All on Four

Replace All Teeth in Naperville IL

Call Naperville Oral, Maxillofacial and Implant Dentistry Phone Number 630-961-5151 to schedule your All on Four consultation with Drs. Blecha and Jandali.

It is now possible to remove your remaining teeth, place multiple implants, and create fixed teeth on those implants that same day. The time it takes to perform the treatment varies with the complexity of the treatment. This treatment requires very careful planning between your restorative dentist and Drs. Blecha and Jandali. A computer guided implant placement is performed under IV sedation. Your restorative dentist fabricates a provisional prosthesis prior to surgery, which is then placed that same day. This prosthesis is fixed and is only removable by your restorative dentist. This treatment approach results in less patient discomfort. Patients can often resume most activities after a few days. Fabrication of the final prosthesis occurs when the implants have healed.

All on four refers to the use of four implants to replace an entire set of teeth on one jaw. The exact number of implants to be placed may be greater than four, depending upon the quality and quantity of bone available and the number of teeth to be replaced.

All on Four

All On Four – Lower Jaw

The process begins with a thorough examination of your mouth by your restorative dentist and Drs. Blecha and Jandali. A computerized tomography scan (CT) scan is taken of the patient’s jawbone. This CT scan allows for the generation of a three-dimensional model of the jawbone that can then be used in virtual reality software to plan the implant placement without the presence of the patient. The result is more accurate implant diagnosis and placement, and often less chair time for the patient at the surgery office.
Some cases are not suitable for Teeth the Same Day.

Each patient should remember that short implant procedures and short implant healing times are preferable to the patient and to Drs. Blecha and Jandali, but only if high quality healing is obtained. What is most important in implant treatment is that we achieve optimum implant bone and soft tissue healing, even if it takes longer or if we have to take a slower approach. Drs. Blecha and Jandali will discuss these options with you and will suggest what is the best approach to be used in your individual case.

The temporary prosthesis is worn for several months until the bone has fused to the implants. During this time the patient can chew foods that they can cut up with a plastic fork. It is very important that the patient observe these dietary precautions as they facilitate the bone properly fusing to the implants. Once the implants have healed your restorative dentist will then carefully make your final prosthesis.

The final prosthesis can be of several different designs. The two main designs are either a totally fixed bridge prosthesis that is only removable by your restorative dentist, or a removable denture stabilized by a bar attachment or ball attachments. These different designs will be discussed in the next sections entitled “Totally Fixed Implant Bridge” and “Bar/ Ball Attachment Denture.”


With either final prosthesis design, you can then eat corn on the cob, apples, steak- the same foods you would normally eat with your previous natural teeth. The difference is that now you are chewing with a healthy implants to support your teeth instead of failing teeth or a denture that never felt secure and comfortable.

History of use of “All On Four”

Dr. P. I. Branemark, one of the main pioneers in modern implant treatment, initially used NobelBiocare implants on patients who were missing all of their teeth in one jaw since the 1970’s. Please note that the teeth needed to be removed 3-4 months prior to the placement of implants, requiring that patients wear a temporary denture. His long-term success is well documented, proving that the use of four to six implants in one jaw can be used to replace all of the teeth in that jaw.

Dr. Paulo Malo made several modifications to Dr. Branemark’s technique in the 1990’s. Dr. Malo extracted the remaining teeth, placed only four implants using special angulation, attached final abutments, and immediately placed fixed teeth on those implants. Dr. Malo found similar implant success rates to Dr. Branemark. Both doctors used specific protocols and both doctors used NobelBiocare Implants.

What is unique about Dr. Malo’s approach is that he only used four implants and that the teeth were immediately attached to the implants. This technique is designed to avoid or minimize the use of bone grafting in rendering the treatment. Dr. Malo, using NobelBiocare implants, developed the term “All On Four” and the term is proprietary to NobelBiocare. Drs. Blecha and Jandali has closely followed Dr Branemark’s and Dr Malo’s techniques and has used NobelBiocare implants for over 25 years for all applications of implants including “All On Four”.

All-on-Four-lower Jaw

All On Four – Lower Jaw


What Are The Goals Of All On Four Treatment ?

