All on 4 Problems: What can go wrong and how to fix it

Deciding to get All on 4 treatment may be one of the most important decisions you'll make. One thing that you will want to know is are there any All on four problems that can occur and what can you do to avoid any possible all on four problems.

In this post, I’m going to go through all the All on 4 dental implants problems I discuss with my patients during consultation. Not to alarm you but rather to ensure that you are informed.

As dentists, it is part of our responsibility to explain potential complications and problems with all on four dental implants, even if there is only a minor chance that it will happen to you.

So read on, information is powerful for patients but remember

All on Four is one of the most successful treatments offered in dentistry today with the average all on four implants success rate being 96% when performed by an experienced All on 4 dentist.

Malo, P. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up


What are the most common All on Four problems?

All on four is a surgical procedure, and as with all surgical procedures, there are some risks. Below I’ll explain the main problems that can occur and provide, where possible, advise on how to minimize the chance.

Implant Failure

All on 4 dental implants risks are very low, but in saying that, it can still occur. On average 5% of implants will not fuse to the bone and we call this an “implant failure”. It is low risk but not impossible. Often it is difficult to know why an implant failed, which is a source of frustration for both the dentist and the patient.

The good news, however, is that more often than not a new implant can be placed again and there is still a high chance that it will integrate into the bone the second time.

How can we minimise this?

This is a toughy, an implant can fail in anyone and there is no way to predict when it will happen. However, by following your dentist’s instructions after All on 4 closely will help reduce risk. This means no smoking, soft foods, good hygiene and more…(more on this below).


There is a low risk of infection with dental implants. Infection can occur for a couple of reasons, either something may have become contaminated during your implant surgery or possibly one of the “patient factors” that we have listed below.

Infection around an implant is a type of gum disease and is called ‘peri-implantitis’. You may notice signs of the following:

  • Loose or wobbly implant
  • Red or puffy gums around the implant
  • Bad taste or breath
  • Pain around the implant
  • Pus
  • You may be able to see the top of the implant
  • Fever
  • Bleeding when brushing around the implant

Caught in time this is not usually a problem, your dentist will suggest an oral hygiene routine and maybe a special mouth rinse to help heal the area. However, left to its own devices it can become very aggressive and may result in the loss of the implants.

How can you avoid this?

Follow the doctor's instructions post surgery. Keep on top of your oral hygiene, keeping the implants and the teeth nice and clean. There are some great products you can use to help keep your implants clean, like a Waterpik or special implant floss - your dentist should talk to you about these and may even provide them as part of the procedure. Also, make sure to keep up your regular 6-month check-ups.

Check with your surgeon that they always perform implant surgery under completely sterile conditions and follow the strict Australian infection control guidelines.

Experience of the Surgeon

The experience of the surgeon performing the All on 4 surgery is probably the most important factor determining the success of your treatment. This treatment is very advanced and it is not something that is taught at dental school.

You will want to ensure that your All on 4 dentist has had adequate and proper training and has performed this surgery many times. More importantly, that they have long-term success with All on 4 patients that they can show you. This treatment has been around for over 10 years so if the surgeon can show you patients dating back to this time, that is a great sign.

Poorly placed implants are one the problems that can occur with an inexperienced surgeon, this could affect your speech, result in delayed healing, a poor cosmetic outcome, and your teeth not feeling right in your mouth.

With today's technology, there is absolutely no excuse for poorly placed implants. Proper planning, x-rays, try-ins of your final teeth and implant planning software can prevent this entirely.

Another All on four problem that can occur with an inexperienced surgeon is teeth breaking off your bridge. Sometimes this is inevitable but again, with proper planning and provision of a nightguard, this can be greatly minimised.

So, how to avoid this?

Do your research. Well trained dental professionals will display credentials on their website. Also look for dental professionals with extensive training.

Check how long they've been performing this surgery and the results. Look at all on 4 before and after photos of the patients they've treated. See if they lecture or teach official courses and conferences.

You can download our comprehensive All on 4 guide here to read more about choosing your surgeon, it comes with a handy checklist of questions to ask your potential All on 4 surgeon.

All on Four Problems

Patient factors

There are very few patients who can’t be treated with All on 4. There are a few medical conditions that may carry a slightly higher risk of failure, these are:

  • Osteoporosis
  • If you have had radiation therapy
  • If you have a compromised immune system

If any of these describe you it does not exclude you from treatment but we recommend to speak to your healthcare professional and your All on 4 dentist so that they can plan the best course of action for you.

If you have one of these conditions and have been told you can’t have dental implants in the past All on 4 may still be a possibility for you. There are often other circumstances, like needing to have bone grafting, that can preclude you from having traditional implant treatment that we can still treat with All on 4.

Also, ensure that you inform your dentist of any medications you are taking or have taken in the past.

Lifestyle factors

Certain lifestyle factors can also increase the risk of failure in dental implants. These include smoking, drinking and your hygiene routine. These things don’t prevent you from having the procedure but can affect the success both in the short term and also over the life of your treatment. Deciding to get the All on 4 treatment is a big investment so you will want to ensure you give it the highest possible chance of success.

You can minimise this risk by speaking to your healthcare professional about strategies to help you cut down or even quit these habits and ensure you follow your dentists' instructions on post-care of your new teeth.

Patient compliance

This last bit is critical and as a patient the one factor that you can control the most.

Your dentist will provide a thorough list of post-operative care instructions. This covers care immediately following the surgery and into the next few months. It's important you follow these instructions to ensure the success of your treatment and attend 6 monthly check-ups.

I have been providing the all on 4 procedure for over 10 years and helped many patients be able to eat, smile and laugh again with confidence. In that time there has not been one patient that I have seen that we haven’t been able to provide fixed, permanent teeth for.

With proper planning and post-treatment care, the success rate is on your side. If you are still unsure, we provide a free initial suitability consultation that we can do over the phone. Call us on 02 9247 1304 to book your free consultation or visit our website to book online.

02 9247 1394