When patients are missing most or all of their teeth, one of the most transformative treatment options available today is known as All-on-4, or more accurately, All-on-X dental implants.

You may have heard the term "All-on-4" floating around, but it's important to understand that this isn't a one-size-fits-all solution. All-on-4 refers to a treatment concept where a full set of teeth is supported by four implants—but in reality, many patients may need more than four implants per arch to achieve proper function, long-term stability, and optimal aesthetics. That’s why we refer to it as All-on-X—with “X” representing the number of implants actually needed, whether that’s four, five, six, or more.

What Is All-on-X, and How Does It Work?

All-on-X is a fixed, implant-supported solution designed to restore a full arch of missing teeth—either upper, lower, or both. Unlike removable dentures, which sit on the gums and can shift or slip, All-on-X prosthetics are anchored securely in the jawbone using dental implants.

Once placed, the implants integrate with the bone (a process known as osseointegration), allowing a full-arch bridge to be attached. This bridge is usually one solid piece and may be made from acrylic, porcelain, titanium, or a hybrid material, depending on the patient’s needs and preferences.

Who Is a Good Candidate for All-on-X?

Not everyone qualifies for immediate All-on-X treatment. Ideal candidates are those with:

• Good overall health

• Sufficient jawbone volume (or the ability to undergo bone grafting)

• A commitment to excellent oral hygiene

It’s also important to consider the cause of tooth loss. Many people lose their teeth due to advanced gum disease or poor hygiene. In these cases, establishing strong hygiene habits before treatment is essential to ensure long-term success.

During your consultation at Azar Dental, advanced imaging like CBCT 3D scans, clinical exams, and diagnostic records will be used to assess bone levels, gum health, and treatment feasibility.

How Long Does the Process Take?

The timeline for All-on-X treatment can vary significantly.

If the jawbone is healthy and strong, implants may be placed immediately and, in some cases, restored with a temporary prosthesis the same day. This is often referred to as “teeth in a day.”

However, for patients who have been missing teeth for many years, bone loss may require grafting. Severe bone resorption can take months—or up to a year—to fully regenerate before implants can be placed.

Smaller grafts may be done simultaneously with implant placement, but larger augmentations require healing time before continuing.

Is One Implant Per Tooth Better?

It might seem logical to replace each missing tooth with a separate implant—but in full-arch cases, it’s neither practical nor advisable. More implants create more points of potential complication. With All-on-X, the goal is to optimize force distribution while minimizing stress on the bone and surrounding tissue. Fewer, strategically placed implants often provide better outcomes.

How Long Do All-on-X Implants Last?

The goal with All-on-X is long-term, ideally lifetime, success. With modern implant surfaces, improved surgical protocols, and strong patient compliance, implants can last for decades. However, factors such as smoking, diabetes, poor oral hygiene, or trauma can compromise longevity. Regular maintenance and follow-up care are non-negotiable for lasting results.

How Do You Care for All-on-X Bridges?

Maintenance is key. Even though implants don’t get cavities, the surrounding gums and tissues can still develop inflammation or infection.

Care includes:

• Twice-daily brushing

• Daily flossing or use of interdental tools designed for implants

• Routine use of a water flosser

• Regular professional cleanings—every 3 months for the first 2 years, then every 6 months after

Each prosthesis is unique, so personalized instructions will be provided after treatment.

What Are the Risks or Complications?

Like any procedure, All-on-X is not risk-free. Potential complications include:

• Implant failure due to poor integration or infection

• Bone loss or soft tissue inflammation

• Mechanical issues, such as loose or fractured screws

• Wear and tear of the bridge material over time

The good news? These complications are uncommon when the treatment is properly planned and well-maintained.

Is All-on-X a Permanent Solution?

All-on-X is a fixed, long-term solution—but no dental treatment is truly “permanent” without proper care. Compared to removable dentures, All-on-X offers superior comfort, function, and aesthetics. It allows patients to speak, eat, and smile confidently without worrying about shifting teeth or adhesives.

Still, it’s important to understand that fixed prosthetics require more meticulous cleaning than removable ones. For patients with dexterity challenges or difficulty maintaining hygiene, an implant-supported overdenture (a removable option that snaps onto implants) may be a better fit.

Are All-on-X Implants Right for Seniors?

Absolutely. In fact, All-on-X is often life-changing for seniors. For those who have struggled with traditional dentures, All-on-X offers the chance to regain secure, stable, natural-feeling teeth.

For others, especially those who may not want a fixed bridge, a removable implant-supported denture may be preferable. It’s easier to clean and maintain and still provides superior stability over conventional dentures.

Next Steps at Azar Dental

If you’re considering a full-arch restoration, the first step is a comprehensive consultation at Azar Dental in Princeton. Using 3D imaging, clinical diagnostics, and years of surgical and prosthetic experience, Dr. Mehrdad Soheili—a dual specialist in periodontics and prosthodontics—will guide you through your options and create a plan customized to your goals and needs. Visit our website, azardentalprinceton.com, or call us at 609-924-7910 to learn more. 

Whether it’s All-on-4, All-on-X, or another restorative solution, you’ll be in expert hands from start to finish.