  1. Remove the existing teeth
  2. Prepare the bone for the implants
  3. Place four implants and final abutment (The abutment is the connecting post between the implant and the teeth)
  4. Attach teeth to the implants that same day
All-on-Four-Upper Jaw

All On Four – Upper Jaw

Now we can avoid or minimize bone grafting, multiple procedures, healing periods, and multiple sets of temporary teeth. We utilize bone that is above the roots of the top teeth or below the roots of the lower teeth. We also tilt the implants around anatomical structures such as the maxillary sinus in the upper jaw and nerves in the lower jaw.

The treatment requires a thorough evaluation and treatment planning by your restorative dentist and Drs. Blecha and Jandali. The better we plan the treatment, the better results we get.

All On Four – Before Treatment

All on four-Preop photos
All on four- preop Photos
All on four-Preop xray

All On Four – After Treatment

All on four- postop photo
All on four - postop xray


Questions that our implant team will want to know from prospective patients include:

  • What do you like or dislike about your current teeth?
  • How do you want your future teeth to look?
  • Do you have problems with your current “bite” and how would you want to change your “bite”? “All On Four” treatment planning often allows us to make changes or improvements to “bite” problems.
  • Will you remain committed to properly care for your implants once the treatment is rendered?

Part of the evaluation process involves planning for the future teeth locations, size, shape, and the future bite. We then incorporate a CT scan evaluation with this information to determine if we have sufficient bone for proper implant support with the implant centered beneath the teeth. Each implant must be carefully positioned beneath the future tooth position. This is why we need to know how you want your future teeth to look before we ever begin the treatment.

Do We Always Use Just Four Implants To Replace All Of The Teeth On One Jaw?

We sometimes need more than four implants depending on the number of teeth being replaced, the type of teeth being replaced, and the location and volume of bone to support the implants.

What To Expect On the Day Of Surgery

On the day of surgery you will comfortably be sedated to have the appropriate teeth removed, prepare the bone for the new implants, and the implants are placed. Typically the bone is deemed strong enough to attach teeth to the implants that same day.

The patient, Drs. Blecha and Jandali, and your restorative dentist all prefer to attach the teeth to the implants that same day, as long as the bone is strong enough to allow this.

What Diet Can The Patient Eat After “All On Four” Implant Placement?

Patients do need to restrict their diet to food that they can cut up with a plastic fork, so some chewing is allowed. Why is this? The screw design of the implant provides initial stabilization for the teeth but the long-term success of these implants is not based on the screw design. The long-term success is based upon your bone fusing to each implant, a process called osseointegration. If proper osseointegration occurs the implant is resistant to ever being lost. If the initial osseointegration is not good the implant is likely to be lost. For proper bone fusion to the implant, the implant cannot be subject to “micromotion”. Micromotion is small movement of the implant within the bone secondary to bite pressure on the implant. If the patient chews food that he cannot cut up with a plastic fork the bone will not fuse to the implants. Thus the patient needs to restrict their diet during the healing period after the implants are placed. Most patients readily accept these short dietary restrictions because they know they really want this treatment to work well.

How Long Is The Implant Healing Period?

The typical time required for your bone to fuse to your implants is two to six months, depending on the individual situation. After this time, Drs. Blecha and Jandali will check the implant healing. Once implant healing has occurred, your restorative dentist will fabricate the final prosthetic teeth. Once you receive your final teeth you can eat steak, corn on the cob, and apples with confidence.

What Long Term Care Responsibilities Does The Patient Have With Their Final Teeth?

  • Daily cleaning at the gum line
  • Regular visits to your restorative dentist for evaluation and professional cleaning about the implants

Finally, most patients we have seen truly appreciate this long-term solution to the initial problems that they started with and they value what they have done. Thus these patients want to take care of these implants so that they never have problems with them.

Teeth in a day or “All On Four” is a highly specialized form of dental implant treatment. Drs. Blecha and Jandali has successfully treated many patients that are missing all of their teeth or are about to loose their remaining teeth using the above techniques for many years. It is important that the patient should chose a surgeon with the depth of training and expertise in performing this type of surgery. It is also important that you chose a good restorative dentist as well. Drs. Blecha and Jandali has worked with many fine restorative dentists in this community as well as in the Chicago land community on this type of treatment.