All-on-4 outcomes — 1,000+ case retrospective

This page summarises the outcome data from our All-on-4 case archive against the peer-reviewed literature on full-arch immediate-load implant protocols. We publish this because patients considering All-on-4 deserve to see the survival and complication data — not just the marketing photographs.

We do not publish a single clinic-wide All-on-4 success rate. Like single-implant data, it is more honest to report the range that the literature supports and document the patient and case factors that matter most.

The All-on-4 protocol origins

The All-on-4 concept was introduced by Paolo Maló and colleagues in Lisbon in 2003 (Clinical Implant Dentistry and Related Research, 2003). The protocol uses four implants per arch — two anterior axial and two posterior angled — to support a fixed full-arch prosthesis with immediate loading.

The published literature on All-on-4 now spans 20+ years of follow-up data. Key sources:

• Maló P, Rangert B, Nobre M (2003) — original protocol paper.
• Soto-Penaloza D et al. (2017) — systematic review of All-on-4 outcomes; cumulative survival 95-99% at 5-10 years across multiple studies.
• Babbush CA et al. (2014) — long-term follow-up; 99% fixture survival at 5 years in 708 patients.
• Maló P et al. (2019) — 18-year follow-up of original Maló cases; 95% cumulative survival.

The protocol survives because the geometry distributes occlusal load efficiently and the immediate temporary prevents soft-tissue collapse during healing.

Picasso All-on-4 case archive

Since 2010, we have treated 1,000+ All-on-4 patients across:

• Osstem (NZD 8,333 per arch) — most placed in our archive by volume
• ETK or Neodent (NZD 10,000 per arch)
• Nobel Biocare or Straumann (NZD 14,667 per arch)

Dr. Tran Thanh Phong, our Head of Implantology, was the first Vietnamese dentist to perform All-on-4 immediate loading in 2010. He has placed all four brands in our archive and selects the brand based on bone profile, patient systemic factors, and patient preference rather than headline price.

When matched for case complexity and patient factors, our cumulative fixture survival sits inside the 94-98% range reported by Maló and the systematic reviews. We do not publish a Picasso-specific point estimate above this range.

What the data says matters more than brand

Across the All-on-4 literature, four factors predict long-term outcome more strongly than fixture brand:

1. Bone quality at the time of placement. Type 1 and 2 bone in the anterior mandible supports immediate loading better than Type 3 and 4 bone in the posterior maxilla. We use CBCT for every case and adjust the protocol per arch.
2. Bite force and parafunction. Heavy bruxers and patients with severe bite force benefit from a night guard for the final prosthesis. Failure to wear the guard is the single most common cause of late prosthetic complication in our archive.
3. Smoking status. Same as single-implant data — smokers experience approximately 2x the failure rate. The All-on-4 literature is consistent on this.
4. Hygiene compliance. All-on-4 prostheses are designed with hygiene access points. Patients who do not maintain professional cleaning every 6 months show higher rates of peri-implantitis around the fixtures.

Prosthetic complications — more common than fixture failures

Across the published literature, prosthetic complications affect 20-40% of All-on-4 cases over 10 years. Our experience matches this range. The most common complications in order of frequency:

• Crown chipping on acrylic temporary or zirconia final bridges (10-25% over 10 years). Usually repairable in place.
• Screw loosening at the abutment (5-15% over 10 years). Routinely re-tightened during 6-monthly reviews.
• Temporary bridge fracture (1-5% within the first year). Replaced or repaired under our warranty.
• Final bridge fracture (1-3% over 10 years). Repair or replacement depending on damage.

Almost all of these are recoverable without removing fixtures. The patient does not lose the implants.

Patient-reported satisfaction

Across our post-treatment survey data (1,000+ All-on-4 patients, 2-touch survey at 14 days and 90 days):

• Eating function: highest-rated outcome. Patients describe being able to bite into foods they had avoided for years.
• Speech: improvement reported especially by patients transitioning from a removable upper denture. Some patients need 1-2 weeks of speech adaptation.
• Aesthetics: very high satisfaction with the final zirconia bridge.
• Common complaint: the temporary phase. Patients are surprised by how restrictive the soft-food protocol feels for the first 6-8 weeks.

We have added explicit “eating timeline” guidance to our pre-trip pack as a result of this survey theme.

What this means for a patient choosing All-on-4

Three takeaways:

1. The All-on-4 protocol is well-established in the peer-reviewed literature. The fact that it is performed in Vietnam is not the variable — the variables are bone quality, fixture brand selection, prosthetic design, and your aftercare compliance.
2. The brand tier choice (Osstem, ETK/Neodent, Nobel Biocare/Straumann) is real but is not about crude survival — it is about manufacturer warranty terms, parts availability if you ever need them in 15 years’ time, and surface chemistry research depth. Dr. Tran Thanh Phong walks through the choice in your written treatment plan.
3. Plan for the 4-month healing window. The published evidence base assumes patients return for a final prosthesis 3-4 months after surgery. Same-trip final bridges are possible in specific cases but not the protocol the literature supports.

What this page does not cover

• All-on-5, All-on-6, and All-on-X variations are different protocols with different evidence bases. See the All-on-6 pillar.
• Zygomatic implant outcomes for severely resorbed maxilla are a different evidence base. We will publish that data when our zygomatic case archive crosses 500 cases.
• Same-day full-arch (single-trip) outcomes are a smaller subset with different complication rates and are not the protocol we recommend by default.

See also

• All-on-4 pillar — protocol, fixture tiers, and NZD pricing.
• All-on-4 recovery — the 4-month healing window in detail.
• Implant survival — 10-year data — single-implant survival data.
• Implant brand transparency — full brand and warranty disclosure.
• Lisa from Wellington — All-on-4 patient story — composite first-person account.

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.

Last clinically reviewed

26 May 2026

Published by

Picasso Dental Clinic

Review policy

Every medical procedure page on this site is reviewed by a named Picasso clinician before publication and re-checked when pricing, materials, or protocols change. Source documents are linked at the bottom of each page.