts, crusty bread, tough meat |
| After final prosthesis (trip two) | Full normal function restored |
This is a general guide. Your written protocol may vary slightly based on the specifics of your case.
Your NZ dentist and Picasso during osseointegration
We do not disappear after you return to New Zealand. Our clinical team is accessible for questions, concerns, and video consultation throughout the osseointegration period.
We also recommend:
- A review with your regular New Zealand dentist or hygienist at 4–6 weeks post-surgery to check provisional bridge stability and tissue healing
- Informing your NZ dentist of your implant specifications — we provide a full clinical summary for this purpose
- Contacting us if anything changes during the healing phase — pain onset, movement in the bridge, difficulty with the bite
Your NZ dentist is a partner in your ongoing care during the months between your two trips. We provide the documentation to make that relationship functional.
Warning signs during recovery
Contact [email protected] and your New Zealand dentist immediately if you experience:
- Mobility or movement in the provisional bridge — the bridge should feel completely fixed
- Pain that worsens after day 7 — recovery is progressive improvement; ongoing deterioration is not normal
- Progressive swelling after the initial peak — swelling should be substantially better by day 5–7
- Persistent unilateral pain — pain focused on one implant site that does not improve
- Gum bleeding or pus around the implant sites
- Fever combined with oral symptoms
- Numbness lasting more than 7–10 days
Do not wait to see if these resolve. Early contact gives the best outcome.
Trip two — the final prosthesis
After 3–6 months of osseointegration in New Zealand, you return to Picasso for trip two. This visit is typically 5–7 days and is far less intensive than trip one.
The sequence:
- Clinical examination and X-ray to confirm osseointegration
- Removal of the provisional bridge
- Digital scanning of the implant positions and bite
- Laboratory fabrication of the final full-arch high-strength prosthesis (typically 3–5 working days)
- Trial placement and shade/fit confirmation
- Final delivery, adjustment, and polish
Recovery from trip two is minimal. There is an adjustment period of a few days while you adapt to the final prosthesis — the bite may feel different from the provisional, and the fit is more precise. This settles within a week for most patients.
After trip two, full normal function is restored. The dietary restrictions of the provisional phase no longer apply.
Next step
Every All-on-4 case is different — bone volume, number of remaining teeth, and general health all affect both the surgical plan and the recovery timeline. For a written assessment specific to your situation, submit a quote request with your current X-rays and dental photos.
- All-on-4 at Picasso — full overview
- Dental implant recovery — single implants
- Dental implant timeline
- Request a free quote
About this page
Medically reviewed by
Dr. Tran Thanh Phong
Head of Implantology, Picasso Dental Clinic
DDS · 25+ years in practice · 15,000+ implants placed · 1,000+ All-on-4 cases
Clinical focus: Implantology · All-on-4 · Zygomatic implants
Dr. Tran Thanh Phong has practised since 2001 and leads implantology across the Picasso group. He was the first Vietnamese dentist to perform All-on-4 immediate loading (2010), placed over 15,000 implants across his career at roughly 600 per year, and has completed 400+ zygomatic implant cases since 2017. Loma Linda University-trained (2010). Clinical representative for Nobel Biocare in Vietnam since 2007.
Frequently asked questions
How long does All-on-4 recovery take?
The acute recovery phase — significant swelling and heightened discomfort — lasts approximately 3–5 days. Most patients are comfortable enough to fly home within 5–7 days of surgery. The provisional bridge phase, during which a soft diet is required, lasts 8–12 weeks. Full osseointegration — the biological bonding of implants with the jawbone — takes 3–6 months, after which the final high-strength prosthesis is fitted on trip two.
How much swelling should I expect after All-on-4?
Significant facial swelling is expected after All-on-4. It typically peaks at 48 hours and begins reducing from day 3 onwards. The swelling is more pronounced than after a single implant because four fixtures are placed and, in most cases, remaining teeth are extracted at the same session. Cold compresses (20 minutes on, 20 minutes off) during the first 48 hours are the most effective tool. Swelling is generally visibly much improved by day 5–7.
When can I eat normally after All-on-4?
A phased dietary progression is required during the provisional bridge phase. Weeks 1–4: pureed and blended foods only — yoghurt, smoothies (no straw), soup, soft mashed foods. Weeks 4–8: soft foods — fish, soft pasta, soft cooked vegetables, eggs, tofu. Weeks 8–12: most normal foods, excluding very hard or crunchy items. After the final high-strength prosthesis is fitted on trip two: full normal function is restored. Your written protocol specifies the progression for your case.
Can I fly home after All-on-4 surgery?
Yes. We recommend a minimum of 4–5 days post-surgery before flying for uncomplicated All-on-4 cases. In practice, most patients allow 5–7 days in Vietnam, which provides a buffer for post-operative review and any adjustments to the provisional bite. Patients who had simultaneous sinus lifts should discuss flying timing specifically with us — a minimum of 7 days is recommended in those cases.
What are warning signs after All-on-4?
Contact [email protected] and your New Zealand dentist immediately if you experience: mobility or movement in the provisional bridge; pain that worsens after day 7 instead of improving; progressive swelling after the initial peak has passed; fever; visible pus or discharge around the implant sites; or persistent numbness or altered sensation lasting more than one week. Do not wait to see if these resolve.
How long is the osseointegration period?
The osseointegration period for All-on-4 is typically 3–6 months. Standard cases without simultaneous bone grafting are usually 3–4 months. Cases involving simultaneous sinus lift or significant ridge grafting are typically 5–6 months. During this entire period the provisional bridge is in place and you should follow the dietary and hygiene protocol we provide.
What is the provisional bridge?
The provisional bridge is a full-arch resin prosthesis attached to your four implants on the same day as surgery. It allows you to leave the clinic with a complete set of teeth — functional and aesthetically acceptable — while the implants undergo osseointegration. It is not the final prosthesis. The final high-strength full-arch prosthesis (typically zirconia or PMMA hybrid) is fitted on trip two after osseointegration is confirmed.
What happens on trip two for All-on-4?
Trip two, typically 5–7 days in Vietnam, involves: confirmation of osseointegration via clinical examination and X-ray; removal of the provisional bridge; digital scanning and bite registration; fabrication of the final high-strength full-arch prosthesis in the Picasso laboratory; fitting and adjustment of the final prosthesis. Recovery from trip two is minimal — an adjustment period of a few days while you adapt to the final bite.