All-on-4 Implants: What Markham Patients Should Know

The All-on-4 concept was designed to maximise bone use while minimising the number of implants needed to support a full arch of teeth. Two implants are placed vertically at the front of the jaw where bone is typically most abundant, and two implants are placed at 45-degree angles toward the back — allowing them to engage more bone and avoid the sinus cavities in the upper jaw. This angled placement is the key innovation: it makes All-on-4 feasible for many patients who lack sufficient bone for standard rear implants.

A temporary full-arch prosthesis is typically attached on the day of surgery, meaning patients leave the clinic with a complete, fixed set of teeth. After a healing period of three to six months — during which osseointegration takes place — the temporary prosthesis is replaced with a final zirconia or acrylic-on-titanium prosthesis designed for long-term use. Compare this to conventional implant-supported dentures, which snap on and off, or traditional dentures, which have no implant support at all.

Traditional dentures rest on the gums and rely on suction or adhesive for stability. They allow roughly 20–25 percent of natural chewing force and require removal for daily cleaning. Because there are no implants stimulating the bone, the jaw continues to resorb over time, causing the denture to fit progressively less well and changing the shape of the face. All-on-4 implants halt this bone loss and provide chewing forces approaching those of natural teeth.

Patients who switch from conventional dentures to All-on-4 almost universally report a dramatic improvement in confidence, comfort and dietary range. Foods that were off-limits with a denture — crunchy vegetables, tough meats, whole apples — become possible again. The fixed nature of the prosthesis also eliminates the social anxiety many denture wearers experience about their teeth shifting in public.

• All-on-4 provides 70–90% of natural chewing force vs. 20–25% with conventional dentures.
• Fixed, non-removable: no adhesives, no removal at night, no slippage when speaking.
• Bone preservation: implants stimulate the jaw and prevent the ongoing resorption that dentures allow.
• Cleaning: brush in place like natural teeth; no soaking solutions required.
• Facial structure: preventing bone loss preserves the natural contour of cheeks and chin.

Treatment begins with a cone-beam CT scan to create a 3D model of the jaw. Using this model, Dr. Kadivar plans the exact position and angle of each of the four implants digitally before surgery begins. On procedure day, any remaining teeth are extracted (if needed), the four implants are placed, and a temporary full-arch prosthesis is screwed onto the implants — all in a single surgical session typically lasting three to four hours.

The patient recovers on the temporary prosthesis for three to six months while osseointegration takes place. Follow-up appointments check healing and adjust the temporary bite as needed. Once implants are confirmed fully integrated by x-ray, impressions are taken for the final, custom-made prosthesis. The final prosthesis is installed at a subsequent appointment and checked for fit, aesthetics and occlusion.

All-on-4 was specifically engineered for patients who have lost most or all of their teeth and have experienced some degree of bone loss. The angled posterior implants allow the system to work in bone volumes that would not support standard implants placed vertically — which is why many patients who were told they needed extensive bone grafting for conventional implants are suitable for All-on-4 without grafting.

Patients should be in reasonably good general health, free of uncontrolled systemic conditions, and ideally non-smoking or willing to quit for the duration of healing. A 3D scan at consultation will show whether the anterior bone — where the front two implants sit — is sufficient. The vast majority of patients who present with most or all teeth missing qualify for All-on-4, often without additional bone grafting.

All-on-4 treatment in the Markham area typically ranges from $20,000 to $35,000 per arch. This range reflects the complexity of individual cases, whether extractions are included, the material chosen for the final prosthesis (acrylic-on-titanium is less expensive than full-zirconia), and the type of sedation used. Full-arch treatment for both upper and lower jaws falls in the $35,000–$60,000 range depending on complexity.

While these figures are higher than the cost of conventional dentures, the all-inclusive nature of All-on-4 (fixed teeth, no ongoing adhesive costs, no relining every few years) means the long-term cost comparison is often more favourable for implants than it first appears. Our clinic offers financing with monthly payment plans, and some patients coordinate benefits across two plan years to maximise insurance coverage. See our dental implants cost guide for a detailed breakdown.

All-on-4 surgery is more extensive than single-tooth implant surgery, and recovery reflects that. Most patients take three to five days away from work and social activities. Swelling is notable for the first week and peaks around day two or three. A prescription or strong over-the-counter pain reliever manages discomfort, and a soft diet — soups, smoothies, yoghurt and soft cooked foods — is maintained for four to eight weeks to protect healing bone.

Patients leave with a fully functional set of temporary teeth, which means they can speak and eat (carefully) from day one. The temporary prosthesis is not designed for full chewing force — treating it gently is essential. By month three or four, most patients feel entirely back to normal. The full recovery timeline and care instructions are available in our dental implant surgery recovery guide.

All-on-4 requires a dentist with specific training in guided implant surgery and full-arch prosthetics. It is not a procedure offered by all general dentists, and outcomes are closely tied to the precision of implant planning and placement. Ask potential providers whether they use 3D cone-beam CT imaging, digital surgical guides, and whether the final prosthesis is fabricated in a certified dental laboratory. At our clinic, every All-on-4 case is planned digitally and executed with guided stents for millimetre-level precision.

Dr. Neda Kadivar is a member of the Royal College of Dental Surgeons of Ontario and has provided full-arch implant restorations to Markham patients for over two decades. Book a consultation to receive a complete 3D treatment plan, cost estimate and timeline — with no obligation to proceed.